MEDICARE FAQ
Medicare is a complex program that has many moving parts and time restrictions and requirements. As you are looking into Medicare for yourself or a loved one, many questions can come up. Here are some basics to start with and to assist you with some answers to those questions. We encourage you to call us at any time to get the answers to your questions as well! Our services are free and can save you a lot of time and trouble.
Medicare's Preventive Services
Screenings:
- Colorectal Cancer Pap Test
- Prostate Cancer Cardiovascular
- Breast Cancer(mammograms) Diabetes (for people at high risk)
- Pelvic Exam Glaucoma (for people at high risk)
- Clinical Breast Exam (as part of the pelvic exam)
Immunizations:
- Pneumococcal Flu Hepatitis B (for people at medium to high risk)
Protect Yourself Against Abusive Sales
Here are a few suggestions to help you:
- Be aware of attending meetings at large venues offered by people who do not work with your personal doctor. Make sure the person who helps you with your insurance is trusted. Your physician may be able to give you names of trusted people who have formed a partnership with them.
- Avoid talking to someone over the phone that you have not worked with or has not come recommended is not in your best interest.
- Do not fill out postcard forms allowing insurance companies to call you or open the door for people you do not know. Deal with people you trust who have come recommended.
- Do not sign any papers that you do not understand. If you do, you could lose the plan you currently are enrolled in.
Important Information About Changing Your Plan
As the changes in our benefit plans are revealed this year, you may be tempted to change your Medicare Advantage Plan.
STOP!!! Make sure you contact our office first. If you make any changes without our representation, we may not be able to help you during the calendar year!
When you call please have the following information:
- Current Primary Care Doctor or Clinic
- Current Health Plan Information
- List of current medications
- Plan you are interested in
Should I get Part B?
I have employer or union coverage.
If you or your spouse (or family member if you’re disabled) is still working and you have insurance through that employer or union, contact your employer or union benefits administrator to find out how your insurance works with Medicare. This includes federal or state employment, but not military service (unless on active duty). It may be to your advantage to delay Medicare Part B (Medical Insurance) enrollment.
Note
You can sign up for Part B without a penalty any time you have health coverage based on current employment. (COBRA and retiree health coverage don’t count as current employer coverage.)
When employer/union coverage ends
Once your employment (or your employer/union coverage) ends, 3 things happen:
- You have 8 months to sign up for Part B without a penalty, whether or not you choose COBRA. If you choose COBRA, don’t wait until your COBRA ends to enroll in Part B. If you don’t enroll in Part B during the 8 months after the employment ends, you may have to pay a penalty for as long as you have Part B. You won’t be able to enroll until January 1-March 30, and you’ll have to wait until July 1 of that year before your coverage begins. This may cause a gap in health care coverage.
- You may be able to get COBRA coverage, which continues your health insurance through the employer’s plan (in most cases for only 18 months) and probably at a higher cost to you.
- If you already have COBRA coverage when you enroll in Medicare, your COBRA will probably end. If you become eligible for COBRA coverage after you’re already enrolled in Medicare, you must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have End-Stage Renal Disease (ESRD)).
I have TRICARE.
If you have Medicare Part A (Hospital Insurance) and TRICARE, you must have Part B to keep your TRICARE coverage.
I’m an active-duty service member.
If you’re an active duty service member, or the spouse or dependent child of an active duty service member:
- You don’t have to enroll in Part B to keep your TRICARE coverage while the service member is on active duty.
- Before the active-duty service member retires, you must enroll in Part B to keep TRICARE without a break in coverage.
- You can get Part B during a special enrollment period if you have Medicare because you’re 65 or older, or you’re disabled.
- If you have End-Stage Renal Disease (ESRD), you should enroll in Part A and Part B when you’re first eligible.
I have Veterans’ benefits.
If you have Veterans’ benefits, enrolling in Medicare may provide you with additional service and location options. If you don’t keep Part B, you may have to wait to sign up later, and you may pay a late enrollment penalty.
Special Circumstances
You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP.
You change where you live
- I moved to a new address that isn’t in my plan’s service area.
- I moved to a new address that’s still in my plan’s service area, but I have new plan options in my new location.
- I moved back to the U.S. after living outside the country.
- I just moved into, currently live in, or just moved out of an institution (like a skilled nursing facility or long-term care hospital).
- I’m released from jail.
You lose your current coverage
- I’m no longer eligible for Medicaid.
- I left coverage from my employer or union (including COBRA coverage).
- I involuntarily lose other drug coverage that’s as good as Medicare drug coverage (creditable coverage), or my other coverage changes and is no longer creditable.
- I had drug coverage through a Medicare Cost Plan and I left the plan.
- I dropped my coverage in a Program of All-inclusive Care for the Elderly (PACE) plan.
You have a chance to get other coverage
- I have a chance to enroll in other coverage offered by my employer or union.
- I have or am enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage).
- I enrolled in a Program of All-inclusive Care for the Elderly (PACE) plan.
Your plan changes its contract with Medicare
- Medicare takes an official action (called a “sanction”) because of a problem with the plan that affects me.
- Medicare ends (terminates) my plan’s contract.
- My Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan’s contract with Medicare isn’t renewed.
Other special situations
- I’m eligible for both Medicare and Medicaid.
- I qualify for Extra Help paying for Medicare prescription drug coverage.
- I’m enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility.
- I dropped a Medigap policy the first time I joined a Medicare Advantage Plan.
- I have a severe or disabling condition, and there’s a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with my condition.
- I’m enrolled in a Special Needs Plan (SNP) and no longer have a condition that qualifies as a special need that the plan serves.
- I joined a plan, or chose not to join a plan, due to an error by a federal employee.
- I wasn’t properly told that my other private drug coverage wasn’t as good as Medicare drug coverage (creditable coverage).
- I wasn’t properly told that I was losing private drug coverage that was as good as Medicare drug coverage (creditable coverage).
What is Medicare?
The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Medicare Part C (Medicare Advantage Plans)
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Medicare Part D (prescription drug coverage)
Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Not sure what kind of coverage you have?
- Check your red, white, and blue Medicare card.
- Check all other insurance cards that you use. Call the phone number on the cards to get more information about the coverage.
- Check your Medicare health or drug plan enrollment.
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
When can I join a Medicare health or drug plan?
When you first get Medicare (Initial Enrollment Periods for Part C & Part D)
I’m newly eligible for Medicare because I turned 65.
What can I do?
Sign up for a Medicare Advantage Plan and/or a Medicare Prescription Drug Plan.
When?
During the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you turn 65, your coverage will begin the first day of the month you turn 65.
I’m newly eligible for Medicare because I have a disability (under 65).
What can I do?
Sign up for a Medicare Advantage Plan or a Medicare Prescription Drug Plan. Your Medicare coverage begins 24 months after you get Social Security or Railroad Retirement Board (RRB) disability benefits.
When?
During the 7-month period that starts 3 months before your 25th month of getting Social Security or RRB disability benefits and ends 3 months after your 25th month of getting disability benefits. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you first get Medicare, your coverage will begin the first day of your 25th month of entitlement to disability payments.
I’m already eligible for Medicare because of a disability, and I turned 65.
What can I do?
Sign up for a Medicare Advantage Plan and/or a Medicare Prescription Drug Plan.
- Switch from your current Medicare Advantage Plan or Medicare Prescription Drug Plan to another plan.
- Drop a Medicare Advantage Plan or a Medicare Prescription Drug Plan completely.
When?
During the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
If you sign up for a Medicare Advantage Plan during this time, you can drop that plan at any time during the next 12 months and go back to Original Medicare.
I don’t have Medicare Part A coverage, and I enrolled in Medicare Part B during the Part B General Enrollment Period (January 1-March 31).
What can I do?
Sign up for a Medicare Prescription Drug Plan.
When?
April 1-June 30
I have Medicare Part A coverage, and I enrolled in Medicare Part B during the Part B General Enrollment Period (January 1-March 31).
What can I do?
Sign up for a Medicare Advantage Plan (with or without drug coverage).
When?
April 1-June 30
During certain times each year (yearly enrollment periods for Part C & Part D)
Each year, you have a chance to make changes to your Medicare Advantage or Medicare prescription drug coverage for the following year. There are 2 separate enrollment periods each year.
Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage.
What can I do?
- Change from Original Medicare to a Medicare Advantage Plan.
- Change from a Medicare Advantage Plan back to Original Medicare.
- Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
- Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
- Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
- Join a Medicare Prescription Drug Plan.
- Switch from one Medicare drug plan to another Medicare drug plan.
- Drop your Medicare prescription drug coverage completely.
When?
October 15-December 7
Medicare Advantage Disenrollment Period.
Enrollment Period
Medicare Advantage Disenrollment Period
What can I do?
- If you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare.
- If you switch to Original Medicare during this period, you’ll have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
What can’t I do?
- Switch from Original Medicare to a Medicare Advantage Plan.
- Switch from one Medicare Advantage Plan to another.
- Switch from one Medicare Prescription Drug Plan to another.
When?
January 1-February 14
When will my coverage start?
Example
Mr. Green’s 65th birthday is July 20, 2014. If he signs up for Medicare in April, May, or June, his coverage will start on July 1, 2014.
If your birthday is on the first day of the month, your coverage starts the first day of the prior month.
Example
Mr. Kim’s 65th birthday is July 1, 2014. If he signs up for Medicare in March, April, or May, his coverage will start on June 1, 2014.
When will my Medicare coverage start?
If you sign up for Part A/ B in this month: Your coverage starts:
The month you turn 65 / 1 month after you sign up
1 month after you turn 65 / 2 months after you sign up
2 months after you turn 65 / 3 months after you sign up
3 months after you turn 65 / 3 months after you sign up
During the January 1-March 31 General Enrollment Period / July 1
Your Medicare coverage choices
Step 1: Decide if you want Original Medicare or a Medicare Advantage Plan
You can choose Original Medicare.
You can choose a Medicare Advantage Plan (like an HMO or PPO).
Step 2: Decide if you want prescription drug coverage (Part D)
You choose Original Medicare.
You choose a Medicare Advantage Plan.
Step 3: Decide if you want supplemental coverage (Original Medicare only)
You may want to get coverage that fills gaps in Original Medicare coverage. You can choose to buy a Medicare Supplement Insurance (Medigap) policy from a private company.
- Costs vary by policy and company.
- Employers/unions may offer similar coverage.
Note
If you join a Medicare Advantage Plan, you can’t use Medicare Supplement Insurance (Medigap) to pay for out-of-pocket costs you have in a Medicare Advantage Plan. If you already have a Medicare Advantage Plan, you can’t be sold a Medigap policy. You can only use a Medigap policy if you disenroll from your Medicare Advantage Plan and return to Original Medicare.
Other options
- In addition to Original Medicare or a Medicare Advantage Plan, you may be able to join other types of Medicare health plans.
- You may be able to save money or have other choices if you have limited income and resources.
- You may also have other coverage, like employer or union, military, or veterans’ benefits.
What's not covered by Part A & Part B?
Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments.
Some of the items and services that Medicare doesn’t cover include:
- Long-term care (also called custodial care)
- Most dental care
- Eye examinations related to prescribing glasses
- Dentures
- Cosmetic surgery
- Acupuncture
- Hearing aids and exams for fitting them
- Routine foot care