Frequently Asked Questions
Do You Have Questions Regarding Medicare?
We receive questions every day from our clients, and have compiled a list of those we are asked most frequently.
If you don’t find your question or answer here, give us a call and we’ll answer your question personally.
There are a few ways to enroll into Medicare when eligible.
- If you are receiving retirement benefits from Railroad Retirement Board or Social Security, you will be automatically enrolled In Parts A and B when you turn 65.
- If you are receiving disability benefits and under the age of 65, you will be automatically enrolled after 24 months of receiving disability benefits. One exception is if you have End Stage Renal Disease, you can apply for Medicare if you had a kidney transplant or are receiving regular dialysis treatments. Lastly, if you have ALS, you are automatically enrolled in the same month your disability benefits begin.
- If you aren’t receiving retirement benefits prior to or on your 65th birthday, you must sign up during your Initial Enrollment Period (IEP) through ssa.gov, in person at a local Social Security office, or through the mail.
Note: If you are working past 65 with creditable health coverage, you can elect to delay your enrollment into Medicare under a Special Enrollment Period. Make sure your coverage is creditable and your employer group is over 20 employees.
- Medicare General Enrollment Period is from January 1st – March 31st of each year. This is for those individuals that did not enroll in Parts A and B during their IEP but are eligible to enroll in Medicare. However, these individuals do face the risk of a penalty for not enrolling when first eligible under their IEP. Beneficiaries approved during this period would begin coverage July of the year they applied.
- Enrollment into Medicare Part D prescription drug coverage, does not occur automatically and is considered optional. However, if you do not enroll when first eligible, you would face a penalty for missing your Initial Enrollment Period. These plans are available through private insurers and provide benefits under this program to Medicare eligible beneficiaries. To enroll, you must live in the service area of the plan and have Medicare Part A and/or Part B. You can find information on Part D on the Medicare website or contact a local Medicare Insurance professional for guidance.
Initial Enrollment period, or commonly referred to as IEP, refers to the initial opportunity an individual has to enroll into Medicare.
IEP begins 3 months prior to your 65th birth month, includes your birth month and extends 3 months after your birth month. For example, if you are born in June, your IEP starts on March 1st and extends through September 30th. Should you be interested in Medicare Advantage as opposed to Original Medicare, your enrollment period, referred to as Initial Coverage Election Period (ICEP), provides the same enrollment period. Part D plan initial enrollment at 65, referred to as IEP, would be the same 7-month period starting 3 months before your birth month and extending through 3 months after your birth month.
No. You should enroll in the Medicare plans that meet your individual medical and financial needs. Because everyone is unique, your combination of plans could differ from your spouse.
Note: Some Medicare Supplement plans offer household discounts if two members of a household enroll with the same company.
You should research the options in your area and find the plan that provides you the lowest out-of-pocket expenses. To calculate your total out-of-pocket expenses for Part D, you need to include both the premium and any copays or coinsurance you would be responsible for. The mediare.gov website provides a comparison tool to calculate these amounts. Pay close attention to the formulary and tier of each plan to see where your medications are listed. If non-formulary, understand that plan will provide no benefits towards the costs of those drugs. It is very important to research and select the right plan for you. You do not have to purchase the same plan as your spouse.
Medicare Supplement plans have standardized benefits associated with each letter. So, plans lettered F have the same benefits with each different carrier, as would plans lettered G and N. With no difference in benefits of a chosen letter, price , length in the market and rate stability are the differentiating factors.
Under Original Medicare, you do not have coverage for vision or dental. You would need to purchase a dental or vision plan outside of Medicare to receive benefits for these services.
Medicare Advantage plans often times provide basic coverage for vision, dental and hearing. They also offer gym memberships, nurse lines and other benefits. Check your local Medicare Advantage plans for more information on what extra benefits are offered.
If you elect to make no changes in your coverages, your plans will automatically renew each year. However, should you elect to make changes, you can do so during the Annual Enrollment Period from October 15th – December 7th of every year.
Medicare Part B is optional. However, failure to enroll when first eligible can place penalties on your future premiums. Therefore, it might feel optional, but also mandatory due to the penalties one might incur for failure to comply with Medicare’s enrollment periods should you choose to enroll at a late date. By not enrolling, you are declining coverage for physician services, preventative care, ambulance services, diagnostics and durable medical equipment. The penalty to not enroll during your initial election period will be an increase of 10% for every 12 months you could have had the coverage.
Note: Carefully review your eligibility and benefits as well as employer coverage before enrolling or delaying Part B enrollment.
In order to enroll in a Medicare Supplement policy at any time, you must be enrolled in Part B. The best time to enroll in a Medicare Supplement Policy is during the Medigap Open Enrollment Period, which is the 6-month window that includes your birth month and the 5 ensuing months. For example, if your birthday is in April, you are eligible from April 1st through September 30th. It is important to enroll during your Open Enrollment Period to avoid all medical questions and underwriting.
If you worked past 65 and delayed enrollment into Part B because you had creditable coverage, you have an 8-month window in which you can enroll into a Medicare Supplement policy with no medical underwriting.
If you do not enroll into a Medicare Part D plan when first eligible, a penalty will be added to your monthly Part D premium for as long as you have Part D coverage.
The penalty for not enrolling when eligible is 1% of the “national base beneficiary premium” for every month you were not enrolled in a Part D policy. So, if someone goes 20 months without creditable coverage or enrollment into a Part D plan, they would pay 20% of the “national base beneficiary premium.” For example, in 2020, the national base premium is $32.74, and multiplied by 20%, the penalty would calculate to $6.55 per month for as long as the beneficiary is enrolled in a Part D plan.
Note: Many will decline coverage when first eligible because they are not taking medications at that time. However, please weigh this against the costs of your Part D plan, as well as the risk of being prescribed expensive medications in the future and not having the financial means to cover the costs.
The Coverage Gap, or commonly referred to as the donut hole, is a stage in your Part D plan where increased financial responsibility is placed on you as the beneficiary if your costs exceed a certain limit. It is called the donut hole because it is a hole, or a coverage gap, in the middle of your drug coverage that can occur during each calendar year.
The donut hole is the third stage of a Medicare Part D plan, and lies between the initial coverage limit and the catastrophic coverage threshhold. The gap begins once the combined spending by you as the beneficiary and your plan reaches a pre-determined amount. The gap is left when you have paid, without the help of your plan, up to the maximum amount of the coverage gap, for the same prescriptions.
In 2019, when the cost of your covered medications passed $3,820, you entered the coverage gap and paid more for your medications. Once your total out-of-pocket costs reached $5,100, you exited the gap and entered into the catastrophic stage, where your costs were reduced to significantly lower levels.
In 2020, Medicare is covering 75% for brand-name prescription drugs, leaving you responsible for 25% of the costs, as long as you purchase your prescriptions at a pharmacy or order them through the mail.
The Annual Enrollment Period (AEP), is an important time of year for Medicare beneficiaries. From October 15th – December 7th of each year, beneficiaries can make changes to their coverage. Changes during this period can include:
- Switch from one Medicare Advantage plan to another.
- Switch from one Part D plan to another.
- Change from Original Medicare to Medicare Advantage.
- Change from Medicare Advantage to Original Medicare.
- Enroll in a Part D plan if you missed your Initial Enrollment Period.
- Opt out of your Part D coverage.
Medicare beneficiaries enrolled in a Part D plan can make changes to their plan during the Annual Enrollment Period (AEP), which runs from October 15th – December 7th of each year. During this time, you have the opportunity to change your Part D plan to another plan offered in your area. You must continue to be enrolled in Part A and/or Part B to be eligible for this change.
Note: You can also switch to Medicare Advantage plan in your area that includes prescription coverage; however, you would have to drop any existing Medicare Supplement plan to qualify for this change in coverage.
You can change your Medicare Advantage plan during the Annual Enrollment Period which runs each year from October 15th – December 7th. During this period, you can switch from your current Medicare Advantage plan to another Medicare Advantage plan. You can also change to Original Medicare and purchase a Medicare Supplement plan as well as a separate Part D plan.
Note: You can’t have a Medicare Advantage plan and a Medicare Supplement plan at the same time. Also, you can’t have both a Medicare Advantage Prescription Drug plan and a separate Part D plan.
If you do not enroll in Part B when you are first eligible, you risk paying a 10% late enrollment penalty for each 12-month period where you went without. The late enrollment penalty will remain for as long as you are enrolled in Part B. So, if you waited 2 years to enroll in Part B from the time you were first eligible, you would pay a 20% penalty on top of your Part B premiums for that year and every ensuing year.
Note: If you miss your Initial Enrollment Period, you can apply for Parts A and B during the General Election Period which runs from January 1st – March 31st of each year. Successful enrollment would start your Part A and B benefits on July 1st of that calendar year. However, if beyond 12-months, you would still face a penalty for Part B late enrollment.
- If you qualify for premium-free Part A, you can enroll at any time and your coverage will begin as early as 6 months before the month you filed, but not earlier than the month you met all Part A requirements.
- Relating to Parts A and B, you can enroll during the General Enrollment Period, which runs from January 1st – March 31st of each year. If successful, your benefits would begin on July 1st of that calendar year. If within 12 months of your initial eligibility, you can avoid facing a penalty for late enrollment into Part B. If beyond 12 months, you would incur a 10% penalty for each period of 12 months you went without coverage. Note: Individuals enrolling in Part A during the GEP would typically not be eligible for premium-free Part A. There is a 10% penalty for Part A late enrollment; however, it would last for only twice as long as the period they went without Part A, not forever like the Part B late enrollment penalty.
- Relating to Part D, after you’ve enrolled in Parts A and/or B during the General Enrollment Period (GEP), you can apply for a stand-alone Part D plan between April 1st and June 30th. If you do, your benefits would start on July 1st of that calendar year. Note: You would face a Part D penalty of 1% for each month you went without coverage.
- If you choose to enroll in Part A and/or Part B during the GEP, but chose to not enroll in Part D, you can apply for Part D coverage during the Annual Enrollment Period (AEP). AEP runs from October 15th -December 7th of each calendar year.
- You can also choose to enroll in a Medicare Advantage plan during the Annual Enrollment Period (AEP) from October 15th – December 7th of each calendar year. You would have to have enrolled in Parts A and B during the General Enrollment Period.
- If you enrolled in Parts A and B during the General Enrollment Period, you can apply for a Medicare Supplement plan once you are approved for coverage. Note: you will be subject to medical underwriting and can be denied enrollment into these plans for pre-existing medical conditions.
Unfortunately, they don’t. If you are enrolled in Medicare, you can no longer make contributions to your Health Savings Account after age 65.
There are three ways to evaluate your plan options.
- Do it yourself. Simply call your existing providers and request information on your current plan as well as other options that might exist with that company.
- Go to www.medicare.gov and research your options based on where you live and the plans that are available to you.
- Seek the assistance of a licensed independent Medicare insurance agent in your area to guide you through your options and enrollment periods.
Note: To cover all your options, make sure you contact an independent agent as they will typically represent numerous plans in your area and can provide unbiased information.
- There are a couple of reasons you might choose to enroll in Medicare when you first turn 65 despite being employed. First, per CMS, if your employer has less than 20 employees, Medicare will become your primary payor of claims and your employer coverage will shift to a supplemental position when you turn 65. Second, if your employer coverage for both medical and prescription is not deemed creditable. If you remain on a plan that does not meet or exceed Medicare standards, you could face penalties when you finally decide to enroll in Parts A and B as well as Part D. If you fail to enroll when first eligible, you can face the loss of guaranteed issue associated with Medicare Supplements. Note: This isn’t always the case, but due to the risk and penalties, please check with your employer or your spouse’s employer to better understand your options.
- If you work for an employer with over 20 employees and the coverage is creditable for Parts A, B and D, you have the option to delay your enrollment. If you meet this criteria, by delaying enrollment you will not incur any penalties for Parts A, B and D. You would be eligible to enroll in Medicare Parts A, B and D under a Special Enrollment Period (SEP) when you finally lose coverage. Qualifying for an SEP through loss of employer coverage, you will have an 8-month period in which to enroll into Medicare Parts A, B and Medicare Supplement. Note: If you elect to enroll in Part B while working, please discuss this with your employer as well as find out the impact on your Medigap Open Enrollment Period – once it’s started, it cannot be changed or restarted.
- If you seek to enroll in Medicare Advantage or Part D under your SEP, you can enroll in these plans from the month that you lose coverage and the two months that follow. The individual in this scenario can apply for an effective date or start date of these plans up to three months from the date they completed their enrollment request. Note: You must be enrolled in Parts A and/or B for Part D plans and you must be enrolled in Parts A and B for Medicare Advantage.