Frequently Asked Questions

Original Medicare is a federal health insurance program. You may be eligible for Medicare Part A and Part B if you are 65 or older, or if you have a qualifying disability, ESRD or ALS.

Parts A and B are from the federal government. Parts C and D are from private insurance companies.
Part A: inpatient hospital, skilled nursing, and hospice care
Part B: doctor visits and other outpatient care
Part C: another term for Medicare Advantage (these often include Part D)
Part D: prescription drug plans

Original Medicare has premiums, deductibles, and cost-sharing.

If you’ve worked for 10 years (they actually count it as 40 quarters) and paid payroll taxes for Medicare, you’re entitled to Part A without paying a monthly premium.

Most people pay a monthly premium for Part B. If you are a high-income earner you might pay a higher premium than the standard premium, and if your income falls below a certain level, your state might help pay the Part B premium on your behalf.

Your out-of-pocket Medicare costs will depend on the coverage you choose and your personal healthcare needs. 

These are some terms you’ll want to know:

Premium: how much you pay each month to purchase your plan.

Deductible: what you have to pay before the plan will pay anything. Sometimes the deductible is $0, but sometimes it can be several hundred dollars.

Copay: you are responsible for paying a fixed amount for services.

Coinsurance: you are responsible for paying a percentage of the cost of services.

Most people are eligible to enroll in Medicare the month of your birthday, or up to three months before or after your birthday month. We recommend planning ahead in case there is any delay in Social Security processing your request. If you think special circumstances might apply to you, contact your broker for personalized advice.

AEP: Annual Enrollment Period (October 15 – December 7)
During AEP you can change your Medicare Advantage or Part D plan for the following calendar year (effective January 1).

OEP: Open Enrollment Period (January 1 – March 31)
During OEP, if you are dissatisfied with your Medicare Advantage plan, you may change your Medicare Advantage plan or go back to Original Medicare and a Part D prescription drug plan.

SEP: Special Election Period (ongoing)
If you have a special reason for changing your Medicare Advantage or Part D plan, you can make changes throughout the year. Special reasons include moving, qualifying for Extra Help, losing employer group coverage, etc. The SEP rules can vary according to your circumstances. Medigap plans have different enrollment guidelines; contact us with your specific questions.

If you are taking your Social Security benefits at age 65, you should be automatically enrolled in Medicare Parts A and B and your Part B premium will be auto-deducted from your Social Security check. If you are waiting you take your Social Security benefits, you will apply for Medicare on the Social Security website (www.ssa.gov/benefits/medicare). You can also call Social Security or 1-800-Medicare for guidance.

It really depends. You’ll want to compare your local options, taking into consideration which plans your providers accept, your personal medical history or chronic conditions, ancillary benefits included in the plans, and more. Also, think about your budget. How much are you willing to pay in premiums each month? Would you prefer to pay less in premiums and pay for services as you receive care?

Your broker will help you apply for the plan of your choice and ensure that your application is submitted correctly. You are not required to work with a broker, but it doesn’t cost you anything to have us advise and assist you with your application.

If you are covered by an employer group plan, you’ll need to find out if your coverage is considered “creditable” for Medicare. If it is, you’ll compare the premium, copays, maximum out-of-pocket, and extra plan benefits to determine if you’d prefer to keep your work plan or enroll in Medicare. Don’t worry – if your employer has more than 20 employees and is creditable, you won’t have a Late Enrollment Penalty if you decide to enroll in Medicare after your initial enrollment period.

IRMAA stands for Income Related Monthly Adjustment Amount. If you are a high-income earner, you may pay an IRMAA for both your Part B and Part D premiums.

LEP stands for Late Enrollment Penalty. If you do not enroll in Medicare or a Part D plan when you are first eligible, you may be required to pay a penalty. Some penalties are permanent.

Medicare
1-800-MEDICARE, TTY 1-877-486-2048
www.medicare.gov – download the “Medicare & You” and “Choosing a Medigap Policy: A guide to Health Insurance for People with Medicare” booklets.

Social Security
(800) 772-1213, TTY 1-800-325-0778
www.ssa.gov

SHIP (State Health Insurance Assistance Program)
www.shiphelp.org