Frequently Asked Questions about Medicare

woman doctor taking mans blood pressue

When do I sign up for Medicare for the first time?

If you are newly eligible for Medicare because you are turning 65 there is an initial enrollment period. The period starts three months before you turn 65 and goes through the three months after the month of your birthday. If you miss this initial enrollment period, you can sign up for Parts A & B during Open Enrollment which happens every year between January 1 and March 31.

There are some special circumstances for enrollment, too. If you have a question, just call us at toll free at (855) 825-1400. We have the answers and are happy to help.

For more detailed information, see this helpful guide from Medicare here.

Is there a tool to compare Plans?

Figuring out what is covered under Medicare can be very confusing. We’ve been helping seniors find affordable coverage for more than 15 years. We always recommend you start with a call to us toll free at (855) 825-1400.

Some general information about what is covered include:

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up, are 100% covered by all Medigap plans A-N.
  • Part B coinsurance or copayment is covered 100% by Medigap plans A-G & M-N.
  • Blood (first 3 pints) are 100% covered by Medigap plans A-G & M-N.
  • Part A hospice care coinsurance or copayment is 100% covered by Medigap plans A-G & M-N.
  • SNF care coinsurance is 100% covered by Medigap plans C-G & M-N.
  • Part A deductible is covered by Medigap plans B-G & N.
  • Part B deductible is covered by plans C & F.
  • Part B excess charges are 100% percent covered by Medigap plans F, G & K.
  • Foreign travel is covered by plans C-G & M-N.

To view a detailed chart comparing the Medigap plans and Benefits, visit the Medicare site here.

How do I know what Medicare will cover?

Medicare coverage varies depending on which Medicare part you utilize. Part A covers most inpatient hospital care which provides 60 lifetime reserve days of inpatient hospital coverage following a 90-day stay in the hospital. Lifetime reserve days can only be used once and once used they may not be renewed. Part A also covers certain Skilled Nursing Facility (SNF) care – covering 100% of the first 20 days of approved SNF care, and up to 100 days for each benefit period if Medicare’s requirements are met. Part A also covers up to 100 home health visits per period of illness following a hospital stay. Hospice care is also available for terminally ill patients. For more detailed information on hospice care coverage, see this Medicare Publication.
Part B of Medicare is optional, covering 80-100% of several services such as doctor’s services, laboratory tests, and outpatient speech therapy. Under Part C, Medicare pays Medicare Advantage (MA) plans to manage beneficiaries’ health care. Currently, 5 types of MA plans exist. You receive all Medicare-covered benefits through the private MA plan you choose. Some MA plans offer Medicare prescription drug coverage, while others do not. If you join an MA-only plan, you may or may not join a separate Medicare Part D plan depending on the type of MA plan you join. Part D provides drug coverage which is available to everyone who has Medicare. Private companies provide the insurance coverage while you choose the drug plan and pay a monthly premium. After assessment of limited income, you may qualify to receive extra help in prescription drug coverage at little or no cost.

How much does Medicare cost?

Medicare requires premiums, deductibles, and other out-of-pocket payments such as coinsurance or copayments for certain services. For a more detailed look at Medicare cost, see this guide from Medicare here.

Part A requires a monthly premium at different costs depending on quarters of Social Security credits. SNF coinsurance, and inpatient coinsurance and deductibles are set on per day costs following a certain amount of days under care.  Assistance programs exist to help cover majority of these costs, if not all them, for beneficiaries with limited income. Monthly premiums for Part B are dependent on annual income. Other costs vary depending on the services.

What are the ways to supplement my coverage?

“Original Medicare” consists of Part A and an optional Part B – though Part B is recommended. Other plans may be added to meet your health needs such as Medicare prescription drug plans (Part D) and medicare supplemental insurance (Medigap), which helps cover costs that aren’t covered by Parts A & B. Medigap offers several plans that pay for part or all of Medicare’s coinsurance and deductibles that are not covered by Original Medicare, and are offered by a monthly premium. 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 and then your Medigap policy pays its share. We can help you find the best policy to fill in the gaps in your coverage and meet your needs and budget.

What is happening to Medicare under Health Reform?

The Affordable Care Act will create changes but they are expected to improve benefits and access to primary care services. The most significant changes will effect Coverage Gap Savings, and Preventive Care. Most likely, Medicare Advantage Plans are expected to have higher monthly premiums, co-pays, deductibles and out of pocket expenses. There should be little, if any, change to those individuals on Original Medicare who choose a Supplement to Medicare (not Medicare Advantage).

For Coverage Gap Savings, a one-time Medicare rebate check of $250 will be received if your coverage gap is reached.  A 7% discount on generic drugs and a 50% discount on brand-named drugs may also be available, as well as additional savings each year up until 2020. All of these details are still being finalized. If you have questions, let us know.

Significant Preventive Care changes include Medicare coverage of the cost of an annual checkup which includes a physical examination, and also complete elimination of the cost sharing for screenings and preventive services.

Call us today Toll Free at (855) 825-1400. We will help you find the best Medicare Plan for you!