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Frequently Asked Questions

General Medicare Questions

Medicare is a federal health insurance program in the United States that provides coverage for individuals aged 65 and older, as well as certain younger individuals with disabilities.

Medicare has four parts: Part A covers inpatient care, Part B covers outpatient care, Part C (Medicare Advantage) is an alternative that combines Parts A and B, and Part D provides prescription drug coverage.

Medicare Part A covers inpatient care like hospital stays, skilled nursing facility care, hospice care, and some home health care services.

Medicare Part B covers outpatient care, doctor visits, preventive services, and some home health care.

Yes, to get full coverage, it’s advisable to have both Part A and Part B. Part A covers hospital-related expenses, while Part B covers medical services and outpatient care.

The costs of Medicare include monthly premiums for Part B, potential premiums for Part A (if applicable), and out-of-pocket costs such as deductibles, copayments, and coinsurance. Most people receive Part A without a premium.

Individuals aged 65 and older are generally eligible for Medicare. Younger individuals with qualifying disabilities or certain medical conditions can also qualify.

If you’re not automatically enrolled based on the previously mentioned criteria, then you can apply by visiting SocialSecurity.gov or call/visit your local Social Security office. If you happen to be eligible for Medicare due to disability or End-Stage Rental Disease, browse Medicare.gov for more information on how you can apply.

The Initial Enrollment Period (IEP) begins three months before your 65th birthday and extends for seven months (three months before, the month of, and three months after your birthday). There are also Special Enrollment Periods for those qualifying due to certain life events.

It’s a 7 month period beginning 3 months prior to your 65th birthday, and it ends 3 months after your birth month. E.g. If you will be turning 65 in July, your Medicare Initial Enrollment Period is from April 1st to October 30th.

You can enroll during the Medicare General Enrollment Period, which occurs each year from January 1st to March 31st. Coverage will begin the 1st of the next month following the enrollment.  In certain situations, you will have to pay a penalty for late enrollment, however.

If you work past the age of 65, then you can be eligible to apply during a Special Enrollment Period that helps you to avoid penalties, coverage lapses and medical underwriting.

Yes, there could be premium penalties for Medicare Parts A and B should you happen to miss the initial enrollment dates, so we do recommend that you sign up when you are initially eligible.

The penalty for not enrolling in Medicare Part A entails 10% of the Part A premium. You’ll pay the premium penalty for 2x the amount of years that enrollment is delayed. The 10% premium penalty applies regardless of how long the Medicare Part A enrollment is delayed. E.g. Should you be eligible for Medicare Part A for 1 year, but you did not enroll, then you will be charged higher premiums for 2 years.

Should you opt not to sign up for Medicare Part B when initially eligible, then you might need to pay a penalty to acquire it down the road. This penalty entails 10% of the Part B premium for every 12 months that enrollment was delayed, and you’ll need to pay the penalty for each month for the entirety of your Medicare Part B enrollment. E.g. If your Initial Enrollment Period ended November 30, 2023, and you delayed enrollment for Medicare B until February 2024 during the General Enrollment Period, the Part B premium penalty is 20%. Although you waited 26 months to enroll, the penalty only includes the two full 12 month periods, BUT you’ll be paying the penalty for the entire duration that you have Medicare Part B.

You can delay enrollment in Medicare Parts A and B without penalty should you qualify for a Special Enrollment Period.

Special Enrollment Periods allow you to sign up for Medicare for the first time or switch coverage beyond the Initial Enrollment Period without having to deal with late premium penalties, lapses in coverage, or medical underwriting.

In the event that you did not enroll in Medicare Parts A and B during the Initial Enrollment Period due to being covered via a group health plan based on your current employer (your own, your spouse’s or a family member’s if you are disabled), you can then apply for Medicare Parts A and B while being covered by the group health insurance plan during the 8 month period beginning the month after your employment or group coverage comes to an end (whatever occurs first).

Other means to qualify for Special Enrollment Periods involve moving out of your plan’s service area, having Medicaid, having a limited income qualifying you for extra help through Medicare, living in an institution (e.g. nursing home).

To begin enrollment, visit SocialSecurity.gov or call or visit your local Social Security office.

Should you happen to be eligible for Medicare due to disability or End-Stage Renal Disease, visit Medicare.gov for more information on enrollment.

There are a few factors determining Medicare eligibility for those below the age of 65, including if you’ve been entitled to Social Security disability benefits for a minimum of 24 months, if you’ve received disability pension from the Railroad Retirement Board, if you have Lou Gehrig’s disease, or if you have End-State Renal Disease.

Generally, you can postpone Medicare enrollment without penalties as long as you remain employed AND covered under your employer’s or union’s group health plan.
However, here are a few exceptions:

  • If your employer has less than 20 employees, you may need to enroll in Medicare. In this scenario, your employer’s health plan is secondary to Medicare. Contact your employer’s plan admin to find out more about your plan and how it works with Medicare. Reach out to your employer’s plan administrator to learn how your plan would work with Medicare.
  • Retiree benefits and COBRA aren’t considered employee coverage. If you’re covered through either of these, you’ll need to apply for Medicare once you’re 65 or older.
  • Should you retire during your Initial Enrollment Period, you won’t be eligible for your Special Enrollment Period until the Initial Enrollment Period terminates. If you don’t sign up during your Initial Enrollment Period, then you risk premium penalties and delays in coverage.

It is possible, but if your employer has 20 employees or more, your group health plan will be considered your primary plan. If your employer covers 100% of most medical expenses, you might pay the Medicare Part B premium, which translates to little value to you. That’s why it is ideal to contact your employer’s plan administrator to find out more about your plan and how it would work with Medicare.

Upon retiring and enrolling in Medicare, you can use the balance of funds in your Health Savings Account (HAS), but according to IRS regulation, you can’t continue to contribute to your HAS account.

Original Medicare consists of Parts A and B and allows you to choose your healthcare providers nationwide. Medicare Advantage (Part C) is an alternative offered by private insurers, combining Parts A and B with additional benefits like vision and dental coverage. Your choice may depend on personal preferences and healthcare needs.

Yes, Medicare Supplement plans (Medigap) can expand coverage and help cover costs that Original Medicare doesn’t, such as deductibles and copayments. These plans are offered by private insurance companies.

Medicare Supplement Questions

Medicare Supplement insurance, also known as Medigap, is private health insurance designed to help cover the gaps in Original Medicare (Part A and Part B) coverage. It helps pay for certain out-of-pocket expenses such as deductibles, copayments, and coinsurance.

The answer is no. Medicare supplement insurance plans work in tandem with Medicare Parts A and B by covering a portion of out-of-pocket health care expenses. For example, Medicare Part B typically covers 80% of costs, and the rest is up to the insured. Buying Medicare supplement plans to go along with your existing Medicare Parts and B coverage can assist you in paying for medical expenses not taken care of by Medicare.

The cost of Medicare Supplement insurance varies depending on factors such as the plan you choose, your age, location, and the insurance company. Premiums can also increase over time due to factors like inflation and other factors. It’s important to compare prices from different insurance companies to find the most affordable option for you.

When researching Medicare supplement plans, take into account how much you will be expected to pay for hospital stays, visits to the doctor, as well as how much you are comfortable spending on monthly plan premiums and out-of-pocket expenses.

 

 

A Medicare supplement plan will differ between plans offered by different insurers; however, they each offer the same standard benefits. Typically these plans offer coinsurance for Medicare Part A hospitalization expenses and cover 20% of Medicare-approved costs. Standard benefits usually cover the initial 3 pints of blood each year and provide Part A coinsurance for hospice care.

Regarding standard benefits, Medicare supplement insurance plans never change. However, there are differences, such as added benefits provided by a particular insurance company, as well as the quality of customer service offered.

The best time to enroll in a Medicare Supplement plan is during your Medigap Open Enrollment Period. This period starts on the first day of the month in which your Medicare Part B is in effect. For most people this is the first day of the month they turn 65.  During this six-month period, insurance companies cannot deny you coverage or charge you higher premiums based on pre-existing conditions.

However, most insurance companies allow you to submit your Medicare supplement application up to 6 months before your Medicare Part B effective date. So it is best to plan ahead and have your supplement approved and ready to become effective the first of the month you turn 65 or your part B becomes effective.

A Medicare supplement insurance plan is lifetime-guaranteed – age and health are not a factor – provided that you are fully paid up on your premium payments and there is no material misrepresentation on your application.

Thankfully, with Medicare supplement plans, you are given the choice of any doctor, specialist or hospital provided they accept Medicare patients.

No, Medicare Supplement insurance does not cover prescription drugs. If you want prescription drug coverage, you need to enroll in a standalone Medicare Part D prescription drug plan.

You can choose between higher-benefit plans (which cost more), or you can opt for lower premiums with minimal benefits.

Plans with higher benefits offer the greatest amount of supplement coverage and may pay up to 100% of your out-of-pocket expenses for a wide variety of services.

Should you choose a lower-benefit plan, you can expect to pay a lower premium month to month but will pay more out-of-pocket for covered services

The right Medicare Supplement plan for you depends on your individual needs and preferences. Consider factors such as your budget, anticipated healthcare needs, and desired level of coverage. It’s important to compare plans and premiums from different insurance companies to find the one that best fits your needs.

 

Upon enrolling in Medicare Parts A and B, you are then eligible to sign up for Medicare supplement insurance plans at any time.

You will be guaranteed approval into Medicare supplement insurance plans should you enroll within 6 months starting on the 1st day of the month that you’re BOTH at least 65 years of age or older AND enrolled in Medicare Part B. In certain states, your approval is a given even if you happen to enroll outside of this timeframe.

In the event that you miss your 6 month enrollment period, you are still able to sign up for Medicare supplement insurance coverage at any time, though you could be denied or charged a higher premium should your health history suggest you are at a heightened risk.

After you’ve done diligent research to decide the Medicare supplement plan that’s most suitable for your needs, reach out to the insurance company to start enrollment.

There could be several different ways to apply (it depends on the insurance company). These could include meeting with a licensed insurance agent or producer, visiting the company’s website, contacting the company by phone, or submitting an application received in the mail.

To be eligible for Medicare Supplement insurance, you must be enrolled in Medicare Part A and Part B. Generally, you need to be at least 65 years old, although some states offer coverage to individuals under 65 who qualify due to disability or other specific circumstances.

Medicare Supplement insurance plans work alongside Original Medicare. When you have a Medigap policy, it helps cover the costs that Medicare doesn’t, such as deductibles and coinsurance. After Medicare pays its share, your Medigap policy pays its share of the covered services.

Medicare Supplement plans are standardized, which means the coverage is the same regardless of the insurance company you choose. There are several standardized plans, each labeled with a letter (e.g., Plan F, Plan G) that offer different levels of coverage. These plans may cover some or all of the following: Medicare Part A and Part B deductibles, copayments, coinsurance, excess charges, and limited coverage for foreign travel emergencies.

Yes, you can switch Medicare Supplement plans at any time, but you may be subject to medical underwriting, which means the insurance company can consider your health status and may charge you higher premiums or deny coverage based on pre-existing conditions. There are certain circumstances, such as losing your current coverage or moving out of your plan’s service area, which may allow you to switch plans without medical underwriting.

Medicare Supplement insurance works with Original Medicare, while Medicare Advantage is an alternative to Original Medicare.

With Medicare Supplement plans Original Medicare is still your primary insurer, a Medicare Supplement helps cover the gaps in Original Medicare (Part A and Part B) coverage. These plans expand Original Medicare coverage and reduce your financial risk by paying for certain out-of-pocket expenses such as deductibles, copayments, and coinsurance. With a Supplement you can choose any doctor or provider in the country that accepts Medicare becuase the are no networks. There are also no preauthorization requirements. 

With Medicare Advantage, you receive your Medicare benefits through a private insurance company, and the plan may include additional benefits such as prescription drug coverage and dental or vision services. Most Medicare Advantage plans do have networks and do require preauthorizations. They also can change the plan coverages from year to year.

You can’t acquire both a Medicare Advantage plan and a Medicare supplement plan simultaneously but are both offered via private insurance companies.

 

Medicare Advantage Questions

Medicare Advantage, or Part C, is an alternative to Original Medicare offered by private insurance companies. It provides the same coverage as Medicare Parts A and B and often includes additional benefits like vision, dental, and prescription drug coverage.

Individuals eligible for Medicare Part A and Part B are generally eligible for Medicare Advantage. This includes people aged 65 and older or those under 65 with certain disabilities.

Medicare Advantage plans may include extra benefits beyond Original Medicare, such as vision, dental, hearing, and prescription drug coverage. Some plans also offer fitness and wellness programs.

You can enroll in a Medicare Advantage plan during specific enrollment periods, including the Initial Enrollment Period, Annual Enrollment Period, and Special Enrollment Periods. You can sign up directly through insurance carriers or through the Medicare website.

Most Medicare Advantage plans have a network of doctors and hospitals. It’s important to check if your preferred healthcare providers are in the plan’s network. Some plans may allow you to see out-of-network providers, but it could come with additional costs.

The cost of Medicare Advantage plans varies. In addition to the Part B premium, you might have to pay an additional premium for the Medicare Advantage plan. Some plans have low or zero premiums, but it’s crucial to consider other out-of-pocket costs like copayments and deductibles.

Yes, you can switch Medicare Advantage plans during the Annual Enrollment Period, which typically runs from October 15th through December 7th each year, coverage takes effect Jan 1. You can also switch Medicare Advantage Plans during the Medicare Advantage Open Enrollement Period, which runs from Jan 1st through Mar 31st each year. If you enroll during this period, coverage takes effect the 1st of the following month. There are also Special Enrollment Periods for certain qualifying events.

 

If you move to a different state, your eligibility for Medicare Advantage continues. However, you may need to switch to a plan available in your new location, as plan availability varies by region.

 

Many Medicare Advantage plans include prescription drug coverage (Part D). It’s essential to review the plan details to understand the specific medications covered, copayments, and any restrictions.

Yes, you can switch from Medicare Advantage to Original Medicare during certain periods, such as the Medicare Advantage Open Enrollment Period (Jan 1st – Mar 31st) and the Annual Enrollment Period (Oct 15th – Dec 7th). You also have the option to enroll in a standalone Medicare Part D prescription drug plan.

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