Medicare Questions
Do you need quick answers? We have them.
Q. What Is Medicare?
Short Answer
Medicare is a health insurance program provided by the U.S. government for people ages 65 plus, as well as younger people with certain disabilities.
However, Medicare does not cover all health care costs, and you can apply for a Medicare supplement insurance policy or Medicare Advantage plan to receive fuller coverage.
More Details
Medicare is split into four parts: A, B, C, and D.
Part A helps pay for hospital expenses. There is no premium for Part A, but there are costs for you. Medicare supplement insurance policies and Medicare Advantage plans can help with these costs.
Part B helps pay for physician expenses. There is a premium, a deductible, and other costs for Part B. Medicare supplement insurance policies and Medicare Advantage plans can help with these costs.
Medicare Parts A and B are sometimes referred to as Traditional Medicare or Fee for Service Medicare. If you would like more coverage than Medicare Part A and Part B provide, you might be interested in a Medicare supplement insurance policy from an insurance company.
Part C is also known as Medicare Advantage. You can sign up for a Medicare Advantage plan through an insurance company. Medicare Advantage plans generally have low or no premium but do have copays and network restrictions. You must also continue to pay your Part B premium. You do not need both a Medicare Advantage and a Medicare supplement insurance plan. You only ever need one or the other.
Medicare Part D is the portion of Medicare that handles prescription drug coverage. You can sign up for a Part D plan through an insurance company. There will be a premium and some copays.
Q. What if I have a pre-existing condition?
Short Answer
If you have a pre-existing condition, it is particularly important to make sure that you apply at the right time when the window for enrollment in Medicare supplement insurance and Medicare Advantage is open. A pre-existing condition is defined as any condition for which the patient has already received medical advice or treatment prior to enrollment in a new medical insurance plan.
More Details
- When you first enroll in Medicare Part B, and the first day of the month you turn 65, it starts your initial six-month Open Enrollment period. During that time, no plan can deny you coverage.
- Once you’re out of your initial enrollment period, you could be denied coverage for a Medicare supplement insurance policy due to health reasons, so it is important to get into the right plan for you during your initial Open Enrollment period.
- You cannot be denied coverage for a Medicare Advantage plan during the Annual Enrollment Period from October 15 to December 7 each year, even if you have a pre-existing condition.
Q. Can my spouse/partner and I share a policy?
Short Answer
The short answer is no. Medicare coverage is individual coverage. That means that you and your spouse/partner each need to sign up for one plan per person. You cannot share a plan. Each of you must decide which Medicare option is best for you.
Q. How does this work with Social Security?
Short Answer
You do not need to be collecting Social Security to enroll in Medicare. If you are collecting Social Security when you turn 65, you will be enrolled in Medicare Part A automatically. However, you will still need to sign up for Part B, and this will start your initial six-month Open Enrollment period. Part B requires a monthly premium, and you can elect to have that premium deducted from your Social Security benefits if you choose.
More Details
Enrolling in Part B is an important decision. It kicks off your initial six-month Open Enrollment period beginning on the first day of the month you turn 65. During this time, no plan can deny you coverage, so it’s an important time to select the right plan for you.
Q. How is Medicare different from Medicaid?
Short Answer
While they sound alike, Medicare and Medicaid are different. Medicare is a health insurance program provided by the U.S. government for people ages 65 plus, as well as younger people with certain disabilities. Medicaid is a government health program designed specifically to help low-income people afford health care.
Q. What decisions do I need to make?
Short Answer
We hear you, and we understand this can all be confusing. You are not alone. Here’s a quick rundown of your decisions: You need to decide if you should sign up for Medicare Part B. Then, if you want additional coverage, you need to decide between Medicare supplement insurance and Medicare Advantage plans and choose an insurance company to purchase coverage through. Finally, you need to make sure you have drug coverage.
More Details
- When you first enroll in Medicare Part B, it starts your initial six-month Open Enrollment period. During that time, no plan can deny you coverage.
- Once you’re out of your initial enrollment period, you could be denied coverage for a Medicare supplement insurance policy due to health reasons, so it is important to get into the right plan for you during your initial Open Enrollment period.
- You cannot be denied coverage for a Medicare Advantage plan during the Annual Enrollment Period from October 15 to December 7 each year, even if you have a pre-existing condition.
Q. What if I’m still covered by an employer or spouse’s/partner’s employer plan?
Short Answer
You can continue to be covered through your own plan or through a spouse’s/partner’s plan if you still qualify. Make sure you check with the sponsor of your existing policy.
More Details
There are times when someone may be eligible for Medicare but continues to be on an employer plan:
- You might be retired and still on your former employer’s plan
- You or your spouse/partner might still be working and on an employer’s plan
Generally, in these cases, you will sign up for Medicare Part A, but not Medicare Part B. Signing up for Medicare Part B triggers your six-month Open Enrollment period beginning the first day of the month you turn 65. You want to save that until you are switching to a Medicare supplement insurance policy or Medicare Advantage plan.
How does this all fit together?
This makes sense now. Let’s see how all these pieces work together.
Q. What’s the difference between premiums, deductible, copays, and coinsurance?
Short Answer
Premiums are regular amounts you pay for coverage. Most people with Medicare supplement insurance policies pay monthly premiums. These premiums can go up over time.
A deductible is a dollar amount you need to pay out of pocket before your coverage begins paying.
Copays are dollar amounts you pay whenever you receive a certain procedure.
Coinsurance is a percentage of the total charge you pay whenever you receive a certain procedure.
How does this all fit together?
This makes sense now. Let’s see how all these pieces work together.
