Medicare FAQs

You’re eligible for Medicare if you are 65 or older, a U.S. citizen or permanent resident, and if Medicare taxes were taken out of your or your spouse’s paycheck for at least 10 years. 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 Gehrig’s disease).

Learn more about Medicare here:

• Medicare & You

Click on the Helpful Links on our website, Download Medicare & You to access Medicare & You 2016 publication.

In most cases, Medicare is a federal health insurance program for people 65 years old or over and for certain disabled people under 65 years of age. You are automatically enrolled in Medicare hospital insurance (Part A) when you apply for Social Security benefits – usually upon reaching 65 years of age. Part A covers inpatient care in a hospital or a limited stay in a skilled nursing facility. Part B covers physician and outpatient hospital services. The premium you pay for Part B is deducted from your Social Security benefits.

Medicare pays for many healthcare services and supplies, but it doesn't cover all of your healthcare costs. For example, you pay a deductible for each hospital stay and coinsurance anytime you use the services of a physician or surgeon. Also, drug coverage is limited. Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage or Medicare Supplement insurance plan.

A Medicare Supplement insurance plan helps cover the costs that are left unpaid after Medicare Parts A and B pay their portion of your healthcare expenses. Unlike a Medicare Advantage plan, which is an alternative to your Medicare Parts A and B benefits, a Medicare Supplement plan is purchased in addition to your Medicare Parts A and B benefits.

Medicare Supplement policies are standardized into 10 plans - labeled "A" through "N", each with its own set of benefits. Plan A covers the most basic benefits. These basic benefits are also covered in each of the remaining Medicare Supplement plans - B through N. Plans B through N provide additional coverage beyond the basics.

Medicare Supplement policies are sold by private insurance companies. While the costs of these policies may vary, individual insurance companies must provide the same standardized benefits. Some companies may offer innovative benefits. To purchase a policy, in general you must be enrolled in Medicare Part A and Part B. In addition to paying the monthly Medicare Part B premium to Medicare, you will have to pay a premium to the insurance company providing your coverage.

Medicare Advantage (MA) plans are available through private health insurance companies and replace Original Medicare. MA plans may or may not include a Medicare prescription drug benefit. Medicare Supplement plans supplement Original Medicare, providing secondary coverage for out-of-pocket costs. Only beneficiaries with Original Medicare may enroll in Medicare Supplement plans. Beneficiaries cannot enroll in an MA plan and a Medicare Supplement plan. However, beneficiaries can enroll in a Medicare Supplement plan and a Medicare prescription drug plan (PDP), also known as Medicare Part D.

If you're enrolled in Medicare Part A and Part B, you're probably eligible to buy a Medicare Supplement policy. During your Medicare Supplement Open Enrollment Period – for people 65 or older, that’s six months after you sign up for Medicare Part B – a company must allow you to buy any Medicare Supplement insurance plan offered. In some states these plans may be available to those under age 65.

Here are key enrollment dates: October 15 – December 7 (Annual Election Period). If you're eligible, you can enroll in Medicare health benefits, such as a Medicare Advantage plan, for the following year. During this period, you can also change plans or enroll in a separate prescription drug plan.

You can enroll in a Medicare Advantage (MA) or a prescription drug plan (PDP) during the Annual Election Period (AEP), Initial Enrollment Period (IEP), Initial Coverage Enrollment Period (ICEP) or Special Enrollment Period (SEP).

You may enroll anytime during the first three months immediately preceding the month your enrollment in Medicare Parts A and B becomes effective. This time is called your Initial Coverage Election Period. It generally coincides with the month you turn 65 years old; however, some people choose to delay Part B coverage if they have other coverage through their employer.

There are no specific enrollment dates for a Medicare Supplement insurance plan. The best time to buy an insurance policy is during your Medicare Supplement Open Enrollment Period which lasts six months. It starts on the first day of the month in which you are BOTH age 65 or older AND enrolled in Medicare Part B.

You can change your Medicare plan during the Annual Election Period (AEP), Oct. 15–Dec. 7.

PFFS plans feature limits on out-of-pocket expenses, coverage for emergency and urgent care, and in some cases, a prescription drug benefit. If you select a PFFS plan, it is an alternative to your Medicare coverage. However, you can return to Medicare later if you wish.

The answer depends on your personal preferences and budget. For many people, the main reasons for choosing a Medicare Advantage plan are: (1) the simplicity of dealing with one company and (2) additional benefits and services not available with Medicare Parts A and B. For others, the choice comes down to price.

Before you select a plan, carefully consider the following questions. Your answers will help guide you to the plan that's right for you.

• Do you already have a doctor you like?
• Are you choosing a new doctor?
• Is freedom to choose doctors and hospitals very important to you?
• Do you need a prescription drug plan?
• Do you have health problems today or old problems that may recur?
• What drugs does the plan cover?
• Does your doctor feel comfortable with the plan's guidelines for your treatment?

You can still apply for a Medicare Supplement insurance plan after your Medicare Supplement Open Enrollment Period has expired. However, your application may be subject to medical underwriting unless you qualify under guaranteed issue rights.

You also may have the right to buy a Medicare Supplement policy outside of your Medicare Supplement Open Enrollment Period if you lose certain types of health coverage.

Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area.

A late enrollment penalty (LEP) is a monthly premium penalty calculated and assessed by the Centers for Medicare & Medicaid Services (CMS).

If you do not enroll in a Medicare prescription drug plan (PDP) by the end of your Initial Enrollment Period and do not have creditable coverage for 63 days or longer, you may have to pay an LEP.

You can avoid a late enrollment penalty (LEP) by:

• Enrolling in a Medicare prescription drug plan (PDP) before the end of your Initial Enrollment Period
• Continuing drug coverage in another plan with coverage that is at least as good as Medicare’s drug benefit

A formulary is a list of prescription medications approved for coverage by a health plan.

Yes. The government pays the health plan to administer Medicare Advantage plans. In some areas, the amount received from the government covers the entire plan premium – so it's possible to get all-in-one coverage for less than drug coverage alone.

Creditable coverage is prescription drug coverage that is at least as good as the Medicare drug benefit.

Prescription drug coverage is insurance — not drug samples, discount cards, or free clinics.

As long as you still qualify for TRICARE, VA, or the Federal Employee Health Benefits (FEHB) Program, your drug coverage did not change with Medicare Part D. Contact your benefits administrator before making any changes to your coverage.

If you lose TRICARE, VA, or FEHB coverage and join a Medicare Part D plan, in most cases you won't have to pay a penalty if you join within 63 days of losing benefits.

Yes. The U.S. Food and Drug Administration (FDA) requires that all drugs be safe and effective. Generics use the same active ingredients and are shown to work the same way as brand-name drugs.

Source: FDA

You should definitely sign up for Medicare Part A, which covers inpatient hospital costs. In fact, Part A may even cover some costs that aren’t covered by your group plan. But you don’t need to sign up for Part B if your employer plan already covers you. After you stop working, you can sign up for Part B.

Source: Medicare.gov

You can sign up during your initial enrollment period (7 months around your 65th birthday) or during open enrollment (October 15–December 7 each year). You can also enroll under special circumstances like moving or losing coverage.

Source: Medicare.gov

If you lost your job or your group coverage, you may qualify for a Special Enrollment Period. You have eight months after your coverage ends to sign up for Medicare parts A and B.

Source: Medicare.gov