Medicare FAQ

Medicare FAQ2021-04-07T15:46:07-07:00
What is the difference between Medicare Supplement Plans and Medicare Advantage Plans?2020-12-17T13:07:32-08:00
Medicare Supplement Insurance pays whenever Medicare A and/or B pays its portion of the bill first. Often this is the hospital deductible for each hospital stay, the skilled nursing care benefit co pay, or the 20% that Medicare doesn’t cover for Part B expenses. Medicare Supplements work in tandem with Medicare itself. With a Medicare Supplement plan you can go to any provider as long as they accept Medicare and no referrals are required.  Medicare Supplements aka Medigap never cover prescriptions. Part D drug coverage would be purchased separately. This allows the consumer to customize their drug plan coverage every year. With all Medicare Supplement plans,  coverage is guaranteed for life as long as you pay your premiums.
Medicare Advantage Plans are completely private plans which actually replace Medicare itself  (it doesn’t supplement Medicare). Your Medicare card is “put to sleep” while you are on a Medicare Advantage Plan. Medicare Advantage Plans usually cover prescription drug cost(known as Part D) but not always if you choose a plan without Part D. Medicare Advantage plans also offer additional benefits that aren’t covered by Medicare itself, such as Dental, Vision, hearing, gym membership etc. Typically you have a lower monthly premium with Medicare Advantage but more co-pays or co insurance until an out of pocket limit is satisfied.  Also, many Medicare Advantage plans are HMO plans which require you to stay in network except for emergency care. The coverage is not guaranteed for life as plans contract with Medicare on a year to year basis. Benefits can also change from year to year where Medigap plan benefits never change unless the policy holder changes their plan on their own.
Someone on Medicare Part A and B can always switch from Original Medicare to a Medicare Advantage between Oct 15th and Dec 7th of each year. However, they are limits to going back to a Medicare Supplement plan later on due to pre existing health issues.
How do I pick the best Rx (Part D) drug plan?2020-07-08T14:26:08-07:00 has a drug lookup tool and some agents also have tools to help you quickly and effectively choose the best Medicare Part D Drug plan for you. Picking the wrong plan can have major consequences. Don’t do this part “willy nilly” unless your take only inexpensive generic drugs. Even then, don’t overpay.

Do Medicare Supplement plans pay when Medicare doesn’t pay?2020-06-29T16:45:25-07:00

No. They only pay their portion of the bill if Medicare pays its portion of the bill. Therefore, since Medicare mostly does not cover Dental, Vision, Hearing etc., neither will the Supplements, by law. You can purchase a separate Dental/Vision plan.

Which Medicare Supplement plan is best?2020-06-29T16:44:19-07:00

It’s not a “one size fits all” answer. It depends on what state you live in, as well as different states have differing rates for the same exact plan. If you want to pay a higher premium and have less co pays (or no co pays), you can. If you want to pay the least amount, then a high deductible plan may be suitable for you or you could be somewhere in the middle (more and more people are gravitating to this approach).

You can’t get MORE benefits moving from one company to the next unless you change the plan letter (example: moving from plan N to a G, or High Deductible G to a regular low deductible plan G.)  Also, a plan N is a plan N, a plan G is a plan G no matter what company you go with. The federal government standardized the plans in all but 3 states. Think of an industrial bakery baking thousands of loaves of bread with the exact same oven and recipe. Each grocery chain will put it’s own bag on it with their own label and sell it for a slightly or sometimes big price difference. The same concept applies to Medicare Supplement plans.

Can I switch Medicare plan types?2020-06-29T16:40:24-07:00

The short answer is, sometimes.

During the AEP (Annual Election Period between Oct 15th and Dec 7th each year), you can change from one Medicare Advantage plan to another Medicare Advantage plan or from one Part D Drug to another Part D Drug plan. BUT….you can’t always go from a Medicare Advantage Plan to a Medicare Supplement Plan (AKA Medigap).

In most cases (unless you are losing credible coverage through an employer or your Medicare Advantage doesn’t renew it’s annual contract with Medicare) you have a ONCE IN A LIFETIME 6 MONTHS from when you are new to Medicare Open Enrollment to sign-up for a Medicare Supplement Plan. (If you are new to Medicare, you can try Medicare Advantage for one year maximum as well and then get a Supplement). If the 6 months is up, all bet’s are off in most cases. Then you must answer several health questions and you could be on the outside looking in for the rest of your life.

Does Medicare Require a Primary Care Physician?2020-06-29T16:32:51-07:00

Medicare doesn’t require a primary care physician and there are no referrals required to see a specialist (however the specialist may require one). As long as the provider is contracted with Medicare (most are, as well as most all hospitals), you can go to any provider that takes Medicare.

On the other hand, most Medicare Advantage Plans do require a primary care physician and most require a referral to see a Specialist.

How do Medicare Advisors (Licensed Insurance Agents) get paid?2020-07-23T10:12:48-07:00

Licensed agents or Brokers get paid a commission and annual renewals from the company/carrier. The Government mandates commission limits on Medicare Advantage Plans and Part D Rx plans. Individual States have limits on Medicare Supplement Commissions.

There are two main types of Agents, captive and non-captive agents. Captive Agents typically can only represent one company and can’t help you compare multiple plans side by side. In other words, they can only market one company. They often have sales quotas as well.

Non-Captive or Independent Agents (Brokers) can represent multiple companies and help you choose the best Medicare plan for you by offering a complete side by side comparison. A good agent will have competence and your best interest at heart at all times.

There are also agents that are only trained to represent Medicare Advantage Plans.  The commissions for these plans are usually double for the first year that someone is on a Medicare Advantage plan and overrides to their up-lines are larger than Medicare Supplement plans pay.

There is no charge to you to utilize a licensed Medicare certified agent. You can go it alone and call an 800 number and never get the same person or find a dedicated agent who should be competent and have only YOUR best interests in mind.

Will the government contact me and let me know what to do, when to do it and how?2020-07-08T14:34:51-07:00

There is no coordinated outreach program by the government. If you are on Social Security you will automatically be enrolled in Medicare A and B effective your 65th (under age 65 if on Social Security Disability for 24 months) birthday month or the month before if you were born on the 1st of the month. It is your responsibility to enroll in additional coverage including Medicare Rx plans (Part D), Medicare Supplement Plans (Medigap) or a Medicare Advantage Plan. CMS (the Center for Medicare and Medicaid services) produce an annual “Medicare and You” booklet with great information. Reading this booklet ahead of time will help you understand when to enroll and how to avoid potential lifetime late enrollment penalties.  A good Medicare advisor can walk you through these steps and help you choose a good Medicare plan to fit your needs.

Is there a limit to how much your out of pocket costs are when you go to a doctor or need hospital care?2020-06-29T16:23:41-07:00

There is no limit to your potential out of pocket costs if you only have Medicare Parts A and B. Medicare Advantage plans (usually HMO’s or sometimes PPO plans) will limit your financial liability especially if you go to in network providers. On the other hand, Medicare Supplement Insurance plans do not have networks and will protect you from large or even huge out of pocket cost.

Is it required that I apply for Medicare or enroll in Medicare when I turn 65?2020-07-23T10:46:47-07:00

It depends. If you are age 65 or older and you (or your working spouse) have payed Medicare payroll taxes for at least 10 years, you are likely eligible for no cost Medicare inpatient hospital insurance (Part A). You should sign up for Medicare hospital insurance (Part A) 3 months before your 65th birthday, whether or not you want to begin receiving retirement benefits.

If you are already receiving Social Security Benefits, enrollment is automatic.

If you have credible employer health insurance you may be able to delay your enrollment as long as you want with no penalties. Yes, you can work until you’re 65 or 95!

How do I get started with Medicare?2020-07-08T14:25:07-07:00

4 Steps to Prepare for Medicare

  1. Enroll in Medicare Part B. If turning 65 or you are within 3 months of your birthday month, it is easiest to go to and click “Apply for Medicare online”. The standard rate for Part B in 2020 is $144.60 a month. However, you may pay more or less depending on your income.
  2. Carefully Choose your Medicare Plan. It is NOT one size fits all … Medicare Supplement (Medigap) vs. Medicare Advantage Plan (Part C).In addition, a Part D Prescription Plan must be considered when you are first eligible to avoid possible future late enrollment penalties. The longer you wait, the bigger the penalty which remains as long as you are enrolled in most cases. You also may pay a higher or lower premium depending on your income for Rx plans.
  1. Plan for out-of-pocket expenses. No one has a crystal ball. Decide if Long Term Care Insurance and Dental/Vision Insurance is worth considering as well.
  2. Review your Medicare Plan once a year on your own or with a trusted agent / consultant (the most advisable way for most people).

If you wait until the month you turn 65 to enroll, your Part B coverage will be delayed. This could cause a gap in your coverage. In most cases, if you don’t sign up for Medicare Part B when you’re first eligible (usually 3 months prior to your 65th birthday month through 3 months after your birthday month), you’ll have to pay 10% penalty for every year you wait – for as long as you remain on Medicare Part B.

Can I have employer insurance and Medicare at the same time?2020-05-20T01:14:48-07:00

For small companies with under 20 employees, Medicare is primary if you are age 65 or older. You will need both Part A & B because Medicare will pay first, and then your group insurance will pay second.

Does Medicare start on my 65th birthday?2021-10-29T13:21:50-07:00

Medicare usually starts on the first day of your birthday month, unless you choose to defer enrollment due to employer coverage. For example, if you were born on July 22, 1955, your Medicare can start as soon as July 1, 2020. If you wait to enroll after July 1, Medicare will start the first day of the following month after you apply.   Learn more at When Does Medicare Coverage Start

When can I apply for Supplemental (Medigap) Insurance?2020-05-20T01:14:34-07:00

Some companies allow you to apply 6 months prior to your 65th birthday, while others allow you to apply up to 3 months in advance. You also have a one-time grace period which lasts for the first 6 months after you have been on Medicare Part B. After that period, you will usually have to answer a health question survey  to qualify for coverage.

When can I apply for Medicare Advantage or Medicare Part D Prescription Drug Coverage for the first time?2020-05-20T01:14:28-07:00

You can do this during a 7-month window. 3 months prior to your 65th birthday month, during your birthday month, and 3 months after your birthday month.

If you are on Medicare Disability prior to age 65, you will have the same window period surrounding your Medicare start month.

When can I change my Medicare plan?2020-05-22T17:46:16-07:00

This can get confusing. If you are on a Medicare Supplement Plan, you can apply for a different plan year-round, 365 days a year. However, in most states, you can be rejected if you have preexisting health conditions and if you aren’t in your initial Medicare Enrollment period.

If you are on a Medicare Advantage (Part C) Plan and/or a Stand-Alone Medicare Part D drug plan, you can review and change or keep your existing plan between October 15 through December 7th of every year. Note: Special Enrollment Periods can apply for unique circumstances; for example, moving to a new county or state.

The new plan you select will always take effect on January 1st of the following year. Be careful, however. If you are on a Medicare Advantage Plan and enroll in a stand-alone Part D Drug plan, you will be dis-enrolled automatically from your Advantage Plan by Medicare itself.

Does Medicare cover Dental or Vision?2020-05-20T01:14:12-07:00

The short answer is no. Medicare will only cover medically necessary dental (for example, related to a broken jaw). Medicare will not cover routine vision or glasses but will cover medically necessary eye conditions such as glaucoma or cataracts.

Do Different Companies offer different Medicare Supplement Plans?2020-05-20T01:13:41-07:00

To make things easier, the federal government standardized all Medicare Supplement plans. The letter of the alphabet (A, B, C, D, F, K, L, M, N, HD F, and HD G) determine your benefits, NOT the company you select. The price companies CHARGE can vary slightly or greatly (even if it’s the same plan letter). Also, if you start Medicare in 2020 and beyond, plans C and F are not available to you.

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