Question 1

What is Medicare?

Accepted Answer

Medicare is a federal health insurance program primarily for people aged 65 and older, though it also covers some younger individuals with certain disabilities or medical conditions, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Question 2

What are the different parts of Medicare?

Accepted Answer

• Part A: Covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.

• Part B: Covers outpatient services like doctor visits, preventive services, and durable medical equipment.

• Part C (Medicare Advantage): An alternative to Original Medicare that combines Part A and Part B, often with added benefits such as vision, hearing, and dental coverage.

• Part D: Covers prescription drug costs.

Question 3

When can I enroll in Medicare?

Accepted Answer

• Initial Enrollment Period: Starts three months before you turn 65, includes your birthday month, and ends three months after your 65th birthday.
 • Special Enrollment Periods: Occur after certain life events, such as losing employer coverage.
 • General Enrollment Period: Runs annually from January 1 to March 31 for those who missed their initial or special enrollment periods.

Question 4

Do I need to sign up for Medicare if I’m still working at 65?

Accepted Answer

If you have employer-sponsored coverage, you may be able to delay Part B without penalty. However, it’s important to confirm whether your employer plan qualifies as creditable coverage for both Part B and Part D.

Question 5

What is the Medicare Part B premium?

Accepted Answer

The standard Part B premium is determined annually by the government and may vary based on income. Higher-income beneficiaries may pay more, while some individuals may qualify for assistance programs that reduce or cover their premiums.

Question 6

What is the difference between Original Medicare and Medicare Advantage?

Accepted Answer

• Original Medicare (Part A and Part B): Offers coverage directly through the federal government, with the option to add a Part D prescription drug plan and/or a Medigap policy for additional coverage.
 • Medicare Advantage (Part C): Offered by private insurers, these plans combine Part A and Part B and often include additional benefits like vision, dental, and prescription drug coverage

Question 7

How does Medicare work with other insurance?

Accepted Answer

Medicare coordinates with other types of coverage, such as employer plans, retiree coverage, and Medicaid. The rules for which payer is primary and which is secondary depend on the circumstances, such as your age, employment status, and the size of your employer.

Question 8

What is Medigap, and how is it different from Medicare Advantage?

Accepted Answer

Medigap (Medicare Supplement Insurance) is a policy you can buy to cover out-of-pocket costs not covered by Original Medicare, like copayments and deductibles. Medicare Advantage, on the other hand, is a way to receive Medicare benefits through a private plan that may include additional services.

Question 9

What services are not covered by Medicare?

Accepted Answer

• Long-term care (such as custodial care in a nursing home)
 • Most dental, vision, and hearing services
 • Cosmetic procedures
 • Routine foot care
Beneficiaries may need to purchase separate coverage or pay out-of-pocket for these services.

Question 10

What is the late enrollment penalty for Medicare?

Accepted Answer

If you don’t sign up for Medicare Part B or Part D when first eligible and don’t have creditable coverage, you may face a late enrollment penalty. For Part B, the penalty increases your premium by 10% for each 12-month period you could have had coverage but didn’t. For Part D, the penalty is 1% of the national base beneficiary premium for each month you delayed coverage.

Question 11

Can I switch from one Medicare Advantage plan to another?

Accepted Answer

Yes, you can switch Medicare Advantage plans during the Medicare Open Enrollment Period (October 15 – December 7) each year. There is also a Medicare Advantage Open Enrollment Period (January 1 – March 31) that allows you to switch from one Medicare Advantage plan to another or return to Original Medicare.

Question 12

What happens if I travel outside the United States?

Accepted Answer

Medicare typically does not cover healthcare services outside the U.S., except in very limited circumstances (such as an emergency near the border or on a cruise within U.S. territorial waters). For coverage abroad, you may need to purchase travel insurance or a Medigap plan with foreign travel benefits.

Question 13

What’s the difference between Medicare Part D and a Medicare Advantage plan with drug coverage?

Accepted Answer

Medicare Part D is a standalone prescription drug plan that works with Original Medicare. Some Medicare Advantage plans also include Part D drug coverage, bundling all your health and prescription benefits into a single plan offered by a private insurer.

Question 14

What is the income-related monthly adjustment amount (IRMAA)?

Accepted Answer

IRMAA is an additional charge added to Part B and Part D premiums for higher-income beneficiaries. The amount is based on your modified adjusted gross income from two years prior. Social Security will notify you if you owe an IRMAA.

Question 15

How can I get help paying for Medicare costs?

Accepted Answer

There are several assistance programs available, including:
 • Medicaid: For low-income individuals, Medicaid may cover some or all Medicare costs.
 • Medicare Savings Programs: These can help with premiums, deductibles, and coinsurance for qualified individuals.
 • Extra Help (Low-Income Subsidy): This program helps with Part D prescription drug costs.
 Contact your state’s Medicaid office or the Social Security Administration for eligibility and application details.

Question 16

What if I live in 2 states?

Accepted Answer

For Medicare Parts A and B, you can get care in any state from any doctor that accepts Medicare. If you have an Advantage plan, you will be restricted to "networks" and will need to find a plan where your doctors are in-network in each location. Working with an agent to strategize this can help reduce high out-of-pocket expenses.

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