MEDICARE FAQS

The Top 10 List - Common Medicare Questions: 

I spend most of my days answering Medicare questions. That is the biggest part of my job and is one that I enjoy immensely. Educating Medicare beneficiaries and soon-to-be Medicare beneficiaries is rewarding in that I get the opportunity to explain confusing aspects of the overwhelming world of Medicare. With that in mind, I’ve compiled a list of the top 10 Medicare questions that I have received over the years.

1. How Do I Sign Up for Medicare?

If you are NOT receiving Social Security but DO want to enroll in Medicare:

you will need to proactively enroll in Medicare Part B (you’ll be automatically enrolled in Part A). To sign up for Part B, your options are to go to a local Social Security office or to call Social Security at 800.772.1213. Alternatively, you can enroll for Medicare online at www.ssa.gov.

 If you are already receiving Social Security, you will be automatically enrolled in Medicare Parts A and B when you turn 65. 

You should receive a “Welcome to Medicare” packet and a red, white and blue Medicare card 2-3 months prior to the month that you turn 65. You do not have to take any action to enroll in Medicare. It will start the 1st day of the month that you turn 65.

2. How Much Does Medicare Cost?

Again, the answer is dependent on your situation. There is no cost for Medicare Part A (hospital) as long as you have worked 40 quarters/10 years in your working life, thereby paying into “the system” through payroll taxes.

There are, however, certain situations that could cause you to pay more or less for premiums. These situations are largely dependent on your income as reported by the IRS from two years ago. This is called the Income-Related Monthly Adjust Amount (IRMAA). 

Also, if you have been on Medicare for a few years, you may be “grandfathered in” to a lower premium amount, which could be between $104 and $134, depending on what year you started Medicare and your specific situation.

3. Does Medicare Cover Preventive Care?

Contrary to popular misconception, Medicare does cover a good bit of preventive care now. 

In general, Medicare covers a “Welcome to Medicare” physical within the first 12 months of going on Medicare. After that, it covers an annual wellness exam and many other screenings/tests on Medicare-established schedules. These include, but are not limited to, bone mass measurements, cardiovascular screenings, breast cancer screenings, colorectal cancer screenings, glaucoma tests, flu shots, lung cancer screenings, prostate cancer screenings, and many more.

4. What is the Difference in Medigap (Supplement) and Medicare Advantage?

These are the two options you have after you sign up for Medicare. It is very important to understand the differences, as there are many and they are significant. 

- In general, Medigap plans supplement Medicare and do not include Part D. If you have a Supplement plan, Part D has to be purchased separately to avoid a penalty.

- Medicare Advantage plans are bundled and include your Medicare (Part A and Part B) benefits, and Part D (Prescription Drug) along with additional benefits such as vision, dental and hearing. 

5. Do I Have to Get a Part D (Rx coverage) Plan?

 “No”. However, if you elect not to get a Part D plan, you will be subject to the Part D late enrollment penalty if/when you sign up for it at a later time. 

· This penalty is 1% of the standard Part D premium per month that you did not have a plan. 

· With this in mind and with the consideration that Part D plans start at $15-20/month in most markets, it’s not a bad idea to get a plan when you are first eligible regardless of whether you “need” it at the time or not.

· The penalty lasts for as long as you are enrolled in Part D, if you signed up late.

6. How Do I Decide Which Part D Plan to Get?

If you are not on any/many medications, you may want to base the Part D decision primarily on the plan premiums. In other words, if you are buying a Part D plan solely to avoid the Part D late enrollment penalty, you can base your decision on the cost of the plan and upgrade later if your needs or the plan changes.

7. Which is the Best Medigap (Medicare Supplement) Company or Plan?

With Medigap plans, that is relatively easy to find because the plans are Federally-standardized. Coverage with one company is the exact same as coverage with a different company for a “like” plan (i.e. one Plan F is the exact same as another Plan F with the only difference being premium and company reputation).

8. What Doctors Will Take My Medicare Supplement Plan?

With Medicare Supplement (Medigap) plans, you can go to any doctor or hospital nationwide that accepts Medicare patients. There are no networks on Medicare Supplements (Medigap plans), so if your doctor takes Medicare (your primary coverage), he or she will also take your Medicare Supplement.

Do not confuse this with Medicare Advantage plans – many people call those plans Medicare Supplements although they are not. Those plans have networks and are either PPOs or HMOs.

9. Why Do I Have to Answer Medical Questions to Get a Medigap Plan?

Since Medigap plans are supplemental in nature, they are not affected by the legislated reforms. Generally speaking, any time you change Medigap plans or enroll in a plan outside of your initial open enrollment window you do have to “qualify medically” by answering health questions.

10. What is the Best Way To Enroll in a Medicare Supplement Plan or Medicare Advantage Plan?

Enrolling in a Medicare Supplement/Medigap or Medicare Advantage plan is easier than ever. 

· The first step is to sign up for Medicare (www.ssa.gov).

· Once you receive your Medicare ID card – you can compare additional Medicare coverage plans/rates for your area. (www.Medicare.gov is a great comparison site)

· Rates are based on zip code, gender and age. 

Whether it is us or someone else, it is highly advisable to use an Independent Medicare Broker to compare multiple options in a centralized place. 

This does not cost you anything but can save you hundreds of dollars a year as well as giving you a direct representative to contact if you ever have any problems or questions.