Frequently Asked Questions

Medicare is the federal health insurance program for:

• People who are 65 or older
• People under the age of 65 with certain disabilities
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant

Part A helps to cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Recipients must meet certain conditions to get these benefits. Medicare Part B Medical Insurance Part B helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Some people get Medicare Part A and Part B automatically, other people have to sign up for it. To sign up for Medicare Part A and/or Part B you can:

• Call Social Security at 1-800-772-1213
• Visit www.socialsecurity.gov to enroll online or find your local Social Security office.
• Medicare Part C (also known as medicare Advantage Plans)
• Medicare Advantage plans provide the same coverage as Medicare Parts A and B. Some plans offer additional coverage, like hearing, vision and dental care. Some plans may also include a bundled prescription drug (Part D) plan.
• Medigap (also known as Medicare Supplement)
• A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare.

“Medicare” and “Medicaid” are both government programs and both help people pay for health care, but that is where the similarities end. Medicare is generally for people who have paid their taxes throughout their working life, and who are 65 and older or disabled.
Medicaid is for people with limited income and resources (as per each state) with no age restrictions.

To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered. If you decide not to get Medicare drug coverage when you are first eligible, you are likely to pay a late enrollment penalty.

People are first eligible at age 65 and can enroll 3 months prior, during, and after their 65th birthday. Coverage can begin as early as the 1st of the month of your 65th birthday. If you are born on the 1st of the month, your coverage begins the month before your birthday.
If you delay enrolling when you are first eligible you may incur penalties. Some exceptions apply, so contact Lauren Altman, your licensed insurance agent to find out.

There are many different enrollment periods, so it is recommended to check with Medicare or a licensed agent to determine if and when you qualify for the various enrollment periods.

In most cases, yes! Check with Lauren Altman, your licensed insurance agent to find out more.

In most cases, yes! Check with Lauren Altman, your licensed insurance agent to find out more.

No, if you are still actively working. If you are not working, you must get Medicare or you will be subject to late enrollment penalties when you finally do apply. If your employment ends, you have a special election period to enroll when your group coverage terminates. Time limitations apply. COBRA is no exception for enrolling in Medicare when employment terminates.

You will be able to change your insurance plan to one in your new location when you move residences.

You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working for a certain amount of time. This is sometimes called premium-free Part A. If you aren’t eligible for premium-free Part A, you may be able to buy Part A. Contact your Social Security office for more details.

Deductibles, Copayments, and Coinsurance

Coinsurance is when you split the cost of a service or product. For example, you pay 20% of the Medicare-approved amount and Medicare pays 80%.

A copayment, or copay, is a fixed amount you pay each time you use a service or in 2019.

A premium is a fixed fee that you pay for your Medicare coverage. You can pay a premium to Medicare, to a private insurance company or to both, depending on the coverage you choose. Most premiums are charged monthly.

People who qualify for both Medicare and Medicaid are said to be “dual eligible.” If you qualify and enroll in both programs, then sometimes the two can work together to cover most of your health care costs.

The Federal Government governs Medicare while Medicaid is governed by State governments.