Understanding how Medicare works may be tricky for some people. The following list of frequently asked questions will give you a deeper understanding of Medicare, its eligibility requirements and how to sign up.
A: Medicare is the U.S. federal health insurance program for people who are 65 or older, younger than 65 with certain disabilities and those with End-Stage Renal Disease (ESRD).
There are four parts of Medicare: Part A, Part B, Part C, and Part D — each part covering different services. Part A (hospital insurance) and Part B (medical insurance) components make up Original Medicare, sometimes referred to as “traditional” Medicare.
In most cases, if you’re covered under Original Medicare you can go to any doctor, health care provider, or hospital that accepts Medicare.
A: Original Medicare (Part A and Part B) is managed by the federal government. More specifically, the Medicare program is managed by the Centers for Medicare and Medicaid Services (CMS), which is part of the Department of Health and Human Services.
Medicare Advantage (Part C) and prescription drug coverage (Part D) are administered by private insurance companies.
A: The Social Security Administration works with CMS by enrolling people in Medicare. It provides an abundance of Medicare information and services online to facilitate enrollment, but if you don’t want to apply for benefits online, or wish to speak to a Social Security Representative for any other reason, you can:
A: Generally, you become eligible to receive Medicare when you turn 65 years old. However, you may become eligible under 65 if you have certain disabilities or End-Stage Renal Disease.
If you’re younger than 65, you may be eligible to receive Medicare benefits if:
A: If you’re already receiving Social Security or Railroad Retirement Board benefits (either for retirement or for a disability), you’ll be enrolled in both Part A and Part B automatically upon meeting eligibility requirements (either your 65th birthday, or the 25th month you receive disability benefits). ALS patients are automatically enrolled in Medicare coverage when their Social Security disability benefits begin, regardless of age.
If you’re not already collecting Social Security or Railroad Retirement Board benefits when you become eligible for Medicare, you will have to manually enroll.
Those with End Stage Renal Disease typically must manually enroll.
A: If you’re eligible for Medicare but not automatic enrollment, you can apply online, over the phone, or in person at your local Social Security office. If you worked for a railroad, you’ll need to contact the Railroad Retirement Board to sign up.
A: Yes. As a Medicare beneficiary, you have several choices for how you receive your health care benefits. Private insurers offer coverage options as an alternative to what the federal government provides through Original Medicare Part A and Part B, as well as options to supplement it.
A: There are several Medicare enrollment periods.
If you are not eligible for automatic enrollment, there is a seven-month Initial Enrollment Period (IEP) based around your birthday month. You’ll have the opportunity to enroll in Medicare three months before your 65th birthday, during your birthday month, and three months after it. If you’d rather enroll in a Medicare Advantage plan, you may do so during this time.
If you’re still covered under you or your spouse’s current employer’s insurance when you become eligible for Medicare, you may qualify for a Special Enrollment Period (SEP). If so, you can sign up for Medicare Part B without having to wait for the GEP or pay a penalty for late enrollment. You must generally enroll within eight months of retiring or coverage loss to avoid late penalties. There may be other circumstances that make your eligible for special enrollment as well — talk to a licensed insurance agent to learn more.
If you don’t sign up for Part A and/or B during your IEP, and you don’t qualify for special enrollment, you can sign up each year during the General Enrollment Period (GEP) from January 1 to March 31. However, coverage won’t begin until July 1 and you may be subject to late enrollment penalties if you wait too long to sign up.
A: If are eligible for Medicare, you have the option of receiving health care benefits through either a Medicare Advantage plan or Original Medicare — the two cannot be combined. Your Medicare Advantage plan may offer additional benefits that Original Medicare doesn’t offer — like vision, dental and prescription drug coverage. This chart provides more information about these differences.
Your Medicare Advantage plan may have different deductibles, copayments, coinsurance and other out-of-pocket costs than those that come with Original Medicare.
A: Standardized by the federal government, but sold by private insurance companies, Medicare Supplement Insurance plans are designed to cover certain out-of-pocket expenses associated with Original Medicare. Rather than pay for gaps in coverage out of pocket, you can purchase a Medicare Supplement Insurance plan to pair with your Original Medicare insurance.
There are 10 standardized Medicare Supplement Insurance plans labeled A, B, C, D, F, G, K, L, M and N available in most states.*** Be careful not to confused the four parts of Medicare (Part A, Part B, Part C and Part D) with Medicare Supplement Insurance plans.
You cannot have Medicare Supplement Insurance and Medicare Advantage at the same time.
A: There are two ways to get Part D prescription drug coverage.
If you have Original Medicare or a Medicare Advantage plan that doesn’t offer drug coverage, you can also enroll in a standalone Prescription Drug Plan (PDP). These are separate plans sold by private insurer companies. Plan cost and availability can vary by location.
If you’d prefer, you can buy a Medicare Advantage plan that includes Part D drug coverage.
A: Yes. You can switch from a Medicare Advantage plan back to Original Medicare (or vice versa) every fall. The Fall Medicare Open Enrollment Period (also called the Annual Election Period, or AEP) runs from October 15‒December 7, during which time you can switch from Medicare Advantage to Original Medicare, and from Original Medicare to a Medicare Advantage Plan. You can also join, switch or drop Medicare Advantage plans or Prescription Drug Plans.
There is also the Medicare Advantage Open Enrollment Period from January 1‒March 31. During this period, you can switch Medicare Advantage plans, or you can drop your Medicare Advantage plan to return to Original Medicare. If you return to Original Medicare during this period, you can also enroll in a Part D prescription drug plan.
A: Part A (Hospital Insurance) covers inpatient hospital care, skilled nursing services, hospice. Part B (Medical Insurance) covers doctor’s visits, durable medical equipment, preventive services and more.
A: Most people get Medicare Part A without having to pay a monthly premium. You can receive Part A without having to pay a premium if you or your spouse paid Medicare taxes while working for at least 10 years.
Everyone has to pay a premium for Part B each month. The standard Part B premium amount is $135.50 in 2019****, but can be higher, depending on your income. If you get Social Security or railroad benefits, your Part B premium will automatically get deducted from your benefits check — otherwise, you’ll be billed for it.
Keep in mind that Medicare Advantage plans have different premiums and costs than Original Medicare.
A: No. Medicare doesn’t cover everything. You will still have to pay some costs out of pocket — expenses like deductibles, copayments and coinsurance.
If you have Original Medicare, a Medicare Supplement Insurance plan may help pay for some of these costs. You can’t buy a Medicare Supplement Insurance plan with Medicare Advantage, but your Medicare Advantage plan may offer lower out-of-pocket costs than Original Medicare.
A: If you have limited income and resources, there are several options to help you pay for health care costs and save money. Based on your income and/or disability status, you may qualify for one or more financial assistance programs.
Every state has Medicare Savings Programs (MSP) that can help pay your Part B premium, along with some deductibles and copays. Medicaid is a joint federal and state program that helps pay for health care costs, some drugs, and provides additional benefits like nursing home and personal care services. You may also qualify for Extra Help, which helps pay for prescription drugs, deductibles, coinsurance, and copays.
To find out what resources are available in your state, which you qualify for, and how to apply, contact your state Medicaid program.
A: Contact a licensed insurance agent today to get started.
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** Medicare Part A still covers hospice care, even if you are enrolled in a Medicare Advantage plan.
***Plans in Massachusetts, Minnesota and Wisconsin are standardized differently. You will have different plan options if you live in those states.
****Medicare.gov, “Part B Costs.” Published 2018. https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html
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