Most Frequently Asked Medicare Questions Answered
If you or a loved on recently signed up for Medicare or are planning to sign up soon, odds are you probably have a few questions. In this article we’ll cover the topics and questions that we get asked to most.
Still have questions? Feel free to reach out to us directly.
What does Medicare cover?
At brief, Medicare covers your hospital and doctor bills. Medicare does not cover all the cost of these and there are restrictions.
Original Medicare consist of Parts A and B.
- Part A: This covers your hospital bills, inpatient rehab, some skilled nursing care, and hospice care.
- Part B: This covers the cost of medical services such as preventive care, diagnosis care, doctor visits, and durable medical equipment.
- Part D: Prescription drugs are covered under Part D. Part D plans can be purchased by themselves (a standalone plan) or as part of a Part C Medicare Advantage plan.
- Part C: Part C Medicare Advantage plans combine the elements of Part A, Part B, and sometimes Part D into one plan offered by private insurance companies. These plans offer coverage equal to or greater than that of Original Medicare, with some plans offering additional benefits.
- Medicare Supplement Plans: Medigap plans work on top of Original Medicare and cover the cost that Part A and Part B do not pay. These may include deductibles, coinsurance, and copayments. Some Medigap plans also help pay medical expenses you might incur when traveling outside the country.
You can read in more detail about all of these using the links below.
Are prescription drugs covered by Medicare?
Original Medicare does not cover prescription drugs. If you wish to have coverage for prescription medications, you will need to enroll in Medicare Part D. Medicare Part D helps cover the cost of prescription medications. Additionally, some Medicare Advantage plans provide prescription drug coverage as well.
If you do not enroll in Medicare Part D, you may be subject to the Medicare Part D late enrollment penalty. This penalty is for those who delay Part D benefits without creditable coverage. You will be required to pay the additional cost as long as you have Medicare Part D.
Who is eligible for Medicare and when can I enroll?
To be eligible for Original Medicare, you must be a permanent legal resident (green card holder) or an American citizen who has lived in the United States for at least five years AND one of the following:
- Age 65 or older
- Under age 65 and receiving Social Security Disability Income for 24 months
- Diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis
To enroll in Original Medicare, you may be required to reach out to your local Social Security office in some circumstances.
How do I enroll in Medicare?
Check out this guide for an in-depth look at the enrollment process.
Am I required to enroll in Medicare?
Enrolling in Medicare coverage is not mandatory. So, you are not required to have coverage at any point. However, if you delay Medicare enrollment without creditable coverage, you may be required to pay late enrollment penalties that do not go away. Thus, it is often more cost-effective in the long run to enroll in Medicare coverage when you are first eligible.
Medicare Part A is typically zero-premium for those who qualify, and delaying Medicare Part B can end in a significant penalty if you do not have creditable coverage. The Medicare Part B penalty adds 10% to the base premium for each 12-month period you go without coverage.
Is Medicare free?
Medicare is not free. For most people Part A will be premium free if you worked at least 40 quarters and paid into the system through taxes. There is also a premium for Part B that is paid each month.
With Original Medicare, beneficiaries have deductibles, copayments, and coinsurance that is paid out of pocket. These cost can be mitigated through by either purchasing a Medigap plan or by enrolling in a Medicare Advantage plan, though both of those options come with cost of their own.
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How can I find out if I have Medicare coverage?
You must call the Social Security Administration at 1-800-772-1213 or contact your local Social Security Office to verify your Medicare Part A and Part B coverage. This information can also be found on your red, white, and blue Medicare card.
Will Original Medicare alone cover my medical cost?
Original Medicare does not cover 100% of your medical costs once you enroll in coverage. Medicare Part A requires you to pay a per occurrence deductible and copayments. Then, Medicare Part B requires an annual deductible and a coinsurance of 20%.
If you wish to be covered entirely, you will need to enroll in a Medicare Supplement plan to help cover these gaps in coverage left by Original Medicare. By doing so, you will reduce your out-of-pocket spending with Medicare.
Will I automatically be enrolled in Medicare?
If you are receiving Social Security or Railroad Retirement or disability benefits, you will be automatically enrolled in Medicare Part A and Part B. About 3 months prior to your 65th birthday or 24th month of disability, you will be sent an Initial Enrollment Package that will contain information about Medicare, a questionnaire and your red, white and blue Medicare card. If you want both Medicare Part A (hospital insurance) and Part B (medical insurance), you should sign your Medicare card and keep it in your wallet. If you don’t want Part B coverage, you must put an X in the refusal box on the back of the Medicare card form; sign the form and return it with the card to Social Security at the address shown. You will then be sent a new Medicare card showing that you only have Part A.
Do I need to enroll in Medicare if I am working past age 65?
While it is not mandatory, we recommend you enroll in Medicare Part A coverage as soon as you become eligible if you qualify for premium-free Part A coverage. However, if you delay Medicare Part A, you will be able to enroll later during the General Enrollment Period or a Special Enrollment Period if you qualify. But, if you delay enrollment to the General Enrollment period, you may be required to pay late enrollment penalties.
If your employer offers creditable health coverage, you do not need to enroll in Medicare Part B if you are working past age 65. Creditable coverage is healthcare coverage that provides at least equal benefits to Original Medicare. Suppose you do not have creditable coverage and do not enroll in Medicare Part B when you first become eligible. In that case, you may have to pay the Medicare Part B late enrollment penalty as long as you have Medicare Part B.
Remember that even if you have creditable coverage, it is essential to compare your current plan to Original Medicare with a Medigap plan and Part D. Often, combining these Medicare plans will provide you with the most comprehensive coverage possible.
I delayed Medicare at 65. How do I enroll now?
If you delayed Medicare coverage past age 65 with creditable coverage, you would need to contact Social Security to enroll in Original Medicare.
Since you have creditable coverage, you will receive a Special Enrollment Period to enroll in Medicare Part A and Medicare Part B benefits. From there, you can enroll in a Medicare Part D prescription drug plan and Medicare Part C or Medicare Supplement.
However, if you delayed Medicare coverage without creditable coverage, you would need to enroll in Original Medicare during the General Enrollment Period. This is an annual period that runs from January 1 to March 31 each year. Remember, coverage does not begin until the month after you enroll during the General Enrollment Period.
What do I do if I lose my Medicare card?
If you lose your card, you can obtain a replacement card by phone at 1-800-772-1213, or online at the Social Security Administration web site. Make sure you have your Medicare number ready when you call. You should receive your new card in about four weeks.
What happens to my Medicare plan when I move?
If you move, even if it is only across the street, you will need to change your address with Social Security.
Because Original Medicare is a federal program, benefits are the same nationwide. So, your benefits will not change.
However, if you enroll in a Medicare Supplement or Medicare Advantage plan, you may be required to choose a new plan or pay a higher (or lower) monthly premium.
How do I change my address or my name for Medicare purposes?
If you have had a recent name or address change, it will need to be reported to the Social Security Administration. Social Security will notify Medicare of the change when they change their records. You also need to notify the insurance company that provides your Part D coverage, your Part C coverage, or your Medigap plan.
Depending on where you move, you may be entitled to enrollment in a different plan based on your new zip code.
Who submits my bills to Medicare? How much do I have to pay?
If you are in Original Medicare, your doctor or other health care provider will file your claim with Medicare. You’ll receive a statement showing how much you’ll need to pay. If you do not receive a Medicare statement (Medicare Summary Notice or Explanation of Medicare Benefits), you’ll need to contact your local carrier to have them send you a copy.
If you have supplemental insurance or Medigap, they may pay part of your costs. Check with your supplemental insurance company to find out what they will pay.
What do I do if I cannot afford my Medicare premiums?
If you cannot afford your Medicare premiums, there are several assistance programs available to help cover these costs.
First, you should visit your local Medicaid office to see if you qualify. If so, Medicaid will cover your monthly premiums and provide you with extra benefits.
Additionally, there are several Medicare Savings Plans available to help cover low-income earners. These plans help pay your Medicare premiums and out-ofpocket costs.
Can Medicare drop my for health reasons?
Original Medicare, Medicare Advantage, and Medicare Supplement plans are NOT able to drop you based on your health status.
Original Medicare, Medicare Advantage, Medicare Part D, and Medicare Supplement plans are guaranteed renewable as long as you continue to pay the monthly premiums.
Keep in mind if you want to change plans, there may be restrictions or roadblocks due to health. Medicare Supplement plans can deny your application based on pre-existing conditions except when you are first eligible for Medicare Part B.
Medicare Part D and Medicare Advantage plans do not review your health history. However, you can only apply during certain times of the year.
Do I need to renew my Medicare every year?
Original Medicare coverage is automatically renewable each year you are eligible. Thus, you do not need to renew your Medicare parts each year.
Medicare Supplement plans work the same way, once you are accepted, the plan is automatically renewable as long as you continue to pay the monthly premium.
Medicare Advantage plans work similarly. However, you have the option to change your plan each year if you do not like the benefits of your current plan
Does Medicare change each year?
Original Medicare benefits do not change each year. However, the premiums, deductibles, and covered services may change each year.
New prices are generally released in October and reflect changes for the upcoming year. Also, if there is a change in covered services, you will receive notice in advance that Medicare will no longer provide coverage.
Medicare Advantage plan benefits do change every year. Thus, it is essential to review the changes to your plan each year during the Annual Enrollment Period. During this time, you do have the option to change your plan if you do not like the new changes for the year.
Any changes made during this enrollment period will be effective on January 1 of the upcoming year.
Medicare Supplement plans do not typically change yearly. However, the deductible and premium costs may differ each year.
Will I have a choice of doctors & hospitals on Medicare?
Original Medicare offers nationwide coverage to all beneficiaries. This means you’re covered for all medical care at any facility that accepts Medicare, even out of state, with no network restrictions.
Medicare Advantage plans and Medicare Part D plans, on the other hand, offer coverage in certain areas. These may be specific counties within a state, an entire state, or a network of healthcare providers across regions of multiple states.
Whether you have Original Medicare or Medicare Advantage, you should always make sure that the provider you’re visiting accepts Medicare assignment.
Do I need Medicare if I have VA benefits?
It is not required for you to enroll in Medicare if you have VA benefits. However, if you ever receive coverage outside of the VA system, you will need medical coverage to cover these costs. Statically, most people will benefit from coverage other than just VA benefits past age 65.
Can I switch Medicare plans?
Plans can only be changed at certain times throughout the year. Depending on what type of plan you have and what type of plan you want to change to, your enrollment period is different.
You can read about all the different enrollment periods, including when you can change plans, here.
Can I enroll in Medicare Advantage and Medigap?
It is illegal to enroll in both a Medicare Supplement plan and a Medicare Advantage plan. If you were to enroll in both plans, neither would become your primary coverage, leading to a denial of services. This could leave you paying out-of-pocket for all your healthcare services, regardless of having both coverages.
To avoid this, it is illegal for an agent to enroll you in one plan if you are already enrolled in the other and do not have a valid way out of the plan.
Does Medicare cover dentures?
Typically, Original Medicare does not offer coverage for dentures, but some Medicare Advantage plans may provide this benefit.
If you have a Medigap plan, you may consider a standalone dental insurance plan or a dental savings plan.
Will Medicare cover hearing aids?
Original Medicare does not offer coverage for hearing aids, but some Medicare Advantage plans may provide this benefit.
Does Medicare cover diabetic supplies?
Medicare covers the same supplies for both insulin and non-insulin dependent diabetics. They include glucose testing monitor, blood glucose test strips, lancets, spring powered devices for lancets, and glucose control solutions.
Some frequency limitations may apply. Medicare does not cover insulin and syringes.
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