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Medicare can certainly be confusing! We decided to compile a list of some of the more commonly asked questions we receive through our call center, website and social media accounts and put all of the answers in one place for you here. Are there any we missed? Please let us know if there is a question (or questions) we can answer for you!
When I turn 65 will I automatically be covered by Medicare? Or do I need to apply?
Good question! You may automatically get Medicare Part A and Part B benefits if you are turning 65 and you are already getting retirement benefits from the Social Security Administration or the Railroad Retirement Board. If this is the case your red, white and blue Medicare card should be in your mailbox 3 months before your 65th birthday, with your benefits starting on the first day of the month you turn 65.
If you are not receiving retirement benefits yet and you are about to turn age 65, you will need to manually enroll in Medicare Part A and Part B through Social Security. First time Medicare beneficiaries have what is called an Initial Enrollment Period. This period starts 3 months prior to your 65th birthday, includes your birth month, and the 3 months after your birth month. It is important that you enroll during this time frame to avoid an indefinite penalty.
If I am still employed and turning 65, and have insurance through my employer, do I need to sign up for Part A and Part B?
If you or your spouse are still working when you turn age 65, and have health insurance through an employer, you may consider delaying Medicare Part A and Part B until you retire as long as you have Creditable Coverage, which means as good as Medicare. Or you can choose to elect your Part A, which is premium free and delay Part B until retirement. Depending on the size of the group, one plan would be primary while the other would be secondary. The first step is to contact your (or your spouse’s) HR Department to make sure that your current coverage is sufficient and find out how it will work with Medicare before you make your decision. When coverage through your employer ends you will be provided with a Special Enrollment Period that last for 8 months in which you will want to sign up for Medicare so you will not incur a penalty.
Does Medicare cover all of my healthcare costs? Does it pay 100%?
No. Medicare does not cover all of your healthcare costs. Although Medicare helps pay for many important health services including hospitalizations, doctors services, and some prescription drugs it does not pay 100% of costs for these services. Many people who are covered under traditional Medicare enroll in either a Medicare Advantage plan or a Supplemental plan to help cover their cost sharing requirements. Depending on which plan you choose, you may be required to pay premiums, deductibles, copayments and coinsurance.
It is crucial that a beneficiary is enrolled in a healthcare plan that not only fulfills all of their healthcare needs, but does not break them financially either. It is imperative that a beneficiary knows what all of their options are before making a final decision.
Does Medicare cover prescriptions?
Part A will only cover the drugs you need during a hospital stay or while at a skilled nursing facility as long as the stay is covered by Medicare.
Part B covers a very limited number of outpatient prescription drugs.
Part D covers outpatient drugs through Medicare approved private drug plans. If you enroll in a Part D plan, it should cover most of the prescriptions your doctor writes for you. Be sure to review the plan’s formulary, list of covered drugs, before enrolling.
Another way to make sure you have proper prescription drug coverage would be to enroll on a Medicare Advantage plan that includes prescription drug coverage. It is so important to make sure that you are covered in the circumstance that you need a medication due to illness or injury.
I’m on a fixed income. Can I get help with costs?
You may be able to get help paying for the costs associated with Medicare if you have limited income and resources. If you are low income, you may qualify for your state’s Medicaid program, and if so, Medicaid will work together with Medicare to provide you with help for your Medicare costs. If you do not qualify for Medicaid you may qualify for one of 4 other Medicare Savings Programs. Each program has a different income and resource eligibility limit.
You may also get help paying for your Medicare drug costs with a program called Extra Help.
What is the difference between Medicare and Medicaid? Can I get both?
Medicare is a federal health insurance program for persons aged 65 and older and for people with disabilities. Medicaid is a program that is overseen at both the state and federal level that assists those with low income to obtain medical care. There is no age limit when it comes to the Medicaid program. For those aged 65 and older, or suffering from a disability enrolled in Medicare, it is possible to also receive Medicaid if you have limited income and resources and fall within your state’s requirements to receive it.
I still have questions regarding Medicare. Is there somewhere I can look for more detailed information? Is there someone I can speak with?
Absolutely! You can give one of our trusted experts a call and it would be our pleasure to assist you. We can not only help you get answers to all of your questions, but we can also assist you in researching Medicare Advantage, Supplement, and Prescription Drug plans that are available to you in your area. We are also able to aid in helping to see if you qualify for programs that provide extra help in paying for your Medicare related costs. Why make several phone calls when you can make just one?
Before you make any decisions, please give us a call. You do not have to go at this alone.
