Medicare
Medicare can be complex, but we make it easier. As your trusted advisor, we’re here to answer your questions about Original Medicare, Supplements, Advantage Plans, Cost Plans, and Prescription Drug Plans — so you can choose with confidence.
Medicare Most Frequently Asked Questions & Answers
Medicare Part A
Medicare Part A is the hospital coverage portion of Medicare that covers inpatient care in hospitals, skilled nursing facility care, nursing home care, hospice care, and limited home health care services. For many people, Medicare Part A is free of charge if they have worked and paid Medicare taxes for a certain period of time.
Medicare Part B
Medicare Part B is the medical coverage portion of Medicare that covers doctor visits, outpatient care, preventive services, and durable medical equipment, including medical supplies and certain medications. It requires the payment of a monthly premium and an annual deductible, and it often covers 80% of the costs of eligible medical services.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare that combines the benefits of Parts A and B into a single plan offered by private insurance companies. These plans often include additional benefits such as prescription drug coverage, dental, vision, and hearing services, and may have different costs and coverage rules compared to Original Medicare.
Medicare Part D
Medicare Part D is the prescription drug coverage portion of Medicare that helps pay for the cost of prescription drugs. Plans are offered by private insurance companies, and cover a range of medications, varying in cost and formulary coverage, with beneficiaries often paying a monthly premium, an annual deductible, and coinsurance or copays.
Medicare Part A, or hospital insurance, covers inpatient hospital care, including semi-private rooms, meals, general nursing care, medications necessary for treatment, and other hospital services such as lab tests and X-rays. It also covers skilled nursing care facility care, home health care services, and hospice care.
Medicare Part B, or medical insurance, covers doctor visits, outpatient hospital services such as emergency room and observation services, preventive care such as screenings and vaccinations, ambulance services and durable medical equipment, such as wheelchairs, walkers, and oxygen equipment. Part B also covers clinical research, mental health care services, and limited prescription medications such as those administered in a doctor's office or outpatient clinic.
There are certain periods throughout the year when you can change your Medicare coverage. Here is a quick overview of the various enrollment periods:
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Initial Enrollment Period (IEP): This is the seven-month period when you first become eligible for Medicare. It starts three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. During this period, you can enroll in Medicare Parts A and B, as well as a Medicare Advantage plan or a stand-alone Medicare Part D prescription drug plan.
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Annual Enrollment Period (AEP): Also known as the open enrollment period, this runs from October 15 to December 7 each year. During this time, you can switch from Original Medicare to a Medicare Advantage plan, switch from one Medicare Advantage plan to another, join, drop, or switch a Medicare Part D prescription drug plan.
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Medicare Advantage Open Enrollment Period (OEP): From January 1 to March 31 each year, you can make a one-time change if you are enrolled in a Medicare Advantage plan. You can switch to a different Medicare Advantage plan or drop your Medicare Advantage plan and return to Original Medicare. You can also add or drop a Medicare Part D drug plan during this period.
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Special Enrollment Period (SEP): There are certain life events that may allow you to make changes to your Medicare coverage outside of the initial enrollment and annual enrollment periods. For example, losing employer-sponsored coverage, moving to a new area with different Medicare plan options, or qualifying for Medicaid. Each SEP has its own rules, and you may need to provide documentation to prove that you qualify.
It's important to note that certain enrollment periods may not apply to all Medicare plans. For example, Medicare Supplement plans have their own enrollment rules that differ from Medicare Advantage and Medicare Part D plans. It's a good idea to review your plan's details and eligibility requirements.
Yes, your income can affect your Medicare premium. If you are considered a "higher-income beneficiary" by Social Security, you may have to pay more for your Medicare Part B premium. The income-related monthly adjustment amount (IRMAA) is an additional premium that certain Medicare beneficiaries must pay based on their income.
The exact income thresholds for determining higher-income status can change annually. For example, in 2023, the standard Part B premium starts increasing once incomes are above $97,000 for an individual taxpayer and $194,000 for a couple filing taxes jointly.
It's important to note that not all Medicare beneficiaries are subject to the IRMAA. Most enrollees pay the standard Part B premium, while only those with higher incomes will pay the additional amount. It is recommended to check with the Social Security Administration or Medicare for the most up-to-date information on income thresholds and IRMAA amounts.
Medicare supplement plans, also known as Medigap plans, are offered by private insurance companies and work alongside Original Medicare to help cover out-of-pocket costs such as deductibles, coinsurance, and copayments. These plans provide additional coverage to fill the gaps in Original Medicare.
Medicare Advantage plans, on the other hand, are comprehensive plans offered by private insurance companies as an alternative to Original Medicare. They provide all the benefits of Parts A and B, and often include additional benefits like prescription drug coverage, dental, vision, and hearing services. These plans may have different costs and coverage rules compared to Original Medicare.
No, not all Medicare supplement plans are the same. Medicare supplement plans, also known as Medigap plans, are standardized plans offered by private insurance companies. Each plan is identified by a letter (such as Plan A, Plan B, etc.) and provides the same basic benefits regardless of the insurance company that offers it.
While the basic benefits are the same, the costs and additional benefits may vary between insurance companies. It's important to compare the costs and coverage of different Medigap plans to find the one that best suits your needs.
Please be aware that the letters used to designate Medicare Supplement plans should not be confused with the parts of Medicare itself. To illustrate, Medicare Supplement Plan A should not be mistaken as being equivalent to Medicare Part A, which covers hospital insurance.
Yes, in most cases, individuals who are already receiving Social Security benefits are automatically enrolled in Medicare. Here's a quick overview:
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Age 65 or older: If you are already receiving Social Security retirement benefits, you will be automatically enrolled in Medicare Parts A and B. Your Medicare card will be mailed to you about three months before your 65th birthday.
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Under age 65 with disabilities: If you have been receiving Social Security disability benefits for 24 months, you will be automatically enrolled in Medicare Parts A and B. The start of your Medicare coverage will generally begin in the 25th month of receiving disability benefits.
It's important to note that automatic enrollment generally applies to Original Medicare (Parts A and B). If you prefer a Medicare Advantage (Part C) or a Medicare Prescription Drug (Part D) plan, you will need to actively enroll in those plans during the appropriate enrollment periods.
Keep in mind that there are some exceptions to automatic enrollment. For example, if you are eligible for Medicare due to end-stage renal disease (ESRD), you will need to sign up for Medicare manually. Additionally, individuals who delay receiving their Social Security benefits may need to actively enroll in Medicare when they become eligible.
Determining whether Medicare is as good as your employer-sponsored group coverage depends on various factors and individual circumstances. Here are a few items for consideration:
- It's important to review the specific benefits and costs of your employer-sponsored group coverage to understand how it compares to Medicare. Each employer plan can vary in terms of coverage, provider networks, and costs.
- You may need to consider the cost of premiums, deductibles, copayments, and coinsurance associated with both Medicare and your employer-sponsored coverage.
- Medicare may have different rules and coverage limitations compared to your employer-sponsored plan. For instance, some medications or specific treatments may have different coverage or require prior authorization.
- If you have dependents or family members covered under your employer-sponsored group plan, you will need to evaluate alternative coverage options for them.
When deciding between Medicare and your employer-sponsored group coverage, it's recommended to carefully review the details of both plans, analyze your healthcare needs and costs, and consider any potential changes to your coverage when transitioning to Medicare.
Eligibility for a zero premium Medicare Advantage plan may vary depending on several factors. In general, individuals who are eligible for Medicare Parts A and B are eligible to enroll in a Medicare Advantage plan. However, the availability of zero premium plans may depend on the individual's location and the specific insurance offerings in that area. It's important to note that while some Medicare Advantage plans may have a zero premium, individuals may still be responsible for paying their Medicare Part B premium.
To determine eligibility for a zero premium Medicare Advantage plan, individuals can consider factors such as their location, their specific health needs, and the available plans in their area. Consulting with a licensed insurance agent or using online resources can help individuals explore their options and find a plan that best fits their needs.
To be eligible for coverage with Medicare, you must meet certain criteria. Here is a quick overview of the eligibility requirements:
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Age 65 or older: If you are age 65 or older, you are generally eligible for Medicare.
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Under 65 with certain disabilities: Individuals under the age of 65 may be eligible for Medicare if they have certain disabilities, such as end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant) or ALS (Lou Gehrig's disease).
It's important to note that specific eligibility criteria may vary, and additional factors may affect eligibility for certain parts of Medicare. For more detailed information about Medicare eligibility, it is recommended to visit the official Medicare website or consult with the U.S. Centers for Medicare and Medicaid Services.
If you plan to continue working at age 65, whether or not to sign up for Medicare depends on several factors. Here's a quick overview:
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Employer coverage: If you have employer-sponsored group health coverage through your own or your spouse's current employment, you may be able to delay signing up for Medicare without incurring penalties. The size of your employer determines whether Medicare or your employer coverage takes primary responsibility for your healthcare expenses.
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Employer size considerations: If the company you work for has 20 or more employees, your employer-sponsored coverage is considered primary, and you can choose whether to enroll in Medicare Part B or not. In this case, you may want to evaluate the costs and coverage of your employer plan compared to Medicare to determine the best option for you.
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Employer size less than 20 employees: If your employer has fewer than 20 employees, Medicare generally becomes your primary coverage when you reach 65, and it is recommended to enroll in both Part A and Part B to avoid any gaps in coverage.
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Late enrollment penalties: If you delay enrolling in Medicare Part B when you have employer coverage, you usually won't be charged a late enrollment penalty as long as you enroll in Part B within 8 months of leaving your job or losing employer coverage.
It's essential to carefully review your employer health insurance plan's details, costs, and coverage compared to Medicare. Additionally, consider any potential changes to your employment or insurance in the future.
If you go on Medicare and your spouse isn't 65, they may have a few options for healthcare coverage. Here's a quick overview based on the information provided:
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COBRA: If your employer offers COBRA coverage, your younger spouse may be able to continue their healthcare coverage under this option. COBRA can generally last up to 36 months after you become eligible for Medicare. It allows your spouse to maintain the benefits they had before you turned 65, although the coverage and provider network may not change.
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Individual Health Insurance: Your spouse can explore individual health insurance options available in the marketplace. They can apply for coverage through private insurance companies or the health insurance marketplace. They may qualify for premium subsidies or other cost-saving programs, depending on their income and eligibility criteria.
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Medicaid: Depending on your spouse's income and circumstances, they may be eligible for Medicaid, a government program that provides health coverage to individuals and families with limited income. Eligibility requirements and coverage options may vary by state, so it's important to check the specific guidelines in your state.
It's important to note that individual circumstances can vary, and it's recommended to explore all available options based on your spouse's unique situation.
If you decide to sign up for Medicare, it's important to know when to begin the enrollment process. The timing can vary depending on your situation and the specific Medicare coverage you are seeking.
Here is a quick overview to help you determine when to start the process:
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Initial Enrollment Period (IEP): If you are not automatically enrolled in Medicare, your IEP is a seven-month period that begins three months before your 65th birthday, includes the month of your birthday, and extends for three months after your birthday. This is generally the best time to sign up for Medicare.
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Special Enrollment Period (SEP): There are certain situations that may qualify you for a SEP. These include circumstances such as working past age 65 and having insurance through your employer or a spouse's employer. In such cases, you may delay enrolling in Medicare without incurring penalties.
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General Enrollment Period (GEP): If you missed your initial enrollment window, the GEP occurs annually from January 1 to March 31. During this time, you can sign up for Medicare Part A and/or Part B. However, keep in mind that late enrollment may result in a late enrollment penalty.
The specific timeline for enrolling in Medicare can vary, so it is always recommended to review your personal circumstances and consult official Medicare resources for the most accurate and up-to-date information. You can also contact the Social Security Administration for assistance and guidance with the Medicare enrollment process.
To enroll in Medicare, the process depends on your specific situation. Here is a quick overview of how to enroll:
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Automatic Enrollment: If you are already receiving Social Security benefits or Railroad Retirement Board (RRB) benefits, you will be automatically enrolled in Medicare Part A and Part B. You will receive your Medicare card in the mail automatically around three months before your 65th birthday or your 25th month of disability.
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Enrollment through Social Security: If you are not automatically enrolled, you can sign up for Medicare through the Social Security Administration (SSA). You can apply online on the SSA website, visit a local Social Security office, or call the SSA customer service.
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Initial Enrollment Period (IEP): This is the seven-month period that begins three months before the month you turn 65, includes your birthday month, and extends for three months after your birthday. It is generally recommended to enroll during your IEP to avoid any coverage gaps or penalties.
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General Enrollment Period (GEP): If you missed your initial enrollment window, the GEP occurs each year from January 1 to March 31. During this period, you can enroll in Medicare Part A and/or Part B, but be aware that late enrollment may result in late enrollment penalties.
It is important to note that additional rules and enrollment periods may apply for Medicare Advantage (Part C) and prescription drug coverage (Part D), so it is advisable to review the official Medicare resources or consult with the Social Security Administration for your specific circumstances.
There’s an abundance of information that’s being fed to you to entice you into buying a Medicare plan. Information like, print ads, mailings, television spots, and radio commercials.
At WA Group, we understand the importance of having a Medicare agent by your side. Our licensed insurance professionals specialize in Medicare and are passionate about guiding you through the enrollment process with expertise and care. With our knowledge of different plans and coverage options, we can help you find the perfect fit for your healthcare needs. Our agents provide ongoing support, ensuring you have the information you need and answering any questions that may arise. Choosing a Medicare agent is a personal decision, and while it's not required, many find the personalized assistance and guidance offered by our agents to be invaluable.
You’re going to pay the same rate whether you work with an agent or on your own. It makes sense to work with someone that can help you during the initial process, but also at renewal time to see if your needs have changed or if any updates need to be made.
Yes, you can choose your own doctor with Medicare, but it depends on the type of Medicare plan you have. If you have Original Medicare (Part A and Part B), you are generally not required to choose a primary care doctor. You have the freedom to visit any healthcare provider who accepts Medicare. However, it's important to note that not all doctors may accept Medicare assignment, so it's recommended to check if your doctor participates in Medicare and accepts Medicare's approved payment rates.
On the other hand, if you have a Medicare Advantage plan (Part C), which is offered by private insurance companies, you may be required to choose doctors within the plan's network. These plans often have established networks of doctors, specialists, and hospitals that you must use for non-emergency care to receive the full coverage benefits. However, emergency care is typically covered nationwide, regardless of network restrictions.
Ultimately, the ability to choose your own doctor with Medicare depends on the specific plan you have. It's important to review the details of your plan's network and provider directory to understand any limitations or requirements.
After reaching the age of 65, you can enroll in Medicare during specific enrollment periods. The initial enrollment period is a seven-month window, which includes the three months before your 65th birthday, the month of your birthday, and the three months after your birthday. This is generally the best time to enroll in Medicare.
If you miss the initial enrollment period, you can still sign up during the general enrollment period, which occurs annually from January 1 to March 31. However, late enrollment may result in penalties or coverage gaps, so it is advisable to enroll during the initial enrollment period if possible.
Furthermore, there are certain situations that may qualify you for a special enrollment period. For example, if you have employer-sponsored insurance or coverage through your spouse's employer when you turn 65, you may be eligible for a special enrollment period, during which you can enroll in Medicare without penalties.
It's important to note that enrollment in Medicare Part A, which covers hospital insurance, is usually automatic for individuals receiving Social Security or Railroad Retirement Board benefits. However, for Medicare Part B, which covers medical services, you generally need to actively enroll if you are not already receiving Social Security or Railroad Retirement Board benefits.
For more detailed information about enrolling in Medicare, you can visit the official Medicare website or contact the Social Security Administration.
If you are eligible for Medicare but do not enroll during the appropriate enrollment period, you may be subject to penalties. Here is a quick overview:
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Medicare Part A Penalty: If you are not eligible for premium-free Medicare Part A but do not enroll when you are first eligible, you may have to pay a late enrollment penalty. This penalty increases your Part A premium by 10% and is added to your monthly premium for twice the number of years you were eligible but did not enroll.
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Medicare Part B Penalty: If you do not enroll in Medicare Part B when you are first eligible and do not have creditable coverage (such as employer-sponsored insurance), you may have to pay a late enrollment penalty. This penalty increases your Part B premium by 10% for each full 12-month period that you could have had Part B but did not enroll. You may have to pay this penalty for as long as you have Part B coverage.
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Medicare Part D Penalty: If you go without creditable prescription drug coverage for 63 days or more after your initial enrollment period, you may have to pay a late enrollment penalty when you do sign up for Medicare Part D prescription drug coverage. The penalty is calculated based on the number of months you were without coverage and is added to your Part D premium.
It's important to note that the penalties described above are lifetime penalties and can significantly increase your Medicare premiums. However, there are certain situations that may qualify you for a Special Enrollment Period (SEP), which allows you to enroll in Medicare without penalty.
Enrolling in Medicare can impact your Health Savings Account (HSA) eligibility and contributions. Once you enroll in Medicare, whether Medicare Part A or Part B, you are no longer eligible to contribute funds to your HSA. This means that you cannot make new contributions to your HSA, even if you have another health plan that is HSA-eligible. However, you can still use the existing money in your HSA to pay for some Medicare costs. It's important to note that if you delay enrolling in Medicare and continue to contribute to your HSA, you should stop contributing six months before your Medicare coverage begins to avoid potential tax penalties.
Additionally, if you have employer-sponsored health insurance and are enrolled in a High Deductible Health Plan (HDHP) with an HSA, you may have to coordinate your HSA contributions with Medicare. It's advisable to consult with your employer's benefits department or a financial advisor for personalized guidance based on your specific situation.
Please keep in mind that this is a general overview, and individual circumstances may vary. It's recommended to consult with a qualified tax advisor or financial professional for personalized advice on how enrolling in Medicare may specifically affect your HSA.
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