Frequently Asked Questions
When taking initiative enrolling into Medicare, you may be wondering… Where do I start? There are a few hoops you need to jump through, so here are the answers to some of the most commonly asked questions by those getting ready to enroll.
Medicare is a federal health insurance program primarily for those 65 and older. Original Medicare consists of two main parts, Part A and Part B. Part A covers hospital expenses, while Part B covers medical services and doctor visits. You can enroll in Original Medicare by visiting your local county Social Security Administration’s office, calling their toll-free number at 1-800-772-1213, or by visiting their website at www.ssa.gov.
Your Initial Enrollment Period is a seven-month window that includes the three months before your 65th birthday, your birth month, and the three months after. Enrolling before your 65th birthday helps avoid potential penalties and ensures coverage begins at the appropriate time.
When applying for Original Medicare with the Social Security Administration, be prepared to provide documents such as proof of age (Birth Certificate or Passport), proof of U.S. citizenship or lawful residency, and Social Security information.
You might also consider supplemental coverage beyond Original Medicare, such as Medicare Advantage Plans (Part C), Prescription Drug Plans (Part D), or Medicare Supplement Plans (Medigap), which can help cover costs NOT included in Parts A and B.
New to Medicare Scenarios
Ageing into Medicare can be confusing and overwhelming. There are many different scenarios you may be faced with, and choosing the wrong path may lead to unnecessary financial penalties. If you work with us, we’ll be sure that does not happen. Here are some of the most common scenarios you may find yourself in when transitioning into Medicare.
In this scenario, applying for Medicare is necessary. Supplemental and prescription drug coverage is recommended. These options will reduce potential out-of-pocket expenses.
If you’re receiving coverage from a Small Group Health Insurance Plan, Medicare is considered primary coverage and transitioning to Medicare is also recommended.
If you’re receiving coverage from a Large Group Health Insurance Plan, evaluating cost and satisfaction with your current plan may help decide whether transitioning to Medicare is optimal. A spouse receiving benefits from your plan is also a deciding factor.
If you’re not covered by a group plan, receiving Federal Employee Health Benefits (FEHB), or making Health Savings Account (HSA) contributions, enrolling into Medicare is also recommended.
Medicare 101
Original Medicare Part A and B don’t cover all your expenses, so typically people will enroll in additional coverage such as a Medicare Supplement Plan and a Prescription Drug Plan or a Medicare Advantage Plan. Supplementing Original Medicare involves personal considerations such as healthcare needs, preferred doctors or hospitals, budget, and desired coverage. Choosing between plans depends on individual circumstances. Here’s a breakdown of all the different Medicare Parts.
Medicare Part A primarily covers hospital stays, Skilled Nursing Facility care, hospice care, and some home health care services. Here’s a breakdown of how it works:
- Deductible: $1,736 (Applies to each benefit period of 60 days)
- Hospital Stays:
- Days 1-60: The deductible applies.
- Days 61-90: After the deductible, there’s a copayment of $434 per day.
- Days 91-150 (Lifetime Reserve Days): After the deductible, there’s a copayment of $868 per day for each of the 60 reserve days.
- After Day 150: The beneficiary is responsible for 100% of the cost.
- Skilled Nursing Facility Care:
- Days 1-20: Covered in full.
- Days 21-100: A copayment of $217 per day.
- After Day 100: The beneficiary is responsible for 100% of the cost.
Medicare Part B covers certain doctor services, outpatient care, medical supplies, and preventive services. Here’s an overview of its associated costs:
- Monthly Premium: $202.90 (May be higher based on your income. See IRMAA)
- Annual Deductible: $283
- Coinsurance: You pay 20% with no cap and Medicare pays 80%.
- Excess Charges: Some doctors may charge up to 15% more than Medicare’s approved amount for services.
- Medicare Advantage plans, offered by private insurance companies approved by Medicare, consolidate benefits from Parts A and B into a single plan.
- They are network-based plans like an HMO or PPO. If you go out of the network for non-emergency services, you may be subject to more out-of-pocket costs.
- These plans often include additional coverage like dental, vision, hearing, and prescription drugs, offering cost savings and extra benefits compared to Original Medicare alone.
- Medigap plans, sold by private insurance companies, help pay for the costs not covered by Original Medicare, including copayments, deductibles, and coinsurance costs.
- Various standardized plans labeled by letters (Plan F, Plan G, Plan N etc.) offer different levels of coverage, helping manage out-of-pocket expenses.
- Medicare Part D plans, provided by private insurers, cover prescription medications not typically included in Original Medicare. Maintaining creditable prescription drug coverage is crucial to avoid penalties for late enrollment.
Penalties
Medicare charges late enrollment penalties to individuals who sign up for specific parts of coverage after their initial enrollment period ends. These fees aim to motivate timely enrollment and maintain continuous health coverage. If you have qualifying creditable coverage, you might not face late enrollment penalties. If you’re not sure if you should delay enrolling into Medicare, contact us!
If you’re not eligible for premium-free Part A and you don’t enroll when first eligible, the penalty is 10% of the standard Part A premium. You’ll pay this penalty for twice the number of years you could have had Part A but didn’t.
The Part B late enrollment penalty is an additional 10% for each full 12-month period that you could have had Part B but didn’t. The penalty is added to your monthly Part B premium. This penalty continues for as long as you have Part B.
The Part D late enrollment penalty is calculated as 1% of the national base beneficiary premium for each full month that you were eligible for Part D but didn’t have creditable prescription drug coverage. This penalty is added to your Medicare Part D plan premium. The calculation may vary, but the overall penalty is based on the number of months you were without creditable prescription drug coverage.