MEDICARE FAQ

When do I qualify for Medicare?

Most people qualify for Medicare at the age of 65. Some people will qualify earlier than the age of 65 because they are approved for Social Security disability income. These people will automatically be enrolled in Medicare after receiving Social Security disability benefits for 24 consecutive months (2 years). While eligible for Medicare, other people may defer registering for any part of Medicare, because they continue to work for a large employer, a company with more than 20 employees, and receive their health insurance through their job. 

 

Do I need Medicare at 65 if I’m still working?

...It depends. 

 

If you work for a company that offers health insurance but has less than 20 employees, the answer is yes, you are required to enroll in Medicare’s Part A and Part B. 

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No matter how large the company, if the company’s group health insurance drug coverage is not considered creditable (Medicare‘s definition of creditable), then you are required to pick up Medicare Part A and enroll in a Medicare Part D Prescription Drug Plan to avoid lifelong penalties later. 

 

However, if your employer has more than 20 employees and the drug coverage at work is considered creditable, then you would not be required to register or enroll in any single part of Medicare. But you may want to compare your options with Medicare coverage versus your group health insurance plan. You may be able to pay less money a month and have better coverage under a Medicare plan. 

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What are the four parts of Medicare (A, B, C, and D)?

Part A is technically called Hospital Insurance, and it is commonly referred to as the hospitalization portion of Medicare coverage. However, it covers much more than just hospitalization. It covers other items such as inpatient rehab, hospice, and some in-home care. 

 

Part B is called Medical Insurance and typically refers to most coverages for outpatient medical needs. 

 

Part C is a Medicare program called Medicare Advantage. The Medicare Advantage program is health insurance offered by private insurance companies to take over your Medicare benefits. Please do not get confused, because Medicare Advantage Plans are often confused with Medicare Supplement Plans. 

 

Part D is the portion of Medicare that sets the rules for drug coverage. You can only buy Medicare Prescription Drug Plan coverage (Part D) through private insurance companies. However, those private insurance companies have to follow the rules set by Medicare’s Part D guidelines. 

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Is Medicare Part D optional?

Medicare‘s prescription drug coverage, known as Medicare Part D, is technically optional. However, if you do not purchase a prescription drug plan/Part D plan and later choose to enroll in one you will be assessed a monthly premium increase penalty, known as the Part D Late Enrollment Penalty (LEP), for the rest of your life. 

 

Additionally, if you do not enroll in a Part D drug plan when you are initially eligible, then you can only enroll in a drug plan later from October 15th thru December 7th during the period called the Annual Enrollment Period (AEP). And even though you sign up during this period (Annual Enrollment Period), your new drug plan would start on January 1st of the coming year. 

 

What is Medicare Supplement Insurance (Medigap)?

A Medicare Supplement Insurance Plan is also known as a Medigap Plan. These plans work only with Original Medicare as your primary insurance and supplement/fill in the gaps left over from your Original Medicare primary insurance coverage. This type of coverage is offered by private insurance companies like Anthem, Humana, or United Healthcare (AARP) and is distinguished by the word plan followed by a letter, such as a Medicare Supplement Plan F, Medicare Supplement Plan G, or Medicare Supplement Plan N. 

 

Medicare Supplement Plans are government standardized, which means, by the letter. One company’s plan has exactly the same coverage as the other company’s plan. So while Humana or Anthem will charge different monthly premium payment amounts, they both offer a Medicare Supplement Plan F and their Plan F coverages are identical. 

 

Who is eligible for Medicare Supplement Insurance plans?

While everyone old enough and on Medicare is eligible for a Medicare Supplement Plan, you have to be aware that there are certain timeframes to be able to purchase a Medicare Supplement Plan. If you purchase outside those timeframes and have pre-existing health conditions, you might not be allowed to buy these plans. 

 

When can I apply for a Medicare Supplement Insurance Plan?

You would first need to have both parts of Medicare Part A and Part B. Then technically you can apply for a Medicare Supplement Plan anytime throughout the year. But be careful because there are only certain periods in your lifetime that pre-existing conditions are not considered. After these periods, you have to go through underwriting and can be denied a Medicare Supplement Plan due to your current health conditions. The best time to buy a Medicare Supplement Plan is within six months following your 65th birthday for six months following the date your Medicare part B starts. 

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Am I required to have a Medicare Supplement Plan?

A Medicare Supplement Plan is not required, but it is a really good idea to get one. Because Medicare will pay 80% of your medical bills, there is a limit on the leftover 20% that you are responsible for. As an example, if you were in an accident, had heart surgery, or needed to have chemotherapy due to cancer and the medical bills totaled $500,000, you would be responsible for paying 20% of $500,000. That means you are responsible for $100,000. By buying a Medicare Supplement Plan, you have the supplement pick up this 20%/$500,000. 

 

What is the difference between Medigap and Medicare Advantage?

Medicare Supplement Plans (Medigap Plans) are completely opposite of Medicare Advantage Plans (Part C Plans). 

 

Will I need to switch doctors if I enroll in a Medicare Supplement Plan? 

The large majority of the time you will be able to continue to go to any doctor that you were currently using after purchasing a Medicare supplement plan. The only requirement would be “as long as the doctor is willing to bill Medicare on your behalf," and they will take your Medicare Supplements Plan (regardless of the Medicare Supplement Plan insurance company you choose) as well. 

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Can I also enroll in a Medicare Supplement Plan if I already have a Medicare Advantage plan? 

No, you cannot use a Medicare Supplement Plan if you are currently on a Medicare Advantage plan. And it is illegal for an agent to sell you a Medicare Supplement Plan while on a Medicare Advantage plan. 

 

How do I get prescription drugs covered under Medicare?

You can get Medicare prescription drug coverage (Part D) in one of three ways. First, it's included inside of a Medicare Advantage plan. Secondly, you get it as a standalone independent prescription drug plan to accompany your Medicare Advantage plan that does not come with drug coverage included. Lastly, you get it as a standalone Prescription Drug Plan with your Medicare Supplement Plan.