What is Medicare?
Medicare is a federal program. The Centers for Medicare & Medicaid services (CMS) run this health program. CMS is one branch of the department of Health and Human Services. Enrollment is via the office of Social Security Administration (SSA).
Is everyone eligible for Medicare?
No, not everyone is eligible for Medicare. Medicare is available to those individuals over 65 and to those under 65 on disability for at least 24 months. If an individual has End-Stage Renal Disease or Amyotrophic Lateral Sclerosis, (Lou Gehrig’s Disease), he/she immediately qualifies for Medicare enrollment.
How old do you have to be to get Medicare?
Most people become eligible for Medicare at age 65. Those who are under age 65 can qualify for Medicare when they have collected Social Security Disability for at least 24 months.
How much does Medicare cost at age 65?
The cost of Medicare depends on a few things. Those with a low income will likely pay less than the standard amount by qualifying for both Medicare and Medicaid. Those with a higher reported adjusted gross income will most likely pay more for both their Part B & Part D—this is called Income Related Monthly Adjustment Amount (IRMAA).
Now, Medicare Part A has no monthly premium and there is no cost to those who meet the requirements. On the other hand, Medicare Part B does have a premium that usually comes out of your Social Security check, if you are already receiving Social Security. Otherwise, you’ll pay the monthly premium, which for 2022, the Part B premium starts at $170.10 a month. Yet, that’s just the premium cost. Both Parts A and B have deductibles and coinsurances that can apply when you have only Original Medicare.
Do I need Medicare Part B if I have other insurance?
If you work for a large employer and have employer coverage, you may choose to delay enrollment. When you delay enrollment because you’re delaying retirement, you won’t need to rush to sign up for Part B, but you may choose to enroll in Part A, especially since, in many cases, it’s no charge to you!
It’s important to note that if you choose to enroll in Medicare Part A, you will no longer be able to contribute to a Health Savings Account. When you retire, you can sign up for both Part A and Part B if you chose not to collect before retirement.
At what age can I apply for Medicare?
For the most part, people sign up for Medicare at age 65, but some may choose to delay enrollment due to delaying retirement. In contrast, others may enroll before age 65 once they’ve been on Social Security Disability for at least 24 months.
Do you have to sign up for Medicare at 65 if you are still working?
You must sign up for Medicare at age 65 if you’re self-employed or working for a small employer (19 or fewer FTE employees). However, if you work for an employer with 20 or more full-time employees, you could choose to delay your enrollment.
Of course, Medicare isn’t mandatory, so you can choose whichever option makes the most sense for your situation. You may always consult your HR benefits administrator at the office where you work to identify your options.
Why is my first Medicare bill so high?
If you aren’t accepting Social Security income, Medicare will bill you for 4 months of premiums at one time—unless, of course, you sign up for Medicare Easy Pay where you can choose to pay premiums monthly using a check, bank draft, credit, or debit card.
What is a Medigap plan?
A Medigap plan is a supplemental option for Medicare. Medigap plans are also known as Medicare Supplement plans; these policies fill the gaps in Medicare. So, when Medicare would otherwise charge you 20% and/or a deductible, a Medigap or Medicare Supplement plan could eliminate these expenses).
How long is an Open Enrollment Period for Medicare Supplement policies?
You can pre-enroll in Medigap up to 6 months before the Part B effective date with some companies. But many companies only allow you to pre-enroll 3 months before Part B effective date. The Open Enrollment Period for Medigap lasts for 6 months and begins the day your Part B is effective.
What is a Medicare Part C (or MAPD) plan?
Medicare Part C is a Medicare Advantage plan. These plans sometimes have a $0 per month premium(x), and many of them include prescription drug coverage (MAPD) at no additional cost. A Medicare Advantage HMO (MAPD) plan and its benefits can vary, but you need to elect a primary care physician and group network when signing up.
You can think of Medicare Part C (MAPD's) as a “bundled plan”
One that rolls Medicare Parts A, B and D all together.
What drugs are covered under Medicare Part D?
There are many drugs covered under Medicare, and every drug plan must cover the six protected classes of drugs. If you have medications that need coverage, you can use the Medicare plan finder tool to identify the policy that will cover your medications.
Does Medicare cover a home health aide?
Medicare will cover intermittent or part-time skilled nursing care. If you need long-term care or a caregiver for personal care assistance, you would be on your own for those costs.
How does secondary insurance work with deductibles?
If you have small employer group health insurance (less than 20 employees), Medicare will be the secondary payer. In this case, if the group policy has a deductible, Medicare may pay a portion of the deductible. It’s best to discuss your coverage with your benefits administrator to determine how your policy will work with any Medicare plans.
What is the coverage gap?
The coverage gap is the Part D “donut hole”. During this time, beneficiaries pay 25% of medication(x) costs until total drug costs reach $7,050.
Do you automatically get Medicare with Social Security?
If you’re on Social Security, you’ll have automatic enrollment into Medicare at age 65. But, if you’re on Social Security Disability, you can get Medicare after 24 months.
Are there Medicare Supplement plans with no premium?
Medicare Supplements have a premium because they offer comprehensive benefits. If you’re hospitalized or in need of major treatment, a Medicare Supplement plan (Medigap plan) will cover the costs that Medicare would leave you to pay.
Can Medicare drop you?
Normally, no, Medicare can’t drop you. But, if you don’t pay your premium on your Medicare Part B, Medicare Advantage or Medigap plans, they can drop you. Also, if you don’t pay your Part D (drug plan) premium, the drug plan can drop you. Usually, they give multiple notices before the plan terminates your policy.
Can you have a Medicare Advantage plan and a Medicare Supplement plan?
No, you can’t have both a Medicare Advantage plan and a Medigap plan. You must choose one or the other. Since Medicare Advantage plans are with private insurance companies, they handle the claims instead of Medicare.
A Medigap plan is supplemental to Medicare, so it can’t coordinate benefits with Part C.
If you for some reason have both, the Medicare Advantage plan will cover you, but the Medigap plan won’t. Therefore, you’d be wasting money on Medigap at that point. If you can’t decide between the two, work with an agent near you to determine which option really makes the most sense.
What are telemedicine services and will Medicare cover telehealth?
Telemedicine services can include telephone appointments and virtual appointments. In general, telemedicine is a remote clinical service. Medicare Part B will cover telehealth services.
Are you Looking to Find Answers to All Your Medicare Questions?
Medicare is a complex maze with an ever-changing landscape. The good news is you don't have to navigate it alone. The good people at Ashbrook-Clevidence can advise and guide you through your enrollment and benefits plan search to find and compare the best available options for you in your area. We’re here to answer all your Medicare questions, so you can feel confident in making an intelligent and informed decision.
Let us do all the hard work… so you don’t have to!
We’re here to help!
Medicare is a federal program. The Centers for Medicare & Medicaid services (CMS) run this health program. CMS is one branch of the department of Health and Human Services. Enrollment is via the office of Social Security Administration (SSA).
Is everyone eligible for Medicare?
No, not everyone is eligible for Medicare. Medicare is available to those individuals over 65 and to those under 65 on disability for at least 24 months. If an individual has End-Stage Renal Disease or Amyotrophic Lateral Sclerosis, (Lou Gehrig’s Disease), he/she immediately qualifies for Medicare enrollment.
How old do you have to be to get Medicare?
Most people become eligible for Medicare at age 65. Those who are under age 65 can qualify for Medicare when they have collected Social Security Disability for at least 24 months.
How much does Medicare cost at age 65?
The cost of Medicare depends on a few things. Those with a low income will likely pay less than the standard amount by qualifying for both Medicare and Medicaid. Those with a higher reported adjusted gross income will most likely pay more for both their Part B & Part D—this is called Income Related Monthly Adjustment Amount (IRMAA).
Now, Medicare Part A has no monthly premium and there is no cost to those who meet the requirements. On the other hand, Medicare Part B does have a premium that usually comes out of your Social Security check, if you are already receiving Social Security. Otherwise, you’ll pay the monthly premium, which for 2022, the Part B premium starts at $170.10 a month. Yet, that’s just the premium cost. Both Parts A and B have deductibles and coinsurances that can apply when you have only Original Medicare.
Do I need Medicare Part B if I have other insurance?
If you work for a large employer and have employer coverage, you may choose to delay enrollment. When you delay enrollment because you’re delaying retirement, you won’t need to rush to sign up for Part B, but you may choose to enroll in Part A, especially since, in many cases, it’s no charge to you!
It’s important to note that if you choose to enroll in Medicare Part A, you will no longer be able to contribute to a Health Savings Account. When you retire, you can sign up for both Part A and Part B if you chose not to collect before retirement.
At what age can I apply for Medicare?
For the most part, people sign up for Medicare at age 65, but some may choose to delay enrollment due to delaying retirement. In contrast, others may enroll before age 65 once they’ve been on Social Security Disability for at least 24 months.
Do you have to sign up for Medicare at 65 if you are still working?
You must sign up for Medicare at age 65 if you’re self-employed or working for a small employer (19 or fewer FTE employees). However, if you work for an employer with 20 or more full-time employees, you could choose to delay your enrollment.
Of course, Medicare isn’t mandatory, so you can choose whichever option makes the most sense for your situation. You may always consult your HR benefits administrator at the office where you work to identify your options.
Why is my first Medicare bill so high?
If you aren’t accepting Social Security income, Medicare will bill you for 4 months of premiums at one time—unless, of course, you sign up for Medicare Easy Pay where you can choose to pay premiums monthly using a check, bank draft, credit, or debit card.
What is a Medigap plan?
A Medigap plan is a supplemental option for Medicare. Medigap plans are also known as Medicare Supplement plans; these policies fill the gaps in Medicare. So, when Medicare would otherwise charge you 20% and/or a deductible, a Medigap or Medicare Supplement plan could eliminate these expenses).
How long is an Open Enrollment Period for Medicare Supplement policies?
You can pre-enroll in Medigap up to 6 months before the Part B effective date with some companies. But many companies only allow you to pre-enroll 3 months before Part B effective date. The Open Enrollment Period for Medigap lasts for 6 months and begins the day your Part B is effective.
What is a Medicare Part C (or MAPD) plan?
Medicare Part C is a Medicare Advantage plan. These plans sometimes have a $0 per month premium(x), and many of them include prescription drug coverage (MAPD) at no additional cost. A Medicare Advantage HMO (MAPD) plan and its benefits can vary, but you need to elect a primary care physician and group network when signing up.
You can think of Medicare Part C (MAPD's) as a “bundled plan”
One that rolls Medicare Parts A, B and D all together.
What drugs are covered under Medicare Part D?
There are many drugs covered under Medicare, and every drug plan must cover the six protected classes of drugs. If you have medications that need coverage, you can use the Medicare plan finder tool to identify the policy that will cover your medications.
Does Medicare cover a home health aide?
Medicare will cover intermittent or part-time skilled nursing care. If you need long-term care or a caregiver for personal care assistance, you would be on your own for those costs.
How does secondary insurance work with deductibles?
If you have small employer group health insurance (less than 20 employees), Medicare will be the secondary payer. In this case, if the group policy has a deductible, Medicare may pay a portion of the deductible. It’s best to discuss your coverage with your benefits administrator to determine how your policy will work with any Medicare plans.
What is the coverage gap?
The coverage gap is the Part D “donut hole”. During this time, beneficiaries pay 25% of medication(x) costs until total drug costs reach $7,050.
Do you automatically get Medicare with Social Security?
If you’re on Social Security, you’ll have automatic enrollment into Medicare at age 65. But, if you’re on Social Security Disability, you can get Medicare after 24 months.
Are there Medicare Supplement plans with no premium?
Medicare Supplements have a premium because they offer comprehensive benefits. If you’re hospitalized or in need of major treatment, a Medicare Supplement plan (Medigap plan) will cover the costs that Medicare would leave you to pay.
Can Medicare drop you?
Normally, no, Medicare can’t drop you. But, if you don’t pay your premium on your Medicare Part B, Medicare Advantage or Medigap plans, they can drop you. Also, if you don’t pay your Part D (drug plan) premium, the drug plan can drop you. Usually, they give multiple notices before the plan terminates your policy.
Can you have a Medicare Advantage plan and a Medicare Supplement plan?
No, you can’t have both a Medicare Advantage plan and a Medigap plan. You must choose one or the other. Since Medicare Advantage plans are with private insurance companies, they handle the claims instead of Medicare.
A Medigap plan is supplemental to Medicare, so it can’t coordinate benefits with Part C.
If you for some reason have both, the Medicare Advantage plan will cover you, but the Medigap plan won’t. Therefore, you’d be wasting money on Medigap at that point. If you can’t decide between the two, work with an agent near you to determine which option really makes the most sense.
What are telemedicine services and will Medicare cover telehealth?
Telemedicine services can include telephone appointments and virtual appointments. In general, telemedicine is a remote clinical service. Medicare Part B will cover telehealth services.
Are you Looking to Find Answers to All Your Medicare Questions?
Medicare is a complex maze with an ever-changing landscape. The good news is you don't have to navigate it alone. The good people at Ashbrook-Clevidence can advise and guide you through your enrollment and benefits plan search to find and compare the best available options for you in your area. We’re here to answer all your Medicare questions, so you can feel confident in making an intelligent and informed decision.
Let us do all the hard work… so you don’t have to!
We’re here to help!
