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Medicare Frequently Asked Questions (FAQ)


The list of frequently asked Medicare questions (FAQ) and answers is presented below.
 
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Question 1: What is Medicare?


Medicare is a Federal Health Insurance Program for:
  • People age 65 or older
  • People under age 65 with certain disabilities
  • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)

Medicare has the following parts. The first two parts, Part A and Part B, are known as Original Medicare.  Original Medicare is run by the Federal government.

In addition, there is Medicare Supplement (Medigap) sold by private insurance companies. It helps to protect you against the financial exposure for some of the Original Medicare out-of-pocket costs (such as deductibles, coinsurances/copayments and excess charges). Medigap is NOT a part of the Medicare Program or any other Federal program. Medigap is a private health insurance.

Medicare Advantage plans are available as an alternative to Original Medicare, but are still considered Medicare coverage.  These all-in-one type plans provide coverage for Hospital, Medical and usually Prescription coverage, and are run by private Providers, such as insurance companies.  They are available in most, but not all, areas. 

 



Question 2: Am I eligible for Medicare?

  • You are eligible for Medicare if:
    • you are 65 years or older, and
    • you are a citizen or permanent resident of the United States who has lived in US for at least 5 years
  • If you are not yet 65, you might also qualify for coverage if you have a disability or End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant). You are entitled for Medicare after you get disability benefits from Social Security for 24 months.
  • Your age is the main determining factor. You do NOT need to retire or receive Social Security benefits in order to be eligible for Medicare.
  • Many Medicare beneficiaries are dual-eligible, i.e. they are qualified for both Medicare and MediCal/Medicaid.

 



Question 3: How do I enroll in Medicare?

  • If you already get Social Security Benefits, then you’ll be automatically enrolled in Medicare Parts A and B effective the first day of the month you turn age 65. Your Medicare Card will be mailed to you about 3 months before your 65th birthday. Enrollment in Part B is optional.
  • If you are under 65 and disabled, you'll be automatically enrolled after you get disability benefits from Social Security for 24 months. You will get your Medicare card in the mail 3 months before your 25th month of disability.
  • If you do NOT yet get the Social Security benefits, then you’ll need to apply for Medicare through Social Security three months before you turn 65 - at the start of Initial Enrollment Period. An Initial Enrollment Period is a 7-month period that begins 3 months before you turn 65, or, in the case of disability, 3 months before your 25th month of disability. You can sign up anytime during the Initial Enrollment Period. However, by waiting until you are 65 or later, your Medicare coverage will be delayed. Enrollment in Part B is optional.
  • If you didn’t sign up for Medicare Part A or Part B during the Initial Enrollment Period, you may sign up during the next General Enrollment Period. This period runs from January 1 through March 31 of each year. The coverage will start on July 1 of the year you sign up. If you aren’t eligible for premium-free Part A and didn’t buy Part A when you were first eligible, your monthly premium may go up 10%. You will have to pay the higher premium for twice the number of years you could have had Part A, but didn’t join. You will have to pay a higher Medicare Part B premium because you could have Medicare Part B and didn't take it. Actual increase is 10% for each full 12-month period that you were entitled for the Part B, and the penalty is as long as you have Part B. You may avoid paying higher premium, if you are entitled for Special Enrollment Period (see below).

 



Question 4: I am still working. Do I need a Medicare?


Even if you continue to work after 65, you should sign up for the Part A – it may help you to cover some costs not covered by the employer group plan. It is free for most of the people. However, the Part B is optional and a monthly premium is required. Does it make sense to enroll into Part B if you are still working and covered under employer group health insurance policy (EGHP)?

Neither Medicare nor EGHP cover all health services. Your decision should take into account the following factors:
  • Services provided by both insurances
  • Cost of Part B and the EGHP
  • Which insurance will be the ‘primary payer’?
  • Are other family members covered by the EGHP?
  • By signing Part B, you’ll trigger your 6-month Medigap Open Enrollment Period

If you didn’t take Medicare Part B when you were first eligible because you or your spouse (of any age) were working and you had EGHP through your or your spouse’s employer or union, you can sign up for Medicare Part B during a Special Enrollment Period:

  • Anytime you are still covered by the employer or union group health plan through your or your spouse’s current or active employment, or
  • During 8 months following the month the employer or union group health plan coverage ends, or when the employment ends, whichever comes first

Special Enrollment-SEP allows you to delay the Medicare Part B enrollment without paying higher premium. Notice, that only employee coverage can be used to defer Plan B; neither COBRA, nor retiree coverage can be used to defer Plan B.



Question 5: Do I need to join Medicare prescription drug plan if I already have prescription drug coverage?


Check your existing drug coverage. Unless you have the Creditable Prescription Drug Coverage (i.e. at least as good as the standard Medicare prescription drug coverage), you want to join Medicare Plan D when you are first eligible. You may have to pay a penalty if you’ll decide to join later.

 



Question 6: Can I have other health insurance?


Yes; you may combine Medicare with other insurances such as employer health plan insurance. Check which plan is the primary payer. Also, if you have the Original Medicare, you may buy the Medigap insurance that will protect you against catastrophic out-of-pocket costs.

 

 

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Copyright 2015 Senior Security Insurance Service, Inc. - All rights reservedWe are licensed independent insurance agency in California.  This website is a private website and is not associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services, or the Center for Medicare and Medical Services.  This site contains basic information about Medicare, and services related to Medicare. If you would like to find more information about the Government Medicare programs, please visit the official US Government site.