Medicare: Frequently Asked Questions (FAQs)

Posted by admin on 14th June 2017

Q: What is Medicare?

A: Medicare provides health insurance if you are retired and 65 or older, under 65 and receive Social Security Disability Insurance (SSDI), or under 65 and have End-Stage Renal Disease (kidney disease). It is funded by a federal payroll tax.

Q: What’s the difference between Medicare and Medicaid?

A: Medicaid covers people with limited incomes. It is funded by federal, state and county taxes.

Q: Are there different kinds of Medicare plans?

A: When you become Medicare-eligible, you can enroll in Original Medicare, the traditional fee-for-service program offered directly through the federal government, or you can enroll in a Medicare Advantage Plan, which is private insurance offered by companies that contract with Medicare.

Original Medicare allows enrollees to go to nearly all doctors and hospitals in the United States. Medicare Advantage Plans have network restrictions, so enrollees will have more limited access to doctors and hospitals.  However, Medicare Advantage Plans can also provide additional benefits that Original Medicare does not cover, such as routine vision or dental care, or gym memberships.

Q: What does Medicare cover?

A: Part A (Hospital Insurance) covers hospital, skilled nursing facility, home health, and hospice care. It is free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years).

Part B (Medical Insurance) covers most medically necessary doctors’ services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. You pay a monthly premium for this coverage which PEF reimburses.

Part C regulates Medicare Advantage Plans. Medicare Advantage Plans must offer at least the same benefits as Original Medicare (those covered under Parts A and B) but can do so with different rules, costs, and coverage restrictions. You also typically get prescription drug coverage as part of your Medicare Advantage benefits package. Many different kinds of Medicare Advantage Plans are available. You may pay a monthly premium for this coverage, in addition to your Part B premium.

Part D provides outpatient prescription drug coverage.

Q: Does It Matter If You Are Still Working When You Turn 65?

A: If you are still working when you turn 65, you and your dependents will continue to be covered under the PEF Health Care Plan. You should enroll in Medicare on or before your 65th birthday, but Medicare does not become your primary insurer (pay first) until you retire.

Q: Does It Matter If You Are Still Working but Your Covered Dependent Spouse is Retired and Over 65?

A: If you are still working, even if you are 65 or over, you and your dependents will continue to be covered under the PEF Health Care Plan. This includes a spouse who is retired and over 65.

Q: How Do I Enroll in Medicare?

A: You may enroll in one of three ways:

  • Enroll online https://www.ssa.gov/planners/retire/justmedicare.html;
  • Call 1-800-772-1213 (TTY 1-800-325-0778); or
  • Visit your local Social Security office. An appointment is not required, but if you call ahead and schedule one, it may reduce the time you spend waiting to apply.

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Categories: Health Benefits
6Jun

Making Health Benefits User-friendly

Posted by admin on 8th August 2016

In order to make health benefits more accessible and user-friendly, the Health Benefits Committee has developed the following information for your use:

Note the Blue Shield Benefit Chart is missing some data that USW was unable to obtain. If we can obtain the data we will update the chart.

Please send questions and comments to Deborah Stayman, dstayman@pef.org.

Categories: Health Benefits
8Aug

Welcome to USW Local 9265′s Collaboration with Consumer Reports

Posted by DStayman on 10th May 2013

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Health care is more complicated than ever. When your doctor recommends a test or procedure, should you agree to it? If you’re uncertain, what questions should you ask? When you want to search the Internet, where do you start?

USW Local 9265 and Consumer Reports are working together on an important initiative called Consumer Health Choices to distribute Consumer Reports’ objective assessments of services and treatments. Through this initiative, USW Local 9265 members and their families have access to high-quality Consumer Reports articles that can be used as the basis for important discussions with their doctors. Everyone can be safer, save money, avoid hassles, and get better sooner if they know how and where to shop for medical care.

Click HERE to go directly for reports about tests, treatments, drugs, supplements, doctors and hospitals.

Your feedback on Consumer Health Choices is very important. Please send comments to dstayman@nycap.rr.com. Thank you!

Categories: Health Benefits
5May

How Do You Find Reliable Medical Information Online?

Posted by DStayman on 10th February 2013

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A recent study found one in three American adults has gone online to figure out a medical condition. The study, conducted by the Pew Research Center, called this 35% of American adults “online diagnosers”.

Fifty-three percent of online diagnosers talked with a provider about the information they had found online. Forty-one percent of online diagnosers had their condition confirmed by a provider.

More generally, 72% of internet users say they looked online for health information of one kind or another within the past year.  This includes searches related to serious conditions, general information searches, and searches for minor health problems. This group was called “online health seekers.”

When asked to think about the last time they hunted for health or medical information, 77% of online health seekers said they began at a search engine such as Google, Bing, or Yahoo. Another 13% said they began at a site that specializes in health information, like WebMD.

There are ways to search more efficiently for trustworthy information. The Medical Library Association has published A User’s Guide to Finding and Evaluating Health Information on the Web (http://www.mlanet.org/resources/userguide.html), which includes a set of guidelines developed for evaluating the content of health-related websites. The Association has also published a list of “Top Ten” Most Useful Consumer Health websites.

Included among the “Top Ten” Most Useful Consumer Health websites are:

www.cancer.gov is the official website for The National Cancer Institute (NCI). NCI coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.

www.cdc.gov The Centers for Disease Control and Prevention (CDC), an agency of the Department of Health and Human Services, is dedicated to promoting “health and quality of life by preventing and controlling disease, injury, and disability.” Of special interest to the consumer are the resources about diseases, conditions, and other special topics arranged under “Health Topics A-Z,” and “Travelers’ Health,” with health recommendations for travelers worldwide. There are also sections on health topics in the news and health hoaxes. Information is available in Spanish.

http://familydoctor.org is operated by the American Academy of Family Physicians (AAFP), a national medical organization representing more than 93,700 family physicians, family practice residents and medical students. All of the information on this site has been written and reviewed by physicians and patient education professionals at the AAFP.

www.healthfinder.gov is a gateway consumer health information website whose goal is “to improve consumer access to selected health information from government agencies, their many partner organizations, and other reliable sources that serve the public interest.” Menu lists on its home page provide links to online journals, medical dictionaries, minority health, and prevention and self-care. The developer and sponsor of this site is the Office of Disease Prevention and Health Promotion, Department of Health and Human Services, with other agencies that also can be linked to via the site. Access to resources on the site is also available in Spanish.

HIV InSite http://hivinsite.ucsf.edu is a project of the University of California San Francisco (UCSF) AIDS Research Institute. Designed as a gateway to in-depth information about particular aspects of HIV/AIDS, it provides numerous links to many authoritative sources. Subjects are arranged into “Key Topics” and the site may also be searched by key words. Many items are provided in full text, and information is available in English and Spanish.

Kidshealth® www.kidshealth.org provides doctor-approved health information about children from before birth through adolescence. KidsHealth provides families with accurate, up-to-date, and jargon-free health information they can use.

MayoClinic www.mayoclinic.com is an extension of the Mayo Clinic’s commitment to provide health education to patients and the general public. Editors of the site include more than 2,000 physicians, scientists, writers, and educators at the Mayo Clinic, a nonprofit institution with more than 100 years of history in patient care, medical research, and education. The website has added interactive tools to assist consumers in managing their health.

MedlinePlus http://medlineplus.gov is the National Library of Medicine’s website for consumer health information. The site offers authoritative, up-to-date health information, without advertisements. A Spanish-language version, MedlinePlus en español (http://medlineplus.gov/spanish) is also available. A site for cell phones and other mobile devices is at http://m.medlineplus.gov. Additional resources include physician and hospital directories, several online medical dictionaries, interactive health tutorials, and information about prescription and over-the-counter medicines, plus herbs and supplements. A full description of all the resources available on MedlinePlus is available at www.nlm.nih.gov/pubs/factsheets/medlineplus.html.

NOAH: New York Online Access to Health www.noah-health.org is a unique collection of state, local and federal health resources for consumers. NOAH’s mission is “to provide high-quality, full-text information for consumers that is accurate, timely, relevant, and unbiased.” Information is arranged in alphabetical “Health Topics” which are then narrowed to include definitions, care and treatment, and lists of information resources. Information is available in both English and Spanish, and the majority of items are provided in full text.MP900443136[1]

Categories: Health Benefits
2Feb

Enroll by Dec 15 to Save on Your 2013 Taxes

Posted by DStayman on 9th November 2012

money_billsThe Flex Spending Account (FSA) can help you pay for out-of-pocket medical and dependent care expenses by using pre-tax dollars, which saves money on your taxes.

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The FSA has two benefits, the Health Care Flexible Spending Account (HCFSA) and the Dependent Care Benefit Account (DCBA). The deadline to enroll is December 15, 2012.

Even if you enrolled last year you must enroll again this year for 2013. Enrolling in either benefit is voluntary. Savings will vary depending on your annual income, the number of dependents you claim on your taxes, and the amount of money you contribute through payroll deductions to your HCFSA and/or DCBA.

Health Care Flexible Spending Account

You may contribute any amount up to $2,500[1] annually in pre-tax dollars to pay for out-of-pocket medical, dental or vision costs not reimbursed by health insurance. The $2,500 limit is per enrollee, so married couples may each enroll for any amount up to $2,500.

Some examples of allowable costs are prescription drug copayments, dental charges, orthodontia fees and implants, deductibles, laser eye surgery, and contact lenses.

Federal law limits reimbursement for over-the-counter (OTC) drugs. Although OTC drugs may be purchased without a prescription, they require a doctor’s prescription to be eligible for reimbursement under the HCFSA.  As a result, the debit card cannot be used to purchase most over-the-counter drugs. Other OTC products including hearing aid batteries, band-aids and contact lens solution may be purchased without a prescription. OTC claims submitted for reimbursement must include a receipt with the name of the medication or supply, store name, purchase date and price.

Dependent Care Benefit Account

If you pay a caregiver to care for your child, elderly parent, or disabled spouse in order to work, you can set aside up to $5,000 in pre-tax salary through payroll deduction to help pay for these expenses. Examples of expenses eligible for DCBA reimbursement include child care expenses (through age 12), summer day camp, before/after school programs and adult day care.

Estimating the Amount to Have Withheld

You should estimate your annual out-of-pocket costs for health care or for dependent care and then decide how much money to have withheld from your paycheck for your 2013 FSA.  Keep in mind there is a 2 ½ month grace period from January 1, 2014 –March 15, 2014 in which you can use your leftover 2013 funds. However, if you do not use your funds by March 15, 2014, you will lose them.

Filing a Claim

Once enrolled you can fill out an electronic claim form online, mail or fax claims, then receive reimbursement by check or direct deposit. If you use the debit card, you may be asked to submit a copy of a receipt to verify that a card transaction was for a qualified expense. You can choose reimbursement by check or direct deposit into your bank account. The Take Care plan website http://www.takecareplans.com/cbp/home.asp gives you 24 hour access to your plan expense and reimbursement information.

More information is available at http://newsroom.infinisource.com/post/2012/05/30/IRS-Provides-Guidance-on-$2500-FSA-Limit.aspx.

PEF requested Blue Shield and Catamaran (previously InformedRx, the pharmacy benefits manager) send all staff letters with their out-of-pocket expenses for the past year, to assist with calculating out-of-pocket expenses for 2013. The deadline to enroll in the FSA is December 15, 2012. If you have questions about the Flexible Spending Account contact Deborah Stayman at x286 or dstayman@pef.org.


[1] This is a higher total than allowed in previous years. Federal law will not permit exceptions above $2,500.

Categories: Health Benefits
11Nov