Marci's Medicare Answers

December 2009

Dear Marci,

Does Medicare cover pneumonia shots?

—Virginia

Dear Virginia,

Yes. Medicare will cover 100 percent of the cost of your pneumonia vaccine with no Part B deductible required. (If you are in a Medicare private health plan—HMO or PPO—you may have a copay for this service. Call your plan to find out what you will have to pay.)

There is a vaccine against one kind of pneumonia caused by bacteria, called "pneumococcal" pneumonia. Ask your doctor if you should get the vaccine. You should only need the shot once in your lifetime.

—Marci

Dear Marci,

How do I change my Medicare coverage for 2010, and when will the changes take effect?

—Clarence

Dear Clarence,

You can change your Medicare coverage during the Annual Coordinated Election Period, which runs from November 15 through December 31 every year. During this period you can change to another private plan or to Original Medicare and add, drop or change Medicare drug coverage (Part D). You can make as many changes as you need during this period, but only your last coverage choice will take effect January 1.  To avoid enrollment problems, it is best to make as few changes as possible. 

You can also switch your Medicare health coverage once during the Open Enrollment Period, which runs from January 1 through March 31 every year. You cannot add or drop Part D during this time, and your new coverage starts the first of the month after you make your selection. Under certain circumstances, you may be eligible for a Special Enrollment Period (SEP) to change your drug coverage and/or health plan. If you get an SEP, your new coverage will start the first of the month after you are disenrolled from your previous plan.

Once you have decided on the changes you want to make, do not call to disenroll from your old plan. Rather, you should change plans by enrolling in the new plan, and it is best to do so by calling 800-MEDICARE, rather than enrolling through the new plan. Enroll early during an enrollment period to make sure that your new coverage starts when it should.You will be automatically disenrolled from your old Medicare private health plan or Part D plan when your new coverage starts.

—Marci

Dear Marci,

I recently applied for Extra Help, but my application was denied. I still can’t afford my drugs. What can I do?

—Richard

Dear Richard,

If your application is going to be turned down, you will receive a “Pre-Decisional Notice” telling you this in advance, and you can use this opportunity to correct your application.

Once SSA has reviewed your application, you may receive a “Notice of Denial” that says you do not qualify or a “Notice of Award that says you only qualify for partial Extra Help. If you disagree with the SSA’s decision, you can appeal.

It is best not to reapply for Extra Help in either case. It is important to appeal, because if you win, your Extra Help will be effective from the first day of the month that you originally submitted an application. In order to appeal, you should

• Request a review of your case (a hearing) within 60 days of receiving notice of SSA's decision on your application.
• Set a date for a hearing. Call your local SSA office or the national hotline (800-772-1213). You can also download an online form and mail it in to request a hearing.

Hearings are held by phone. You will get a notice in the mail that confirms your hearing date and tells you what number to call (the number will be toll-free). This notice will also explain how to send in evidence supporting your case (for example, bank statements that show your assets). If you have a scheduling conflict you can reschedule once or twice if you have good cause (for example, you were in the hospital).

If you do not want a hearing, you can just ask for a “case review,” where an SSA agent will review your application and any additional information you send in.

—Marci

Read more sample issues >>

Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To subscribe to “Dear Marci,” MRC’s free educational e-newsletter, click here.

_________________________________

Maintained by Medicare Rights Center
Last Modified: