WHAT YOU MAY NOT KNOW ABOUT MEDICARE

 
 

Q:    How do I qualify for Medicare?


A:    Medicare is for all people, regardless of income, who are age 65 or older.
If you’re under 65 and disabled, you’ll automatically get Part A and Part B after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. 
If you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease), you’ll get Part A and Part B automatically the month your Social Security disability benefits begin.

Q:    I turn 65 this year.  How do I sign up for Medicare?


A:    If you are receiving Social Security benefit payments, you will be automatically enrolled into both Parts A and B of Medicare, and the Medicare Part B premium will be deducted from your Social Security benefit check.  If your birthday falls on the 2nd to 31st of the month, then your Medicare is effective on the 1st day of the month you turn 65, but if your birthday falls on the 1st, then your Medicare is effective the 1st day of the prior month. (Example, if your birthday is July 1st, then your Medicare Parts A&B will be effective on June 1st.  You should receive your Red White and Blue Medicare card in the mail approximately 3 months prior to the date your Medicare coverage is effective.


If you are not receiving Social Security benefit payments, then you must enroll yourself into Parts A and B of Medicare.  If you have internet access, this can easily be done by going to the Social Security Administration website and done very quickly online.  When signing up on the Social Security website, you will be given the option to pay the Medicare Part B premium quarterly by check, or have the premiums automatically deducted from a bank account.  Once you begin to draw Social Security benefits payments, the Part B premium can be deducted from your Social Security payments. The earliest you can sign up for Medicare is 90 days prior to the 1st day of the month you turn 65, and then 4 months  We have included the link to the Social Security website here.
https://www.ssa.gov/medicare/


For more detailed information, see pages 23-25 of the 2016 Medicare and You Publication which is available for download on our resources page.

Q:    I am planning to work beyond my 65th birthday and stay on my employer’s health insurance coverage.  Will this affect my Medicare eligibility?


A:    Working beyond age 65 doesn’t alter your eligibility for Medicare, but it does raise some questions that you should pay attention to.  For example, it may be to your benefit to not enroll in Medicare Parts A or B.  Talk to your benefits person at your employer.  Once your health insurance coverage from your or your spouse’s active employment ends, you will have a special period to sign up for Parts A&B, without a penalty, and more importantly, you won’t have to pay the Medicare Part B premium while you have employer group insurance coverage due to your or your spouse’s active employment.  
See pages 26-31 of the 2016 Medicare and You Publication which is available for download on our resources page for more detailed information on this subject.

Q:    What do I pay when I have Medicare?


A:    Medicare premiums, deductibles and co-pays/co-insurance are set by CMS, the US Government agency that manages the Medicare program, and normally change every calendar year.  Generally speaking most people who worked for 40 quarters (10 years) do not pay premiums for Part A of Medicare, but do pay a premium for Part B of Medicare.  The 2016 standard premium for Part B is $121.80 each month, but it can be higher for Medicare beneficiaries with higher incomes.  


See the current 2016 Medicare premiums, deductible and co-pays in a file we have available for download on our resources page.

Q:    What is the difference between Medicare and Medicaid?


A:    Medicare is for people age 65 or older or some people with certain disabilities, regardless of income.  Medicaid is generally for people of any age, but is based more upon low income.  A person can have both Medicare and Medicaid.  These people are commonly referred to as “Dual Eligibles”.

Q:    Does Medicare cover Dental and Vision services?


A:    No, most Dental and Routine vision care is not covered by Medicare.  Medicare will cover eye exams related to a disease or condition of the eye such as cataracts, glaucoma, macular degeneration, etc..  


See page 71 of the 2016 Medicare and You Publication which is available for download on our resources page for more detailed information on services Medicare does not cover.

Q:    What’s the difference between Medicare Supplement Insurance and Medicare Advantage Plans?


A:    A lot.  Medicare Supplements do exactly that, they supplement the coverage of Original Medicare by helping to pay all or most of the deductibles, co-pays or co-insurance Medicare doesn’t pay.  Generally speaking, Medicare Supplements are not tied to a Dr or Hospital network and allow you to see any healthcare provider who accepts payment from Medicare.  Medicare Supplements do not include coverage for prescriptions, so if you want prescription coverage, you would need to enroll in a separate stand alone Part D drug plan. 

A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies that Medicare approves. If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. You’ll generally get your services from a plan’s network of providers. Remember, in most cases, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.


See page 17 of the 2016 Medicare and You Publication which is available for download on our resources page for an overview of your Medicare choices.

Q:    Are all Medicare Supplements the same?


A:    Yes.  Back in 1992, Congress “standardized” Medicare Supplements and labeled them Plans A thru J.  Over the years, Congress has changed the plans a little here and there, and we now have Plans A – N.  The most commonly sold is Plan F Medicare Supplement which pays all the deductibles, co-insurance and co-pays of Original Medicare.  So if you are comparing a Plan F supplement from 2 or more insurance companies, the benefits you receive will be exactly the same.  Standardized supplements make it easier for a person with Medicare to compare based upon price.


See page 100 of the 2016 Medicare and You Publication which is available for download on our resources page for an overview of the benefits of Standardized Medicare Supplements.  You may also wish to download the “2016 Choosing a Medigap Policy” publication which is also available on our resources page for more detailed information about Medicare Supplement or Medigap plans.
 

 
 
 
 
 
 
 
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