Medicare Frequently Asked Questions

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Is Medicare a state or federal program?

Federal. The Medicare program was established in 1096 by president Lyndon B. Johnson. It is run by the Centers for Medicare and Medicare, which is a branch of the Health and Human Services department.

Who is eligible for Medicare?

There are several types of individuals who are eligible for Medicare. First, it is available for those who are 65 and older. Second, it is available for individuals under 65 years of age who have been on disability for a minimum of 24 months. Finally, it is available for individuals with certain conditions such as End-Stage Renal Disease or Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s disease).

At what age are you eligible for Medicare?

If other qualifications are not met prior, individuals may enroll in Medicare at age 65.

How much does Medicare cost?

The cost for Medicare can vary. The program sets a standard monthly premium for Part A and B each year. However, those with low incomes may pay less, and those with high incomes may pay more.

If an individual meets certain requirements, they will receive premium-free Part A. To meet the requirements, the individual must have worked for 10 years or 40 quarters and paid Medicare taxes during that time.

The premiums do not include any deductibles, copays, or coinsurance amounts.

I have other insurance. Do I need Medicare Part B?

If you have other health insurance from a large employer, you may choose to postpone your Medicare Part B enrollment. Your current insurance must be “creditable,” meaning that it offers the same coverage (or more) as Part B. Employers with at least 20 employees all have creditable insurance.

Even with other coverage, many individuals choose to enroll in Part A since it is often premium-free.

When should I apply for Medicare?

If you decide you would like coverage when you are 65 years old, you may apply for coverage 3 months prior to your 65th birthday.

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Many seniors have questions about Medicare and the surrounding topics that they often need to be answered.

I’m 65 years old and still working. Do I have to enroll in Medicare?

Medicare is not a mandatory requirement. However, if you do not enroll as soon as you are eligible (unless you have other creditable coverage), you will be penalized when you do decide to enroll.

If your current employer has at least 20 employees and offers a group health plan, you can postpone enrollment with no penalty.

Why is the first Medicare bill so high?

Unless you are receiving Social Security benefits, Medicare will bill the first 4 months of premiums on the first month. You may also choose to sign up for Medicare Easy Pay, which allows you to pay your premiums by check, credit or debit card, or your bank account.

What are Medigap Plans?

Medigap plans are also known as Medicare supplements. These plans are made to fill in the “gaps” left from Original Medicare. Since Original Medicare only covers 80% of the cost for services, Medigap plans are structured to help pay for the remaining 20%. 

There are currently 10 Medigap plans, all with varying levels of coverage.

What is the Medigap Open Enrollment Period?

Individuals are eligible to apply for a Medigap policy 3-6 months prior to their Part B effective date, depending on which insurance carrier you choose. Your Open Enrollment Period will end 6 months after your Part B effective date. After this 6-month period, you are not guaranteed to be issued a Medigap plan. 

What is Medicare Part C?

Medicare Part C is also known as Medicare Advantage. These plans bundle your coverage from Orignal Medicare – Parts A and B – and also include extra benefits. Part C plans may include coverage for dental, vision, and hearing services as well as prescription drug coverage. Many of these plans have a $0 premium, but there are restrictions to be aware of.

What medications are covered with Medicare Part D?

Every Medicare Part D plan is required to cover certain medications. These include anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants. 

The other covered prescriptions will depend on the specific plan. Each plan will have a “drug formulary” that lists which medications are covered and the price for each.

Does Medicare cover skilled nursing care?

Medicare does cover some part-time skilled nursing. However, it does not offer benefits for long-term care.

If I have other insurance, will Medicare pay my deductible?

That will depend on what other coverage you have. If it is from an employer with less than 20 employees, the group health plan will be the primary payer, and Medicare will be secondary. In this case, Medicare may pay part or all of the primary’s deductible.

What is the Part D coverage gap?

The Part D coverage gap is also referred to as the Part D donut hole. If a Medicare beneficiary is in the coverage gap, they will pay 25% of covered prescriptions until they reach a total of $6550, at which time catastrophic coverage will begin.

Will I automatically be enrolled in Medicare if I’m on Social Security?

Yes, if you are currently receiving Social Security income, you will be automatically enrolled in Medicare at age 65. If you are receiving Social Security benefits for disability and you are under age 65, you will be automatically enrolled beginning on the 25th month of disability.

Are there premium-free Medicare supplement plans?

No, there are no premium-free Medicare supplement plans. 

Can Medicare end your coverage?

Unless you fail to pay your Medicare premiums, Medicare cannot end your coverage. This applies to Original Medicare, Medicare Advantage, Medigap, and Part D plans. You will receive several notices before your coverage is terminated.

Can you enroll in both a Medicare Advantage and Medicare supplement plan?

No, you cannot be enrolled in both types of plans. 

Does Medicare cover telehealth?

Yes, Medicare Part B offers coverage for telehealth services. Benefits for telehealth were extended during the COVID-19 pandemic, and those changes have been made permanent.

What is a drug formulary?

A drug formulary is part of every Part D plan, whether it is a stand-alone plan or part of a Medicare Advantage plan. A drug formulary lists all the prescriptions covered under the plan and then places each one in a tier. The lower tiers contain generic, common medications and the higher tiers contain brand-name, specialty drugs. The higher the tier, the more individuals will pay out-of-pocket.

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Justin Brock

President & CEO of Bobby Brock Insurance