Medicare Frequently Asked Questions

A: Anyone age 65 or older, those disabled for at least 24 months or who have been diagnosed with ALS or ESRD.

A: Most people do not pay for Part A as long as they worked and paid in enough or can draw off someone else’s record. Part B has a Standard Premium of $174.70 (2024). People who are considered high earners may pay an Income-Related Monthly Adjusted Amount (IRMAA).

A: You may be automatically enrolled in Original Medicare upon turning 65 if you are already drawing Social Security or Railroad Retirement Benefits. Additionally, you may auto-enrolled in Medicare when you have been drawing SSDI for 24 months.

A: You can sign up online at SSA.gov or by going to your local Social Security Office. Depending on when you are enrolling, you may have more than one form that needs to be submitted.

A: To avoid late enrollment penalties, it is always best to enroll in Part A, which is premium-free for most people. To avoid possibility of penalties, you will also want to join Part B if you are not continuing in a creditable group plan.

A: No. As long as you continue to pay your Part B premium, you will not lose coverage and do not ever need to reapply. The premium comes straight off the top of your Social Security or RRB check each month before it is deposited into your account. If you are not drawing benefits, you will have to pay it direct or by setting up payments online to come out of your checking account by EFT each month.

A: Assuming you have met the work-related eligibility requirements, you may begin enrollment into Medicare 90 days in advance of the month you turn 65. Turning 65 marks your initial enrollment period (IEP) into Medicare. This initial enrollment period lasts a full 7 months, starting three months before your birth month and ending three months after it. It is important to know enrolling in Medicare is not the same as enrolling in drug coverage or other Medicare health plan that helps with out-of-pocket costs.

A: If you missed your Initial Enrollment Period (IEP) and you do not qualify for a Special Enrollment Period, you will have to wait for the General Enrollment Period that runs from January 1-March 31. Your coverage will begin the following month. You may pay late enrollment penalties.

A: While you are not required to enroll in Medicare, you may incur late enrollment penalties by delaying. You will have limitations on when you can enroll which can leave you without any coverage in an emergency. You may not be able to enroll in your preferred plan.

A: Doing this is possible but there are pitfalls. You will begin accruing a late enrollment penalty for each month you do not have creditable drug coverage (Part D) beyond 63 days. Additionally, Parts A and B have several deductibles, copays and 20% coinsurance. Further, there is no maximum out-of-pocket. This means you have no financial safety net limiting your exposure.

A: In some cases, you may qualify for a special enrollment period. If you do not qualify for a special enrollment period, you will have to wait for the general enrollment period. You may, also, be subject to late enrollment penalties.

A: It depends. While many doctors do accept Medicare assignment, a few don’t. Furthermore, if you choose a Medicare Health Plan with a network of doctors, you need to confirm your doctor takes it.

A: You can update your address at www.ssa.gov, by calling Medicare at 1-800-772-1213, TTY users :1-800-325-0778, or you can visit your local Social Security office. RRB call 1-877-772-5772.

A: No.

A: No. Original Medicare, Medicare Supplements, Medicare Advantage, as well as Prescription Drug plans are always individual.

A: Original Medicare does not have a network but your doctor must accept Medicare Assignment. Medicare Advantage plans do have networks but PPOs provide coverage if you need to go out-of-network.

A: No and Yes. While Medicare does not change what medically necessary services are covered from year to year, premiums and deductibles do change. If you have a Medicare Advantage plan, premiums, copays, and extra benefits may change.

A: No. Original Medicare has numerous deductibles, copays, coinsurance and there is no cap on what you may pay each year – the sky is the limit. That is why there are medigap plans and Medicare Advantage plans that limit what you pay.

A: If your employer does not have at least 20 people, you may experience gaps in coverage if you do not enroll in Medicare. Additionally, you face possible late enrolment penalties.

A: You may be able to keep your employer coverage but need to understand how it will pay if your employer has less than 20 people so you do not find yourself underinsured. While there may be reasons to keep such coverage, quite often, it may benefit an eligible beneficiary to go ahead and begin Medicare with a medigap or medicare advantage plan along with creditable drug coverage.

A: If you work past the age of 65 and continue on a group plan, you will not be auto-enrolled. You will need to apply for coverage. Plan ahead for the big day so you do not experience gaps in coverage or late enrollment penalties.

A: COBRA is not considered creditable coverage so failing to enroll in Part B may result in late enrollment penalties. Since COBRA is not creditable, once it ends you will also have to wait for an enrollment window to open which could further increase your penalties, not to mention the gap in coverage during the time you are uninsured.

A: Yes. As quoted on www.va.gov “VA does not recommend Veterans cancel or decline coverage in Medicare.” Failing to enroll in Medicare when first eligible may cause you to incur late enrollment penalties and may miss out on additional coverage options and benefits.

A: Some people qualify for financial assistance in the form or Extra Help or Medicaid. You may apply for Extra help at Social Security. You may apply for Medicaid through your state. Additionally, if you have a trusted advisor, they can check your eligibility and assist you in applying.

A: Yes, if you qualify for both.

A: No. You need a stand-alone drug plan (Part D) or other creditable drug coverage for prescription medications.

A: Part D is a Medicare Prescription Drug Plan PDP). PDPs are creditable drug coverage.

A: Yes, you may change your Medicare Part D Plan during the Annual Enrollment Period, October 15-December 7.

A: Social Security cannot enroll you in a Medicare Supplement plan nor will be auto-enrolled in a Medicare Advantage plan. Social Security representatives are not trained to advise on Medicare Supplements or Medicare Advantage plans nor are they licensed to sell them. If you need assistance comparing plans and enrolling, seek a licensed, certified and trained agent for guidance.

A: No. Medicare Advantage plans are all in one plans and that often have creditable drug coverage built in. They often have no premium or a low premium. Medicare Supplements are gap plans. They pay after Original Medicare pays and you will need a stand-alone drug plan if you do not have other creditable drug coverage. Medicare Supplements have a monthly premium that increases year to year.

A: Yes, as long as you can pass underwriting. Once your open enrollment window for a Medicare Supplement ends, you must answer medical questions to enroll in a plan. Medicare supplements may charge you a higher premium due to your health or they may decline you altogether. In very limited circumstances, someone may have a guaranteed issue situation available, but this is rare. It is important you speak with someone who is licensed, certified and trained in Medicare products to understand your options.

A: While you may be able to switch from Medicare Advantage plan to Medicare Advantage during Annual Enrollment and Open Enrollment periods, you cannot switch to a Medicare Supplement without passing underwriting.

A: No, you can have one or the other but not both. In fact, agents are not allowed to sell a Medicare Supplement plan (medigap) to someone on a Medicare Advantage (MA) plan unless that person is dropping the MA plan. Furthermore, if you have an MA plan, you no longer have Original Medicare and the medigap plan will not pay. Lastly, if you decide to leave an MA plan for medigap, you will want to be sure and purchase a stand-alone drug plan to avoid penalties.

A: Part C plans are commonly called “Medicare Advantage” plans, “All-in-One” plans and sometimes “Medicare replacement” plans. Part C plans have a contract with Medicare to administer your Part A and Part B benefits.

A: Medicare Advantage HMO means you only have in-network access to providers. If you have a Medicare Advantage PPO, you have out-of-network access to providers but you may pay more for those services, depending on the plan.

A: If you move, you should update your address with Medicare. If you have Medicare Advantage or prescription drug plan, speak with a licensed agent to make sure your plan is available at your new address. Depending on where you relocate to, there may be other plan options available so be sure to speak with your licensed, trusted advisor for guidance.

A: Medicare does not pay for routine dental, dentures, or offer dental plans but some Medicare Advantage plans have these extra benefits built in.

A: Medicare does cover medically necessary eye services, including those for conditions such as glaucoma and cataracts. Medicare does not cover routine vision exams or eyeglasses. Some Medicare Advantage plans cover routine vision exams and eyeglasses as an extra benefit.

A: Medicare does not cover hearing aids, exams, or fittings. Some Medicare Advantage plans have these extra benefits built in. It should be noted, though, that seeking treatment for hearing loss from an Audiology Specialist who is experienced with cochlear implants may be able to diagnose Medicare covered conditions that the average hearing loss provider can miss.

A: It is a federal requirement that someone hold a valid health insurance license, in the State in which they plan to sell or advise on Medicare Supplements or other health insurance. Additionally, licensed agents must hold separate certifications to advise on Medicare Advantage Plans and Prescription Plans. Agents who are not “Certified” may only offer Medicare Supplements and may not advise on options. Being properly trained (and experienced) teaches an agent how to properly analyze the needs of a beneficiary to help them understand all available options, not just one.

Calling Medicare or your State Health Insurance Plan office will allow you to speak with someone who can tell you what Medicare sponsored plans are commercially available, but they are not licensed, certified or trained in determining how a given plan may meet your needs.

Additionally, if you call a State Health Insurance Plans (SHIP) representative, be aware that they are only volunteers. Since they do not have federally required or State licensure to sell. advise, or council, any information you choose to act on is your sole responsibility. If inaccurate or incomplete information is received, you have no recourse for any financial harm.