Frequently Asked Questions

What is Medicare and who is eligible to enroll in Medicare?

Medicare is insurance provided by the Federal government for individuals who are 65 and older, disabled or have a qualifying medical condition. Those eligible must be a legal resident who has lived in the United States for a minimum of five years in a row and includes the five years just prior to applying for Medicare.

Will I be automatically enrolled in Medicare?

If you are receiving Social Security or Railroad Retirement Benefits at least four months prior to turning 65, you will be automatically enrolled in Medicare Part A and Part B. Your identification card will arrive in the mail. If you are receiving benefits you are required to take Part A but may decline Part B. If you are not receiving any Social Security or Railroad Benefits, you will need to enroll in Medicare yourself by visiting SSA.gov to enroll online or by calling or visiting your local Social Security office.

When should I enroll in Medicare?

The Initial Enrollment Period begins three months before the month of an individual's 65th birthday, the month 65th birthday and three months after. This makes a total of seven months. If you want Medicare to start on the first day of the month you turn 65, you must enroll during one of the 3 months prior to your 65th birth month. Enrollment in the month you turn 65 will cause Medicare to start the month after, and enrollment during the three months after the 65th birthday will result in Medicare starting the first day of the month after enrollment. If you or a spouse will continue working and have employer coverage, you may delay starting Part A, Part B or both depending on your circumstances.

If I continue to work after 65 and have employer benefits do I need to enroll in Medicare? What are the benefits of delaying enrollment?

If an individual is covered by employer benefits either through their employment or a spouse’s employment and work for a company of 20 or more employees, they commonly may delay starting Part B of Medicare to avoid paying additional premiums. They may also delay Part A if they are contributing to an HSA account and not receiving Social Security or Railroad Benefits. When they are ready to retire and employer benefits end, this will start a special enrollment period of 8 months to enroll in Medicare Part B (and Part A if delayed).
Individuals who work for a company with 19 or fewer employees will most likely need to start Medicare Part A and B. It will become the primary insurance and employer insurance will be secondary.

Does Medicare cost?

For individuals that have worked 40 quarters, Part A is premium free. Part B has a monthly premium and may be adjusted for higher wage earners. This adjustment is called the Income Related Monthly Adjustment Amount. Medicare does adjust the premiums yearly and the new premiums become effective January 1 every year.

Am I required to enroll in Medicare?

No. However, there are penalties for not enrolling in Medicare when you are first eligible and do not have a special enrollment event at the time you do choose to enroll.

What is Original Medicare?

Original Medicare is the insurance administered by the Federal government and consists of two parts, Part A and Part B. Part A helps pay for admitted hospital stays, inpatient care, skilled nursing care and hospice. Part B covers doctor visits, outpatient care, durable medical equipment and diagnostic testing. There is no network with Original Medicare and you may see any doctor, nationwide, who accepts Medicare.

Does Original Medicare pay for all healthcare costs?

No. Original Medicare has deductibles, copays and coinsurance for which the beneficiary is responsible. It also does not pay for regular prescription medications, routine dental, vision, hearing, long-term care, cosmetic surgery or experimental procedures, to name a few. Contact us to discuss coverage options for the costs that Original Medicare does not pay.

Are spouses covered under one Medicare Plan?

No. Medicare is individual insurance. Spouses each have their own identification cards.

If I have retiree insurance, should I enroll in Medicare?

Unless you have coverage through your or your spouse’s current employment, you should sign up for Part A and B of Medicare when turning 65. This is because at age 65, retiree coverage becomes secondary and works like a medigap (Medicare Supplement) plan and prescription plan with Original Medicare.

I have a health savings account at work. Can I still contribute to it after I turn 65?

You may continue contributing to the health savings account as long as you have not enrolled in Medicare Part A or Part B. We suggest contacting a certified accountant for advice to make sure you do not risk a penalty.

What are the Parts of Medicare?

Medicare has four parts. Part A and Part B are referred to as Original Medicare. Part C is commonly known as Medicare Advantage, and Part D is prescription drug coverage.

What is Part C, Medicare Advantage?

Medicare Advantage plans are offered by private insurance companies that have been approved by Medicare. They must offer the actuarial equivalent of Part A and Part B of Medicare. Many plans offer additional benefits like prescription drug coverage, dental, vision, hearing, gym memberships or more. These plans often have very low monthly premiums. They may require you to have a primary care doctor and have networks that you must work within to pay less for services. As services are provided, you are responsible for deductibles, copays or coinsurance specific to that service. Plans have an out-of-pocket maximum which will limit the amount you are responsible to contribute. This amount is set by Medicare, and plans may choose to have lower amounts. You must continue paying your Part B premium to Medicare if you enroll in one of these plans, and you may not have a Medicare Supplement plan. Contact us to discuss options including enrolling in a Medicare Advantage plan.

What is Part D, Prescription Drug Coverage (PDP)?

These are stand-alone prescription coverage plans offered by private companies that have been approved by Medicare. They charge a premium which is set by the individual company. Many also have a deductible which must be met before paying a copay or coinsurance for the medication. Medicare sets a limit for the deductible. Copays and coinsurance amounts vary based on the tier level of the medication. Part D plans may also have a network of pharmacies or may offer nationwide coverage. Contact us to discuss options including enrolling in a Part D plan.

Do I need to enroll in Medicare Part D, Prescription Drug Coverage, if I do not take prescription medications?

Whether or not you currently have prescriptions, you may want to enroll in Part D to avoid a penalty, unless you have credible prescription drug coverage. These may include Veteran’s Benefits, Federal Employee Health Benefits, TRICARE, Indian Health Services, CHAMPVA or an employer plan.

Is there a penalty for not enrolling in Medicare Part D?

There is a penalty for not enrolling in Part D when first eligible or if you do not have a special enrollment right, such as employer group insurance or other credible coverage ending.

What are Medigap (Medicare Supplement) Plans?

Medigap plans, also known as Medicare Supplement plans, help cover some or all of the deductibles, copays and coinsurance of Original Medicare depending on letter type. Currently there are ten plans available. These plans are offered by private insurance companies and are standardized by the federal government. This means that each standardized plan must offer the same basic benefits regardless of the company selling it. Premiums are set by the private companies, can vary from company to company and change year to year. Medigap plans may require underwriting of individuals who are not in a guaranteed issue period. Some insurers have started to offer value-added services like discounts on vision or gym memberships. Contact us to discuss options that are specific to your situation.

I keep seeing commercials advertising extra benefits and rebates. Can I trust these companies' advertising?

While there is some truth to these companies' advertisements, there are often specific qualifications to enroll in the plan or receive the additional benefits. These qualifications range from living in the plan’s service area to meeting financial requirements. An especially important thing to be aware of is many times these commercials direct you to call a phone number to a telemarketing company trained in high sales pressure tactics. They are not concerned about your best interests, only making the sale. Contact us to discuss a variety of options that are specific to your situation.

Are there programs that can help lower or provide extra help for Medicare costs?

There are state and federal programs that offer extra help for individuals that meet income requirements. If qualifications are met, these programs can help pay some Medicare related costs like premiums and copays. To find out if you qualify, call Social Security or visit ssa.gov, and call your State Medicaid Program.

Can I change my Medicare coverage?

Yes. Every fall from October 15th to December 7th you may enroll or disenroll from your Part D prescription plan or Part C Medicare Advantage plans. There are other circumstances outside that time that may allow changes as well. Medicare Supplement plans, on the other hand, can be applied for year round. Unless you are just starting Medicare or have a special election event, there is medical underwriting that you must pass to be issued a policy. Contact us to discuss options that are specific to your situation.

Do your services cost?

No. We do not charge for our services. We are compensated by the private insurance companies.

How is Medicaid different from Medicare?

Medicaid is a state sponsored program for individuals with incomes falling below a specific threshold. Medicare is a federal program for qualifying individuals 65 and older, or with certain health conditions or with disabilities.

What are important factors to consider when choosing Medicare coverage?

• Cost- You will pay the Part B premium regardless of whether you are enrolled in Original Medicare or a Medicare Advantage plan. However, plans have different monthly premiums, yearly out-of-pocket maximums and coverages or amounts of co-pays, coinsurance and deductibles. Contact us to discuss options that are specific to your situation.
• Coverage- Different plans have different coverage levels as well as offering ancillary benefits like dental and vision. It is important to think about the services and frequency of services you plan to use, as well as any current health conditions that may require higher levels of care. Contact us to discuss options that are specific to your situation.
• Providers- Original Medicare has no network, and you may see any doctor who accepts Medicare. Medigap (Medicare Supplement) plans follow the same rule. Medicare Advantage plans do have networks that you need to work within to receive coverage at a reduced cost. It is important to check that hospitals, doctors and other medical facilities you want to use are in the plan's network. Otherwise, you may pay higher costs or the full cost of the service. Contact us to discuss options that are specific to your situation.
• Prescription Needs- Does the plan include prescription coverage, or do you need to purchase a stand-alone plan? Are the medications you are on covered by the plan? Contact us to discuss options for prescription drug coverage.

What sources can I use to get information about Medicare?

Medicare.gov is the primary source of accurate information. On this government website you can access all information about Medicare like enrollment, covered services, plan finder tool, and forms and publications. Medicare and You booklet published by Medicare every year. It is available online or by calling Medicare and requesting one to be mailed to you home. Social Security- Visit SSA.gov or your local office.

If I am eligible for Medicare, what are the options for how I can receive Medicare benefits?

There are two ways to receive Medicare benefits. First, you may enroll in Medicare Part A and Part B, or second, you may enroll in a Part C Medicare Advantage Plan. You will be required to pay the Part B premium regardless as to which option you choose. Original Medicare has no network, and you may see any doctor who accepts Medicare. Medicare Advantage plans do have networks, and care must be received within the network to receive coverage at a lower cost. Contact us to discuss options that are specific to your situation.