Medicare FAQ
What is Medicare?
Medicare is a health insurance program administered by the U.S. federal government that covers Americans aged 65 and over and well as those younger people who have certain disabilities, End-Stage Renal Disease, or ALS. So-called Original Medicare, which is the basic plan that most people think of as Medicare, includes hospital insurance through Medicare Part A and medical coverage through Medicare Part B, covering things like inpatient hospital care, doctors’ visits, medical tests, and general preventive services. Medicare recipients pay a monthly premium for Medicare coverage that varies based on their pre-retirement income and well as out-of-pocket for some services.
When do I sign up for Medicare?
When you sign up for Medicare depends on your age and when you start receiving your Social Security benefits. If you are under 65 and are already getting retirement or disability benefits from Social Security at least four months before you turn 65, you’ll automatically be enrolled in Original Medicare – including Medicare Part A and Medicare Part B when you turn 65. If you are waiting until you turn 65 to begin claiming your Social Security benefits, Your initial enrollment window will open three months prior to your 65th birthday, so you will want to contact your local Social Security Administration office or create your online Medicare application in ssa.gov at that time.
There are many variables that can determine the right time to sign up for Medicare. Have questions about your personal situation? Contact us for more information.
How do I sign up for Medicare?
If you are under 65 years old and already receiving retirement or disability benefits from Social Security you don’t have to do anything – you’ll automatically be enrolled in Medicare Parts A and B the month that you turn 65. If you are not yet receiving benefits you will need to contact Social Security three months before you turn 65 to start receiving Medicare. You can complete the enrollment application in person, over the phone, or by going to Medicare.gov.
What happens if I don’t sign up for Medicare?
If you choose not to or forget to sign up for Medicare Part B during your Initial Enrollment Period – which runs from three months before you turn 65 and ends 3 months after you turn 65 – you may be subject to a Late Enrollment Penalty. This is an extra fee that will be added to your monthly premium as long as you have Medicare coverage, and that increases the longer you wait to sign up. However, if you are still covered by another health plan, such as one through your employer, during your Initial Enrollment Period then these fees can be waived.
What does Medicare Part A cover?
Medicare Part A covers inpatient care, including hospital stays, critical access hospitals, and services provided by skilled nursing facilities, such as inpatient treatment and rehabilitation centers. In addition, Medicare Part A helps cover hospice care and some home health services, depending on the situation.
What does Medicare Part B cover?
Medicare Part B covers both medically necessary services like those provided by your doctor to diagnose or treat a medical condition, as well as preventative medicine to prevent illness or detect it at an early stage. Medicare Part B also covers ambulance transportation, medical equipment purchases, some prescription drugs administered in a medical setting, in-home oxygen equipment, mental health and substance abuse treatment, and more.
What does Medicare Part D cover?
Medicare Part D covers a wide range of commonly prescribed prescription drugs. Medicare plans are administered by many different carriers, who update their list of covered drugs and associated costs every year. Drugs can be covered on different “tiers”, with drugs on lower tiers generally costing less than drugs on higher tiers. As a Medicare recipient, your Medicare Part D premium and copay costs will depend on several factors, including which plan you choose, the drugs you take, which pharmacy you use, etc.
How do I know whether my prescriptions are covered?
Under Medicare, each plan’s list of covered drugs is known as its “formulary” and formularies differ between plans. Medicare also updates its list of covered drugs every year, and the current list of covered drugs under Part D is available at Medicare.gov.
If you are worried that your prescriptions won’t be covered under the plan you choose, contact us for a personalized assessment and plan review to be sure.
How does my income affect my cost for Medicare?
Your annual Medicare costs can vary significantly based on the coverage and services you choose, and what providers you visit. However, those with higher incomes before retirement will pay a higher premium for Medicare Part B and Part D, known as an “income-related monthly adjustment amount”, commonly referred to as an IRMAA. If you are a higher-income beneficiary, you will pay a larger percentage of the total cost of your Part B premiums based on your income. This amount will range between 35% to 85% above the standard amount. The same applies to Part D prescription drug coverage, with higher-income beneficiaries paying a larger monthly premium based on their income level.
Do I have to notify Medicare if my income changes?
Yes, you must notify Medicare if your income changes, as this can affect your IRMAA for Part B and Part D premiums. A decrease in income may qualify you for a lower premium or even extra help with paying for your Medicare premiums, if you qualify. To report the change, contact Social Security with your updated income documentation.
Is it necessary to have a supplemental medical insurance plan?
Typically retirees are choosing to add either a Medicare Advantage plan oor a Medicare Supplement plan to help them manage the services (and costs) not covered by Medicare Parts A & B. The choice of which route to go is based on your personal preference, your medical needs, and your budget. For example, you may prefer to pay predictable premiums, with lower out-of-pocket pocket costs, or you may want to pay lower premiums, but higher co-pays and out-of-pocket costs when you need healthcare services.
I’ve heard that Medicare Advantage is cutting many services and doctors are not accepting Medicare Advantage patients. Is this true?
Medicare Advantage plans have been known to narrow their provider networks, which can lead to fewer available doctors and specialists. Many plans require prior authorization for services, creating delays that some providers may find burdensome, leading them to not accept these patients. Additionally, lower reimbursement rates and the complexity of Medicare Advantage payments may deter doctors from participating.
While Medicare Advantage must cover everything Original Medicare does, some plans may reduce or limit extra benefits, and the specific impact can vary by plan and region.
Can you switch from Original Medicare to Medicare Advantage during the year?
Yes, you can switch in or out of Original Medicare to or from an Advantage plan each year; however, if you move from a Medicare Supplement to a Medicare Advantage plan and then later want to move back to a Medicare Supplement, you would have to be medically underwritten to move back to the Supplement. There are some exceptions to this, including when exercising your 12-month trial right.
I am a veteran. Do I still need Medicare?
Veterans of the U.S. military qualify for healthcare coverage either through the Department of Veterans Affairs (VA) or TRICARE when they leave active duty, and that coverage extends past age 65 when most people enroll in Medicare. As a result, veterans are not required to enroll in Medicare at age 65, though the VA recommends still signing up to ensure that you are covered for any services you receive in facilities that are outside the VA health system or TRICARE’s coverage. If you sign up for Medicare Part B after your Initial Enrollment Period (which would be necessary if you lose your VA benefits or need to receive medical treatment outside of the VA), you’ll pay the same Late Enrollment Penalties as those who do not sign up for Medicare when they turn 65.
What if I am still working? Do I still need to sign up for Medicare?
Well, that depends. If you or your spouse are still working when you both turn 65 and have health insurance through an employer that is comparable to Medicare you may be able to delay signing up without paying the Late Enrollment Penalty. As soon as you stop working or lose your health insurance you’ll have an 8-month Special Enrollment Period (SEP) during which you can sign up for Medicare without paying a penalty.Depending on your specific health plan, sometimes it is more cost effective to move to Medicare, even if you have access to employee health benefits.
There are many variables when it comes to delaying Medicare sign up due to existing coverage. We can help you make sense of what applies to your specific situation. Schedule a call today.
My doctor is in another state. How does this affect my Medicare Advantage plan choice?
Under Original Medicare, you can visit any doctor, anywhere in the U.S. who takes Medicare. This means that you could visit any doctor, regardless of their location or network. With Medicare Advantage plans, however, you may be required to only use doctors who are in the plan’s network and get a referral to see a specialist, or pay higher copays to see specialists who are out of their network. If you are considering a Medicare Advantage plan it is important to review the conditions before signing up to ensure that you can continue seeing your preferred doctors.
I am having trouble paying for my Medicare Part B premium. How can I get help?
Medicare offers a variety of programs to help beneficiaries with their coverage costs. If you qualify, a Medicare Savings Program run by your state could help pay your Part A and Part B premiums and might also pay any deductibles, coinsurance, and copayments. These savings programs are offered through your state, so you’ll need to contact your state’s Medicare office to determine if you qualify and submit an application.
What is an IRMAA, and why do I have one?
Medicare’s Income-Related Monthly Adjustment Amount (IRMAA) is the fee high-earning beneficiaries pay on top of their Medicare Part B and Part D premiums and you’ll have one if your annual income is above a certain level. Like the IRS’ tax brackets, the Social Security Administration determines your IRMAA based on which of four income brackets you are in. As of 2024, the minimum threshold for an IRMAA is a modified adjusted gross income of $103,000 for an individual or $206,000 for a couple filing jointly.
My spouse (or I) may need long-term care soon. What steps should I take now?
Like most health insurance plans, Medicare does not cover long-term care expenses. If you believe you will need this coverage in the future, you can purchase long-term care insurance from a private insurance company or see if you qualify for long-term care assistance through Medicaid. There are also ways to help protect your life savings from being eaten up by long term care costs, so having a conversation early with your trusted Medicare professional is very important. As with everything,the key is to plan ahead so that you have a plan in place for long-term care when and if you need it.
Find Your Plan
Comparing plans can be overwhelming! It can be very helpful to work directly with an agent in Michigan who is licensed, and educated in the Medicare market and can help you choose the plan that is right for you.
Your partners at Silvur Insurance are here to help and can meet with you one-on-one in your local MSU Credit Union Branch, over the phone, or even virtually - all, at no cost to you! To schedule a meeting with one of our agents, click HERE or call (888) 372-3999.
Sources:
https://www.medicare.gov/basics/get-started-with-medicare
https://www.medicare.gov/providers-services/original-medicare
https://www.medicare.gov/providers-services/original-medicare/part-a
https://www.medicare.gov/providers-services/original-medicare/part-b
https://www.medicare.gov/basics/get-started-with-medicare/before-65
https://www.medicare.gov/basics/get-started-with-medicare/after-65
https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties
https://www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans-cover
https://www.ssa.gov/benefits/medicare/medicare-premiums.html
https://www.va.gov/health-care/about-va-health-benefits/va-health-care-and-other-insurance/
https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65
https://www.medicare.gov/publications/12026-Understanding-Medicare-Advantage-Plans.pdf
https://www.medicare.gov/basics/costs/help/medicare-savings-programs
https://www.nerdwallet.com/article/insurance/medicare/what-is-the-medicare-irmaa
https://www.medicare.gov/coverage/long-term-care
