Medicare Frequently Asked Questions (FAQ)
We’ve put together all of the questions that we commonly hear into this one page. If you have a question that you don’t see an answer to here, send us a chat using the “let’s chat” function in the lower right-hand corner of your screen.
What are Medicare enrollment periods?
Enrollment periods are the various times individuals can enroll in Original Medicare as well as Medicare Advantage plans and prescription drugs plans through out the year.
Initial election period – This is when first enroll in Medicare and can now choose a Medicare Advantage plan, Part D drug plan and Medicare supplement.
Annual election period – This is the time frame to review and choose new Part D plans and Medicare Advantage plans for the upcoming year. These plans change every year, so everyone should review their benefits between Oct 15th and December 7th to ensure you are in the correct plan for the upcoming year.
Open enrollment – This is from January 1st – March 31st and designed to allow you to make one change in your plan selection in case you made a mistake during the previous enrollment period.
Special enrollment period – This is for special circumstances that can allow you to make a change outside of the designated enrollment periods. Special enrollment periods can be due to Medicaid status, moving out of a service area, impacted by a natural disaster, and more.
What is the difference between Medicare part A and Part B?
Medicare part A is responsible for hospital related health care expenses such as inpatient hospitalization, and Part B is responsible for doctor relates healthcare expenses such as Medical equipment or primary care visits among others. Both Part A and Part B have deductibles and depending on the type of plan you pick (Medicare Advantage or Medicare Supplement), you can reduce your out of pocket expenses on deductibles and copays.
Part A premium is usually covered at no cost due to working and paying into social security taxes for at least 40 working quarters.
Part B premium is deducted from your social security check each month and can vary based on your reported income. Some individuals may have their Part B premium covered based on low-income status verified by their resident state.
Part A and Part B are parts of Medicare that make up “Original Medicare”. Medicare Part D is for drugs and Part C is for Medicare Advantage.
How can I get a new Medicare card if mine is lost or stolen?
To get a new Medicare card, you’ll need to either go to your local Social Security Office or visit the Social Security Administration website. You’ll need to input your legal name, your Social Security number, and your birthday.
If you get your Medicare through the Railroad Retirement Board (RRB), you’ll need to contact the RRB directly to order a replacement. If you have a Medicare Advantage (HMO, PPO, or PDP) plan, you’ll need to call your plan carrier directly to get a replacement card.
Make sure to write down your Medicare number and keep it in a safe place so that you can remember your number if your card is lost or damaged. Don’t forget to use your new Medicare card (you should have received a new one in 2018 – click here for more info).
If you lose your card and are concerned that it may have been stolen, be sure to watch your statements for any billing that looks incorrect. You can call 1-800-HHS-TIPS (1-800-447-8477) to report fraud or a stolen card.
When can I enroll in Medicare?
Every Medicare beneficiary has three types of enrollment periods: IEP, AEP, and SEP.
IEP is the Initial Enrollment Period. You will have an IEP that begins three months before you turn 65 and ends three months after. You must enroll during that time. Then, every fall, you will be able to make changes during AEP, the Annual Enrollment Period, which runs from October 15 through December 7.
Some (but not all) beneficiaries will have an SEP, or Special Enrollment Period. Events like moving to a new service area or gaining or losing an income source can give you an SEP. Anyone who has Extra Help or a Medicare Savings Program has a continuous enrollment period. Those with a continuous SEP can enroll or make changes once per quarter during the first three quarters of the year.
What is the late enrollment penalty fee?
You are required to enroll in Medicare during your IEP (Initial Enrollment Period). That means that from three months before your 65 birthday to three months after, you are required to select Medicare coverage for prescription drugs and medical care. If you do not enroll during your IEP, you may be charged a late enrollment penalty fee. The fee will be added to your Medicare costs when you enroll.
How do I pay my Medicare bills?
If you receive Social Security benefits, your Medicare payments may be automatically deducted from your SS benefits. If not, There are a few ways you can pay your Medicare costs.
- You can set up an online bill payment through your bank, you can sign up for Medicare Easy
- Pay to have your premiums automatically deducted from your bank account, you can send in a check or money order to your local Social security office. Call and confirm with your specific location.
- Pay by credit or debit card by completing and returning the bottom portion of your Medicare bill.
If your Medicare bills come from the Railroad Retirement Board, you will instead have to mail your premium payments to RRB, Medicare Premium Payments, PO Box 979024, St. Louis, MO 63197-9000. If you miss more than one payment, your Medicare plan can be terminated.
If all Medigap plans of the same type have the same coverage, why would I pick one with a higher premium?
Medicare supplement plans are standardized. That means a plan G from one company is exactly the same as a plan G from another company, except the price.
Instead of looking at the plan cost, you want to make sure the plan you are choosing is a financially stable company with history of stable rate adjustments. For example, you may look at a plan that is $10 more per month than another, but the cheaper company has only been on the market a couple years and has had double digit rate increases every year vs. the more expensive company having single digit rate increases, stable financial rating and in the market for 20+ years.
A licensed agent can go over all of these benefits with you in full detail to help you select the best option for your needs.
Does my plan cover physical fitness?
Some plans do.
Many Medicare Advantage plans include a physical fitness program for seniors & Medicare eligible. They often host various fitness classes and activities at local parks, YMCAs, etc. that are designed to both bring people together for a unique social activity and create an opportunity for physical fitness.
Each plan is a little different, but the most common fitness benefits are through SilverSneakers or Silver and Fit.
I lost my job and got COBRA coverage from my employer. Can I still have Medicare?
COBRA (the Consolidated Omnibus Budget Reconciliation Act) allows you to stay with your employers group health plan for a limited time after your employment ends. It usually lasts from 18-36 months. You cannot keep COBRA forever, so it’s a good idea to enroll in Medicare once you are eligible.
You may be eligible for Medicare if you are 65 or older or if you have certain qualifying disabilities. Keep in mind that if you are turning 65 soon, you should enroll in Medicare ASAP. If you wait too long, you may have to pay a late enrollment penalty fee.
Can I have both Medicare and COBRA?
If you already have Medicare but then lose your job and receive COBRA, you can have both. You’ll use your Medicare coverage first, then COBRA. That means that if you become ill, all of your medical costs will go through your Medicare coverage. Any leftover health care costs that you have to pay out-of-pocket may be covered by your employer coverage (COBRA). If you already have COBRA and then become eligible for Medicare, you may lose your COBRA coverage. It is always important to enroll in Medicare as soon as you become eligible. A Medicare Plan Finder agent can help you enroll.
Will Medicare cover me if I leave the country?
Medicare can only cover your care within the United States (including Puerto Rico, American Samoa, Guam, the Northern Marina Islands, and the U.S. Virgin Islands). The only exception is if you are on the border and a foreign hospital is closer. For example, if you are near the Texas/Mexico border and you are in an accident that is technically closer to a Mexican hospital, Medicare can cover your care at that hospital.
Will my pre-existing conditions prevent me from getting Medicare coverage?
No!
Everyone over the age of 65 is eligible for Medicare, regardless of preexisting conditions. However, if you wait until after your Initial Enrollment period, some Medicare Supplement plans may make you wait to begin coverage or charge you more if you have a preexisting condition. Additionally, some Medicare Advantage plans won’t cover you if you have ESRD (End-Stage Renal Disease).
Does Medicare cover mental health?
Yes, Medicare Part B covers outpaitent mental health doctor visits (psychiatrists, psychologists, social workers, nurses, therapists, addiction centers). Medicare will also cover counseling if your counselor accepts Medicare assignment. You can also get one depression screening each year, group and family counseling, psychiatric evaluations, medication management, injections, yearly well-visits, and partial hospitalization with Part B. If you need mental health hospitalization, Medicare Part A will provide coverage for up to 190 days.
Does Medicare cover dental, vision, and hearing?
Original Medicare (Part A and Part B) does not cover dental, vision, and hearing.
You have two choices.
- You can either purchase a separate dental plan, a vision plan, and a hearing plan.
- Enroll in a Medicare Advantage plan that includes dental, vision, and hearing benefits. Here is some more information on each benefit:
How are Medicare plan star ratings measured?
Every Medicare plan is given a star rating derived from member surveys, information from clinics, billing reviews, and regular monitoring. For medical plans, ratings are based on the quality of preventative medicine (screenings, test, vaccines), chronic condition management, customer service, member experience, and member complaints. Prescription drug plan ratings are based on customer service, member complaints, and experience as well as drug safety and price accuracy.
What are the differences between HMOs and PPOs?
If you choose to enroll in a Medicare Advantage plan, you’ll have four main options (HMO, HMO-POS, PPO, and PFFS). An HMO, or Health Maintenance Organization, will require you to select one primary physician. The only way for you to receive other care is if your primary physician recommends a different doctor. Similarly, an HMO-POS (Health Maintenance Organization, Point-Of-Service), requires you to select a primary physician, but you have the option to visit separate specialists for an extra fee.
A PPO (Preferred Provider Organization) is the opposite of an HMO. You don’t have to select just one primary physician (but of course doctors in your network will be much cheaper). A PFFS is similar in that you can select any doctor, but PFFS plans are less common and therefore less doctors will accept your plan. There may be additional fees if you see a doctor who does not accept your plan.
The main difference to remember is that HMO and HMO-POS plans require you to select one primary physician, while PPO and PFFS plans allow you to see any doctor you choose.
Can I have both Medicare and Medicaid at the same time?
Yes! As long as you are eligible for both Medicare and Medicaid, you can have both at the same time. In fact, we encourage it. You may be able to save more money and get more benefits!
Can I add my spouse and kids to my Medicare plan?
No.
Medicare plans are for individuals only. There are no Medicare family plans. Your spouse and children will need to enroll separately.
However, if you are your spouse are both on the same Medicare supplement insurance company, you should ask about spousal discounts.
If I retire early, can I enroll in Medicare?
Only if you are eligible due to age or disability. Retirement does not make you eligible for Medicare. If you lose your employer insurance, COBRA or a short-term policy can hold you over until you are eligible for Medicare.
Do I need to renew my policy every year?
Your Medicare policy will automatically renew each year (unless your plan terminates its contract). However, every year you will have the option to change or update your plan from October 15 through December 7. This is known as the Annual Enrollment Period (AEP). If you have a special circumstance that leads to you losing your coverage during any other time of the year, you will have 60 days to find a new plan.
Do I need Medicare if I am still working?
You don’t NEED it, but you don’t have to be retired to enroll in Medicare. Plus, if you’ve worked for at least 39 quarters, your Part A can have a $0 premium. There’s no reason not to sign up once you’re eligible, even if you’re still working and have employer insurance.
When will I get my Medicare card?
If you are automatically enrolled, you’ll get your Medicare card in the mail about three months before you turn 65. If you have to enroll yourself, you’ll get your card about three weeks after you complete your enrollment. Your card will show what coverage you have (Part A, B, or both) as well as the date that your coverage becomes effective. Health providers will need to see your card to make sure that Medicare will cover your treatment.
