Silver Tips is written by the Senior Citizens’ Law Office in Albuquerque.

Most people qualify for Medicare when they reach age 65, or when they have been receiving social security disability benefits for two years. As you approach either of those milestones, you should be aware of some choices, rights, and benefits you will have—and not just those involving Medicare’s infamous new drug coverage.

Taking Medicare First, you must decide whether to take the coverage, and when (usually the choice applies just to Medicare Part B, which has a monthly premium). And you have to make a choice, because when you reach either milestone the Medicare agency will give you Part B unless you decline it in writing. The choice is fairly easy for most, because either they need the coverage, or their current insurer—e.g., “TRICARE,” and many public and private retiree health plans—requires them to take Medicare.

If you have employer-provided group health coverage, based on your or your spouse’s current, actual employment, you can delay taking Medicare for up to eight months after the coverage ends. Otherwise, if you don’t take Medicare in your “initial enrollment period” (IEP)—which runs from three months before to three months after the month your milestone event occurs—you will later face significant late enrollment penalties (the same initial enrollment period applies to the Medicare drug coverage). If you get social security, you should receive a mailing describing all this, shortly before your IEP starts.

How to Use Your Medicare Next, you have to decide the format under which you want to use your Medicare, whether on a “fee-for-service” basis (called Original Medicare), or by joining an HMO- or PPO-like Medicare Advantage (MA) plan (and getting most of your Medicare services—including prescription drugs—through the MA plan). MA plan choices now are available throughout New Mexico. If you prefer the fee-for-service option, you may want to consider buying Medicare supplemental insurance (“Medigap”) to help defray Medicare’s out-of-pocket costs (see the next section of this article). During the first six months you have Medicare, you have the right to buy any Medigap policy sold in New Mexico, regardless of your health status. MA plans cannot deny enrollments due to health status at any time.

Benefits Medicare covers a wide range of services, although with significant deductibles and co-pays (which may be defrayed through MA plan enrollments, Medigap insurance, state Medicaid coverage, and, e.g., TRICARE, and other retiree coverages). Your providers must show that the services are medically necessary, but special coverage limitations also can apply. The number of covered preventive services under Medicare has grown, including a comprehensive “Welcome to Medicare” physical exam (you have a right to get one, but only during your first six months on Medicare).

Medicare beneficiaries have the right to appeal any decision about coverage or payment for services (appeals about eligibility also are allowed, but are rare). Appeals do not have a charge, and, at least in the initial stages, they are not very hard to pursue—a supportive letter from your provider will often suffice. Whenever coverage decisions are made, beneficiaries receive a written notice that explains how to appeal.

Additional information about these subjects is available from the federal Medicare agency (1-800-MEDICARE; www.medicare.gov), which has many pertinent publications. Additional information is also available from the state Aging and Long-term Services Department’s HIBAC benefits counseling service (1-800-432-2080; Bernalillo County residents can also contact 265-1244).