Our Top 12 most Frequently Asked Questions
You’re eligible for Medicare if you are 65 or older, a U.S. citizen or permanent resident. If you’re under 65, you may still qualify for Medicare if you have a disability or permanent kidney failure or ALS (Amyotrophic Lateral Sclerosis also known as Lou Gehrigs disease).
What are the parts of Medicare?
Part A (Hospital Insurance) Helps cover:
• Inpatient care in hospitals
• Skilled nursing facility care
• Hospice care
• Home health care
Part B (Medical Insurance) Helps cover:
• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)
Part D (Drug coverage)
Helps cover the cost of prescription drugs (including many recommended shots or vaccines). Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.
Source: Medicare & You 2021
Who has to sign up for Part A and/or Part B?
If you’re close to 65, but NOT getting Social Security or Railroad Retirement Board (RRB) benefits, you’ll need to sign up for Medicare. Contact us and we will walk you through the entire process with Social Security 3 months before you turn 65. In most cases, if you don’t sign up for Part B when you’re first eligible, you may have a delay in getting Medicare coverage in the future (in some cases over a year), and you may have to pay a late enrollment penalty for as long as you have Part B. If you have End-Stage Renal Disease (ESRD) and you want Medicare, you’ll need to sign up. Contact us to find out when and how to sign up for Part A and Part B.
How much does Part B coverage cost?
The standard Part B premium amount in 2021 is $148.50. Most people pay the standard Part B premium amount. If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium. To determine if you’ll pay the IRMAA, Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago. Note: You may also pay an extra amount for your drug coverage (Part D) premium if your modified adjusted gross income is above a certain amount.
What’s the Part B late enrollment penalty?
If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Part B. Your monthly Part B premium may go up 10% for each 12 month-period that you could’ve had Part B, but didn’t sign up. If you’re allowed to sign up for Part B during a Special Enrollment Period, you usually don’t pay a late enrollment penalty.
Learn about your Medicare coverage options. There are 3 main ways to get your Medicare coverage—Original Medicare (Part A and Part B), Medicare Supplement (Medigap), and Medicare Advantage. If you already have Medicare: Remember, Medicare plans can change each year. We highly recommend a yearly review of your Medicare health and drug coverage and make changes if it no longer meets your needs, or if you could lower your out-of-pocket costs.
What time of year can I enroll?
The first enrollment period will be 10/13 through 3/31/14. After this first enrollment period is over, open enrollment will be January-March of every year. However, if someone has a "qualifying event" they can enroll any time of year as a "special enrollment" within 60 days of the event (such as loss of job, death of a spouse, birth of a child). Medi-Cal enrollees can apply any time of the year.
When can I make changes?
Mark your calendar with these important dates! This may be the only chance you have each year to change your coverage. October 1st: Start comparing your current coverage with other options. You may be able to save money or get extra benefits. October 15th to December 7th: Change your Medicare health or drug coverage for the upcoming year, if you decide to. This includes changing to Original Medicare, joining or changing a Medicare Advantage Plan, and changing to a new Prescription Drug Plan. January 1st: New coverage begins if you made a change. If you kept your existing coverage and your plan’s costs or benefits changed, those changes also start on this date. January 1st to March 31st: If you’re in a Medicare Advantage Plan, you can change to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare prescription drug plan (PDP) once during this time. Your Birthday Month: If you’re in a Medicare Supplement plan, each carrier has different guidelines, call us before your birthday month. The main reason why you would consider one insurance carrier over another is premium savings – call us for details.
Some ways to get help with Prescription Drug Costs
You may find it necessary to get help paying for prescriptions even after enrolling in Medicare drug coverage (Part D). For example, you may reach the annual spending limit and enter what is called the coverage gap. Here are some tips to consider if you think you might need to get help with the costs of prescription drug coverage.
- Consider switching to generics or other lower-cost drugs.
There may be generic or less-expensive brand-name drugs that would work just as well as the ones you're taking now. Talk to your doctor to find out if these are an option for you. You might also be able to lower prescription costs by using mail-order pharmacies.
- Choose a Medicare drug plan that offers additional coverage during the gap.
There are plans that offer additional coverage during the Medicare drug coverage gap, like for generic drugs. However, plans with additional gap coverage to help pay for prescriptions may charge a higher monthly premium.
Check with the drug plan first to see if your drugs would be covered during the gap. Contact us to find health and drug plans.
- Apply for Extra Help
Medicare and Social Security have a program called Extra Help—a way for people with limited income and resources to get help with prescription costs. If you qualify for Extra Help, the amount you would pay:
- $0 - $3.70 for each generic covered drug
- $0 - $9.20 for each brand-name covered drug
- Explore County, State, and national and community-based charitable programs that help pay for medications and Part B Premiums. Contact us.
What if I have a pre-existing condition?
Applicants to the health exchange plans will receive health coverage through the exchange regardless of any pre-existing health conditions.
How do I receive my subsidy?
Subsidies will be sent directly to the carriers. You will pay the remaining premium amount due to the carrier.
Medicare Advantage Plans
Some carriers have a Rebate for the Part B premium.
How do I get a rebate for Part B Premium
If you pay a Medicare Part B premium, you may qualify for a Part B rebate with a few different insurance carriers. Please contact us for details.