Medicare Basics FAQs - Allboc Insurance Solutions - Allboc
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Medicare Basics - FAQs
Q: What is Medicare?
A: Medicare is health insurance from the federal government for Americans age 65 and over, and some people under age 65 with certain disabilities. It is not based on your income. It provides partial coverage for medical costs.
Q: Is Medicare the same as Medicaid?
A: No. Medicaid is a jointly-run federal and state program for people wth lower incomes who meet the income and asset limits and are age 65 or over, blind, or have a disability.
Q: Can someone have both Medicare and Medicaid?
A: Yes. Some people with lower incomes qualify for both programs at the same time.
Q: What are the parts of Medicare?
A: Medicare has four Parts:
Part A: Hospital care: Covers care you receive in inpatient hospital settings.
Part B: Medical care : Covers your doctor visits, lab work, durable medical equipment, outpatient services, etc.
Part B: Medical care : Covers your doctor visits, lab work, durable medical equipment, outpatient services, etc.
Together, Parts A and B are sometimes called Original Medicare or Traditional Medicare.
Part C (Medicare Advantage or Medicare Health Plans): Optional, privately-run health plans that substitute for Original Medicare as long as you have the plan, and sometimes include Part D. These plans must provide the same benefits as Original Medicare, but may provide them in a different way (such as with different copays or coinsurance). If you leave a Medicare Advantage plan, you return to Original Medicare.
Part D: Optional, privately-run prescription drug plans. These may be stand-alone plans covering prescriptions only, or be included in a Medicare Advantage plan.
Q: Does Medicare include coverage for prescription drugs?
A: No. If you have Original Medicare and want drug coverage, you may want to think about joining an optional stand-alone Part D plan. This is a private insurance plan that covers prescription drugs only. Many Medicare Advantage plans already include Part D.
Q: What does a Medicare card look like?
Q: Is there a cost for Medicare?
A: Part A (hospital coverage) is typically premium free because most people have paid into that program during their working years. Some people may have to pay a premium if they (or their spouse) earned fewer than 40 credits (often worked fewer than 10 years) in jobs that paid into Medicare.
Part B (medical coverage) typically has a standard monthly premium. Some people with higher incomes may have higher premiums. As of 2015, the standard premium was $104.90 per month which is deducted directly from your Social Security beneifts if you are receiving Social Security.
Q: How do I join original Medicare?
A: If you started getting Social Security retirement or disability benefits before age 65: The Social Security Administration automatically enrolls you in Medicare Parts A and B. Medicare will let you know the effective date, and will also give you the option to defer Part B. You will need both Parts A & B in order to take a Medicare Supplement plan or Medicare Advantage plan.
If you have not yet applied for Social Security benefits: You will need to enroll in the parts of Medicare that fit your situation. This will not happen automatically. You may join Medicare Parts A and B during your Initial Enrollment Period - the seven month window surrounding the month of your 65th birthday. This includes the three months before your birthday month, the month of your birthday, and the three months after your birthday month.
Most people enroll through the Social Security Administration (SSA). Use one of the following options:
- Call the SSA at 1-800-772-1213
- Go online to www.socialsecurity.gov
- Visit your local SSA office
Q: Can I enroll in Medicare outside of my seven month window?
A: Always check with Medicare but the usual special timeframes are:
- Special Enrollment Period 1: If you're covered under a group health plan based on current employment, you have a Special Enrollment Period to sign up for Part A and/or Part B any time as long as you or your spouse (or family member if you're disabled) is working, and you're covered by a group health plan through the employer or union based on that work.
- Special enrollment Period 2: You have an 8-month Special Enrollment Period to sign up for Part A and/or Part B that starts the month after the employment ends or the group health plan insurance based on current employment ends, whichever happens first.
- The General Enrollment Period occurs every year from Jan. 1 March 31. Your coverage will start July 1, and you may have to pay a late-enrollment penalty.
Q: What is the Late Enrollment Penalty (LEP)?
A: While Part D is optional, some people who join Part D later than when they first qualify may have to pay a late-enrollment penalty.
Q: What questions should I consider when choosing between a Medicare Supplement and Medicare Advantage program?
A:
- Does my doctor take this plan?
- If I qualify for the Low Income Subsidy or Extra Help from Social Security, how will this change my options and costs?
- If I qualify for a Medicare Savings Program through Medicaid, how will this change my options and costs?
- Will I be able to go to the provider or hospital of my choice?
- Does my out-of-pocket cost grow if I use the plan more?
- Is there an out-of-pocket limit per year? (This is a maximum amount I would have to pay out of pocket before the plan covers all care.)
- Will I have coverage if I travel outside my immediate area?
- Are there any protections (such as guaranteed renewability, etc.) for me in this plan? What are they?
- Are there any extra benefits provided to me in this plan? What are they?
- What is not covered?
- Will I need to consider buying a Part D plan?
Q: Are there programs to help me pay for Medicare and my Part D Plan?
A: Yes. These programs are typically based on your income level. Contact Social Security and/or your state's Medicaid to see if your qualify.
Q: Why would I join a Medicare Advantage plan instead of staying in Original Medicare?
A: This is a very personal decision and people may make it for a variety of reasons. Some reasons we have heard from clients include:
For greater provider access in some areas of the state. Some counties have few providers willing to take new Medicare patients, or patients with both Medicare and Medicaid. In some cases, people find they have better provider access with a Medicare Advantage plan that has a network of providers.
No health screening. Some people, especially those with disabilities who are under age 65, may not qualify for a Medigap/Medicare Supplement plan due to their health. Unless people have End Stage Renal Disease, they can join a Medicare Advantage plan regardless of health.
No health screening. Some people, especially those with disabilities who are under age 65, may not qualify for a Medigap/Medicare Supplement plan due to their health. Unless people have End Stage Renal Disease, they can join a Medicare Advantage plan regardless of health.
Q: Why would I stay in Original Medicare with a Medigap instead of joining Medicare Advantage?
A: This is a very personal decision. Some reasons we have heard from clients include:
- Peace of mind paying a flat rate for a premium to have lower or no out-of-pocket costs and balances when you get care.
- Ability to travel in the U.S. without worrying if you are in a plan's service area.
- Freedom to choose providers with no referrals required.
Q: If I choose a Medicare Advantage plan, do I have to keep it forever?
A: No. You can change plans every fall from October 15 through December 7. Your new plan starts Jan. 1. If you do nothing during this annual enrollment period, and your plan is offered for the following year, you will remain on the same plan subject to any changes noted for the new year. You also can leave the plan for Original Medicare during this enrollment period and every year from Jan. 1 - Feb. 14. Some people get additional chances to change, or special enrollment periods, for other events (such as moving, qualifying for help with costs, etc.). To switch plans, just enroll in the new plan (do not disenroll from the old plan first). Medicare will disenroll you from the old plan when your new plan starts.
If you choose a Medicare Advantage plan when you first get Medicare and then decide within 12 months it is not right for you, you may have rights to rturn to Original Medicare and buy a Medigap plan instead. Also, if you left a Medigap plan for a Medicare Advantage plan, you might be able to return to that Medigap plan within 12 months. Keep in mind your premium could be different than when you left.
Q: Are you leaving a Medigap plan?
A: If you change from a Medigap to a Medicare Advantage plan or other replacement plan, its up to you to cancel your Medigap/Medicare Supplement coverage. If you paid a yearly premium for your Medigap plan, the law does not require the plan to refund you any portion of that premium. Do not cancel your old plan until you verify you are active in your new coverage.
Q: What is a Medicare Select Policy?
A: Medicare select policies supplement the benefits available under the Medicare program and are offered by insurance companies and health maintenance organizations (HMOs). Medicare select policies are similar to standard Medicare supplement insurance but the covered services must be obtained through plan providers selected by the insurance company or HMO. Each insurance company that offers a Medicare select policy contracts with its own network of plan providers to provide services. Medicare Select insurers must pay supplemental benefits for emergency health care furnished by providers outside the plan provider network. Medicare select policies typically deny payment or pay less than the full benefit if you go outside the network for non-emergency services. However, Medicare still pays its share of approved charges if the services you receive outside the network are services covered by Medicare.
* Contacting us via any of our phone numbers will connect you with one of our employees and/or agents. Allboc Insurance Solutions is not connected with or endorsed by the United States government or the federal Medicare program.