Basic Medicare
What is Medicare?
Medicare is a federal health insurance program primarily designed for individuals aged 65 and older, as well as certain younger individuals with disabilities.
Who is eligible for Medicare?
Individuals who are U.S. citizens or legal residents and have worked and paid Medicare taxes for a certain period are eligible for Medicare.
When can I enroll in Medicare?
You can enroll in Medicare during your Initial Enrollment Period (IEP), which begins three months before your 65th birthday and ends three months after.
What are the different parts of Medicare?
Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).
How does Medicare differ from Medicaid?
Medicare is a federal health insurance program primarily for seniors and certain disabled individuals, while Medicaid is a state and federally funded program serving low-income individuals of all ages.
Medicare Part A and Part B
What does Medicare Part A cover?
Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and limited home healthcare services.
What does Medicare Part B cover?
Part B covers outpatient services, doctor visits, preventive care, and durable medical equipment, among other services.
Do I need to pay premiums for Medicare Part A and Part B?
Most people receive Part A premium-free if they or their spouse worked and paid Medicare taxes for at least 10 years. Part B requires a monthly premium.
What is the Medicare Part B late enrollment penalty?
If you don’t enroll in Part B when you’re first eligible, you may have to pay a higher premium when you do enroll.
Can I get Part A or Part B if I’m still working and have employer coverage?
Yes, you can delay enrolling in Part A or Part B if you have employer-sponsored coverage and meet certain criteria.
Medicare Part C (Medicare Advantage)
What is Medicare Part C (Medicare Advantage)?
Medicare Advantage plans are offered by private insurance companies approved by Medicare. They provide all the benefits of Original Medicare and may include additional coverage like dental, vision, and hearing.
What benefits does Medicare Advantage offer?
Medicare Advantage plans often include Part A, Part B, and Part D benefits along with extra services such as dental, vision, hearing, and wellness programs.
Can I have both Original Medicare and Medicare Advantage?
No, you cannot have both. You must choose between Original Medicare (Parts A and B) or a Medicare Advantage plan (Part C).
How do I choose the right Medicare Advantage plan for me?
Consider factors like your health needs, preferred doctors and hospitals, prescription drug coverage, and whether you need additional benefits.
What are HMO and PPO plans in Medicare Advantage?
HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) are types of Medicare Advantage plans that offer different levels of network flexibility.
Medicare Part D (Prescription Drug Coverage)
What is Medicare Part D?
Medicare Part D is prescription drug coverage offered by private insurance companies. It helps cover the cost of prescription medications.
What prescription drugs does Part D cover?
Each Part D plan has its own formulary, which is a list of covered prescription drugs. Different plans cover different medications.
When should I enroll in a Part D plan?
It’s best to enroll in a Part D plan when you’re first eligible for Medicare to avoid potential late enrollment penalties.
What’s the “donut hole” in Part D coverage?
The “donut hole” is a coverage gap where you pay more for your prescription drugs until you reach catastrophic coverage.
Can I have Part D coverage with Medicare Advantage or Medigap plans?
Yes, Part D coverage with a Medicare Advantage plan is often included in the plan, but you cannot have a stand alone Part D plan and a Medicare Advantage plan. Part D coverage is not included
Medicare Penalties
What is the Part D Late Enrollment Penalty?
If you don’t enroll in a Medicare Part D prescription drug plan when you’re first eligible and you go without creditable prescription drug coverage (coverage that’s at least as good as Medicare’s), you may face a late enrollment penalty when you do sign up. This penalty is added to your monthly Part D premium and increases the longer you’re without coverage.
How is the Part D Late Enrollment Penalty Calculated?
The penalty is calculated by multiplying 1% of the national base beneficiary premium by the number of full, uncovered months you were eligible but didn’t enroll. This penalty can be applied for as long as you have Part D coverage.
What is the Part B Late Enrollment Penalty?
The Part B Late Enrollment Penalty can occur if you don’t sign up for Medicare Part B when you’re first eligible, and you don’t have other credible health coverage. The penalty increases your Part B premium by 10% for each full 12-month period you could have had Part B but didn’t enroll.
Can the Part B Penalty be Permanent?
Yes, the Part B penalty can be permanent. It remains as long as you have Part B coverage. Additionally, if you’re subject to the Part B penalty, you may also face a late enrollment penalty for Part A if you’re not eligible for premium-free Part A and you don’t sign up when first eligible.
How Can I Avoid Medicare Penalties?
The best way to avoid Medicare penalties is to enroll when you’re first eligible. This typically means enrolling during your Initial Enrollment Period (IEP) around your 65th birthday. If you have creditable coverage from another source, such as an employer plan, you may be able to delay enrollment without penalties.