10 Medicare Questions

Where do I start?
- Go to www.ssa.gov and sign up for benefits Part A (Hospital Insurance) and/or Part B (Medical Insurance)
- Choose how you want to manage your Medicare health coverage
  - Original Medicare (Part A & Part B) with two options
    - Drug Coverage (Part D)
    - Supplement Coverage (Medigap)
  - Medicare Advantage (Part C)
    - Replaces Original Medicare but may include Part D
Medicare comes with a cost
- Part A (Hospital Insurance) is $0 for most people since they have paid Medicare taxes while working
  - $1,556 Deductible for each time you're admitted to the hospital per benefit period (not per year.)
- Part B (Medical Insurance) is $170.10 each month for most people but could be higher if you had a larger income in the past 2 years.
  - $233 Deductible per year before Medicare starts to pay.
- Part D (Drug Coverage) has a monthly premium that varies depending on the plan you choose.
  - This is optional but may include a penalty if you wait to enroll later.
  - Plans are handled by Insurance Companies and not by Medicare.
- You also have a choice of a Medicare Advantage (Part C) or Medicare Supplement (Medigap)
  - You cannot be on both only one or the other.
- Medicare Advantage (Part C) plans are handled by Insurance Companies not Medicare
  - Plans vary in cost for Deductibles, Co-Insurance, Co-pays, and other benefits
  - Many plans include a Part D drug coverage
- Medciare Supplement (Medigap) plans are handled by Insurance Companies secondary to Medicare
  - Monthly premiums vary by the plan you choose and the coverage they provide.
  - You will still need a Part D Drug coverage plan
High Income Earners pay more for Medicare
- If your income was above a certain threshol, you will pay more for Parts B and D.
- The surcharges are based on your adjusted gross income from two years earlier.
When to Sign Up for Medicare
- If you are already taking Social Security benefits, you will be automatically enrolled in Parts A & B.
- If you are still working and have health insurance through your employer you may delay enrolling without a penalty.
- Otherwise you have a 7 month opening to enroll, 3 months before your 65 birthday, the month of your birthday and 3 months after your birthday.
Other Medicare Enrollment Periods
- There are several additional enrollment periods after your Initial Enrollment Period.
- Annual Enrollment, Open Enrollment, Special Enrollment, each has it's own requirements to enroll.
The Doughnut Hole for Medicare Part D
- The hole is a coverage gap in which you will be required to pay more out of pocket costs for your drugs.
Medciare offers more Free Preventive Services
- Beneficiaries can receive a number of free preventive screenings, annual "wellness" visit, and flu shots
Medciare expands Telehealth offerings
- When the Corona virus pandemic hit, telehealth was expanded, a feature that could become permanent
What Medicare does not cover
- Medicare generally does not cover long term care, cosmetic surgery, dental, vision, or "custodial care"
You have the Right to Appeal a Medicare Decision
- If you disagree with a coverage or payment decision made by Medicaree or a Medicare health plan, you can file an appeal.