Medicare Questions & Answers

Q1:  How can I get Medicare?

A1:  You are eligible for Medicare if you:

  • Are 65 or older and you (or your spouse) have paid Medicare tax for at least ten years
  • Have been receiving Social Security Disability payments for 24 months or more
  • Have End Stage Renal Disease

 

Q2:  Do I have to apply for Medicare by myself?

A2:  Most people are eligible to receive Medicare Part A benefits at no premium if they have paid Medicare taxes by working long enough.  Even if you are not ready to retire, you should enroll in Medicare Part A three months before the month of your 65th birthday.

 

Q3:  How do I apply for Medicare?

A3:  If you are already receiving Social Security benefits before you turn 65, you will automatically be enrolled in Medicare.  Otherwise, to sign up for Medicare:

  • Apply online at http://www.SocialSecurity.gov
  • Visit your local Social Security office
  • Call Social Security (1-800-772-1213)
  • If you worked for a railroad, call the RRB at 1-877-772-5772
  • Complete an Application for Enrollment in Part B (CMS-40B)

 

Q4:  Is Medicare mandatory?

A4:  If you have credible health insurance coverage from a private health insurance carrier, you may be able to opt out of parts of Medicare.  However, you should sign up for Medicare Part A 3 months prior to the month of your 65th birthday, since most people can get Medicare Part A premium free.  Individuals who are already receiving Social Security benefits before they turn 65 will be automatically enrolled in Medicare.

 

Q5:  Can I get Medicare if I did not work?

A5:  Depending on your work history and citizenship status, you can get full Medicare benefits at age 65 by:

  • Paying part of or the full amount of the Part A premium

 

Q6:  What is Medicare?

A6:  This is a long one.

To make this question easier to understand, you can take a look at some of these Medicare Made Clear Videos.  This video series defines Medicare in an easy-to-understand manner.

Original Medicare is comprised of Medicare Parts A and B.  Medicare Part A provides you with inpatient hospital care, skilled nursing and hospice care.  You are eligible for premium-free Part A if you are over 65 and you or your spouse have worked and paid Medicare taxes for at least ten years.  You can get Part A at age 65 without paying premiums if you are receiving retirement benefits from Social Security or the Railroad Retirement Board.  You should sign up for Part A three (3) months BEFORE the month of your 65th birthday.  The Part A deductible for 2018 is $1,340 per sixty day period admitted in the hospital.

Medicare Part B covers doctor services, outpatient procedures, and durable medical equipment.  The Medicare Part B premium for 2018 is $134 per month (for most people), and there is a $183 deductible.  Once you have met your Part B deductible, you are responsible for paying 20% of the Medicare-approved amount for your Part B services.  Part B is not mandatory, but if you do not sign up for Part B when you become eligible for Medicare and do not have other credible coverage (such as you keep working), you may be penalized with a fine if you decide to get Part B in the future.

Medicare Part D or Prescription Drug Coverage is available to those enrolled in Original Medicare and assist in lowering your drug costs.  Drug plan premiums are plan-specific and can change every year.  It is important to select a drug plan that covers all of the drugs in your formulary.  If you do not sign up for a Part D when you become eligible for Medicare and do not have other credible coverage, you may be penalized with a fine if you decide to get Part D in the future.

As you can see, the amount you pay for Part A, B and D services can cost you a lot of money, fast.  You have two options to help you get more coverage than what Original Medicare offers:

  • Get a Medicare Supplement Plan (Medigap Policy)
  • Get a Medicare Advantage Plan (Medicare Part C)

A Medicare Supplement Policy is additional insurance mandated by the government that can fill the gaps (Medigap policy) in coverage between Original Medicare and your Part D (Prescription Drug Coverage).  There are many Supplement Plans available, each offering different levels of coverage (see our Medicare Options page to learn more).

A Medicare Advantage Plan (Part C) is insurance offered through private insurance companies that takes the benefits of your Original Medicare (Parts A and B) and your Prescription Drug Plan (Part D) and combines them in one plan offering fewer out of pocket costs for you.  Medicare Advantage Plans have been referred to as “pay-as-you-go” plans because you only pay for services when you utilize them.  An Advantage Plan may also offer additional benefits such as dental, vision and hearing allowances.

 

 

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