Q:
What is Original Medicare? Answers to Medicare Questions
A: Original Medicare is the traditional, fee-for-service healthcare program provided and managed by the U.S. government. In Original Medicare, you are able to go to a doctor or hospital whenever you feel that you need care as long as they accept Medicare. Part A (hospital insurance) and Part B (medical insurance) are included in Original Medicare.
Q: What doesn’t Original Medicare cover?
A: Medicare does not cover Part A deductible ($1,632) and Part B deductible ($240) and coinsurance (20%) It also does not cover items such as routine hearing exams, eye exams and outpatient prescription drugs.
Q: Why is Part B Optional?
A: Part B is optional because some people don’t need Medicare Part B (medical)as they are still covered by an employer’s or spouse’s health plan. However, if you do not join Part B right away and you are not covered under another health care plan, called credible coverage, you will have a late enrollment penalty consisting of a 10 percent Part B premium increase per year for each year that you were first eligible and didn’t enroll.
Q: What options do I have for Medicare plans?
A: Options that you have for Medicare plans are listed below. All of these plans help cover health care expenses not covered by Medicare.
- Medicare Advantage plans include Part A and Part B Original Medicare benefits as well as other benefits in one plan. Medicare Advantage plans often also include prescription drug coverage. Types of Medicare Advantage plans include Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO).
- Medicare Supplement plans help to cover the unpaid costs after Medicare Part A and Part B have paid their portion of your healthcare costs. There are several different plans available on the market all offered by private companies. Plans are standardized so a plan F with one company is the same as Plan F with every company.
To choose, you’ll need to compare the level of coverage for each plan to see which best fits your needs.
Q: What is Part D Prescription coverage?
A: Medicare Part D is optional coverage, and you don’t have to get it. However, if you don’t sign up for it when you’re first eligible and don’t have creditable prescription drug coverage, you may have to pay a higher premium if you end up enrolling down the line.
Q: When can I join a Medicare Prescription Drug plan?
A: You can enroll in a Medicare Part D plan
- If you are newly eligible for Medicare because you are turning 65. You may enroll 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. Or If you are under 65 you are eligible to enroll in Medicare if you have a qualifying disability.
- You can also enroll during Medicare’s AEP which begins October 15 and ends December 7 of each year. The choices you make generally take effect January 1 of the following year.
- There are other special enrollment period that you may qualify for. (See below)
Q: What if I don’t take any prescription drugs?
A: Medicare Part D is optional coverage, and you don’t have to get it. However, if you don’t sign up for it when you’re first eligible and don’t have creditable prescription drug coverage, you may have to pay a higher premium if you end up enrolling down the line.
Q: I have a retiree prescription drug plan from my employer or union. Should I consider a prescription drug plan?
A: If your employer or union plan covers as much as or more than a Medicare Prescription Drug Plan, you can choose to:
- Keep your current drug plan. If you join a Medicare Prescription Drug Plan later, your monthly premium won’t be higher (no penalty).
- Drop your current drug plan and join a Medicare Prescription Drug Plan. If you choose this option, be aware that you may not be able to get your employer or union drug plan back if you change your mind. Check with your employer or union to see if you can rejoin at a later date.
- For more information, check with the person that answers questions about your employer or union drug plan.
Q: My income is very limited. It will be hard for me to pay the premiums and deductible under the Medicare prescription drug coverage. Is there any extra help for me?
A: If your income is very limited you may be able to get extra help to pay for your prescription drug premiums and costs. To see if you are eligible contact your local Social Security office or call Medicare at 1-800-633-4227 and tell them you would like to apply for Extra Help
Q: Can I drop my Medicare Advantage Plan?
A: You can drop your Medicare Advantage Plan, by switching to another Medicare Advantage plan with or without Part D coverage, or, Disenroll from your plan and return to Original Medicare anytime between January 1 – March 31. If you disenroll and return to Original Medicare, you are also given a Special Election Period (SEP) to enroll in a Part D plan during this time.
Q: What do the letters in Medicare A, B, C & D mean?
A: The Medicare meanings for the letters A, B, C, & D are:
- • Medicare Part A covers Medicare inpatient care, including care received while in a hospital, a skilled nursing facility, hospice and limited in home care.
• Medicare Part B covers medical services and supplies that are medically necessary to treat your health condition. This can include outpatient care, preventive services, ambulance services, and durable medical equipment.
• Medicare Part C is another name for Medicare Advantage. Medicare Part C is administered by private insurance companies contracted with Medicare. Medicare Part C covers everything that Original Medicare (Part A and Part B) cover and may cover extra benefits as well. They are generally HMO or PPO plans.
• Medicare Part D is a federal program administered through private insurance companies. These companies offer retail prescription drug coverage to Medicare beneficiaries. Prior to 2006, when the Medicare Part D began, tens of thousands of Medicare beneficiaries in America had little help with retail drug costs.
Q: When is the Medicare Initial Enrollment Period?
A: Medicare Initial Enrollment Period (IEP) is when you’re first eligible for Medicare and you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. For example, if you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that: Begins 3 months before the month you turn 65.
If you have credible coverage such as a group plan at 65 and drop or lose that coverage at a later date you have the same 7 months window to enroll in Medicare Part B
Q: I have heard of Medicare Supplement Guaranteed Issue. What is that?
A: Under federal law, you have a six-month open enrollment period that begins the month you are 65 or older and enrolled in Medicare Part B. During your open enrollment period, Medigap companies must sell you a policy at the best available rate regardless of your health status, and they cannot deny you coverage. You also have a guaranteed enrollment period if you lose your current coverage. See special enrollment periods.
Q: What is the Annual Enrollment Period?
A: The Annual Medicare Election Period (AEP) begins on October 15 and ends December 7th of each year. During this period, anyone who is enrolled in Medicare may enroll for the first time in a Medicare Advantage Plan; or change from one Medicare Advantage Plan to another; or return to Original Medicare from a Medicare Advantage Plan. You can also enroll or change a Medicare Prescription Drug Plan. You may be eligible for other Special Enrollment periods such as new to Medicare or new to the area.
Q: How do I enroll in Medicare?
A: To enroll in Medicare, you must be 65 or older to be eligible for Part A and Part B. Also, if you have been receiving Social Security disability for 24 months you are eligible for Medicare regardless of age.
If you are on or starting Social Security you will enrolled automatically. You can also visit www.Medicare.gov or call Social Security at 1-800-772-1213
Q: Why would I want a plan to supplement original Medicare?
A: You might want a Medicare supplemental plan because Original Medicare does not cover Part A and Part B deductibles and coinsurance. In 2020 the hospital deductible is $1,1,632.00 and the Part B deductible is $240.00. and you would usually be responsible for 20% of all outpatient services (Part B). It also does not cover items such as routine hearing exams, eye exams, custodial nursing care and most outpatient prescription drugs. Coverage is provided by multiple plans or riders.
Custodial nursing care is for example is typically only covered under long term care plans.
Q: What is a Medicare Supplement Plan (Medigap)?
A: Supplement policy (also known as Medigap plan) is a Medicare Option. Medicare Supplement Plans fill in the gaps in Original Medicare coverage such as, co-pays and deductibles for hospitalization, doctor visits and other medical services.
Medicare Supplemental plans do not cover prescriptions and routine dental and vision expenses.
Q: What is a Medicare Advantage Plan?
A: Simply explained, Medicare Advantage also called Medicare Part C allows private health insurance companies to provide all of the standard benefits of Medicare Parts A and B within a managed care plan like an HMO or PPO. Medicare Advantage Plans usually provide prescription drug, insurance and some may include extras such as gym memberships or vision & dental insurance.
Q: Can I get a plan to cover prescriptions?
A. Medicare works with private insurance companies to offer prescription drug plans. These Medicare-approved drug plans are also known as stand-alone Part D plans. Medicare Prescription Drug Plans provide insurance coverage for generic and brand-name prescription drugs.
If you join a plan, you will likely pay a monthly premium, plus a share of the cost of your prescriptions. There are different drug plans available that vary by types of drugs covered, how much you have to pay and the pharmacies you can use. All drug plans must provide at least a standard level of coverage.
Just a note, many Medicare Advantage plans cover prescriptions.
Q: What if I can’t afford my prescriptions?
A: If you cannot afford your prescriptions, you may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, seven days a week; or
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., ET, Monday through Friday. TTY users should call 1-800-325-0778; or
- Arizona State ACCCHS Office.
Q: How do I choose a Medicare supplement plan?
A: To choose a Medicare Supplement Plan, contact an independent Medicare Broker, such as myself, that represents several top-rated insurance companies and have a comparison done to break down what each plan covers along with premium cost ranges, and lists the companies that offer them in your area.
Q: Am I eligible for a Medicare Supplement plan?
A. You are eligible for a Medicare supplement plan,
- If you’re turning 65, the best time to buy a Medigap policy is the 6-month period that starts the first day of the month you’re 65 or older and enrolled in Part B. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November. After this enrollment period, your option to buy a Medigap policy may be limited, and it may cost more.
- If you’re 65 or older, your Medigap open enrollment period begins when you enroll in Part B and can’t be changed or repeated. In most cases, it makes sense to enroll in Part B when you’re first eligible, because you might otherwise have to pay a Part B late enrollment penalty.
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If you have group health coverage through an employer or union because either you or your spouse is currently working, you may want to wait to enroll in Part B. Employer plans often provide coverage similar to Medigap, so you don’t need a Medigap policy.
When your employer coverage ends, you’ll get a chance to enroll in Part B without a late enrollment penalty. That means your Medigap open enrollment period will start when you’re ready to take advantage of it. If you enrolled in Part B while you still had the employer coverage, your Medigap open enrollment period would start. Unless you bought a Medigap policy before you needed it, you’d miss your open enrollment period entirely.
Q: When can I enroll in a Medicare Advantage Plan?
A. You can enroll in a Medicare Advantage Plan when you turn 65 and signed up for Medicare Part A and Part B during your Initial Enrollment Period. This enrollment period is 7 months long. It starts 3 full months before the month in which you turn 65. You can also sign up below age 65 if you are disabled and have been on Social Security for 2 years. If you don’t sign up then you will have to wait until the Annual Enrollment Period.
Q: What is the Medicare Part D Late Enrollment Penalty?
A. The late enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:
- A Medicare Prescription Drug Plan (Part D)
A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage
Creditable prescription drug coverage
Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($33.19 in 2019) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.
Q: Who pays the Medicare Broker?
A: The companies that contract with Medicare to provide health care coverage or prescription drugs typically use agents/brokers to sell their Medicare plans to Medicare beneficiaries. In other words, there is never a charge to the Beneficiary.
Q: I have heard that Medicare Supplements will no longer offer Plans F and C. Is this true?
A. Medicare Supplements offering of Plans F and C is as follows. If you are first eligible for Medicare after January 1, 2020, then you cannot enroll in Plans F and C. Anyone eligible prior to that date can still enroll in those plans. However, you might find that Plan G is another great option.
Q: What are Special enrollment periods
A. Special circumstances (Special Enrollment Periods) 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) There are several others SEP’s available. Call or fill out the contact form for a complete list.
