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  • Home
  • About Us
      waving hand icon

      Who We Are

      State-licensed agents specializing in Medicare.

      Learn More

      shaking hands icon

      Careers

      Interested in Becoming a Medicare Teacher?

      Learn More

  • Services

      Medicare Supplements

      What are Medigap plans?

      Learn More

      Medicare Advantage

      What are Medicare Advantage plans?

      Learn More

      Part D

      How do prescription drug plans work?

      Learn More

  • Learning

      Blog

      Read the latest news and advice for Seniors.

      Blog

      Medicare 101

      Attend an in-person or virtual Medicare 101 class and learn everything you need to know.

      Medicare 101

      FAQ

      Answers to frequently asked questions.

      FAQ

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Frequently Asked Questions

Contact Us

Have Questions?

Medicare is changing every day so of course you have questions. The Medicare Teachers are here to make it easy to understand so you can make educated choices for your own health care.

We’ve listed a few common questions below, but everyone’s situation is different, so please don’t hesitate to contact us with any of your personal Medicare questions, big or small.
What is Medicare?

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.

What are the parts of Medicare?

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

How much will Medicare cost me?

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.

When can I enroll?

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.

When can I change plans?

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.

How do I apply for Medicare?

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.

Is a Medicare Supplement or Medicare Advantage plan right for me?

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?

How do I apply for Medigap or Medicare Advantage coverage?

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.

What if I’m still working?

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.

What are IRMAAs and LEPs?

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.

Are there other resources?

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

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