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Medicare Overview FAQs

Medicare Overview FAQ

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1. What Is Medicare Part A?

Medicare Part A is hospital insurance. Part A covers inpatient hospital care, limited time in a skilled nursing care facility, limited home health care services, and hospice care.

2. What Is Medicare Part B?

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

*On all Medicare-covered expenses, a doctor or other healthcare provider may agree to accept Medicare assignment. This means the patient will not be required to pay any expense in excess of Medicare's approved charge. The patient pays only 20% of the approved charged not paid by Medicare.

Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge for covered services. The most a physician who does not accept Medicare assignment can charge for services covered by Medicare is 115% of the Medicare allowable amount. This additional charge is referred to as “excess charges.”  Currently, excess charges are not permitted to be assessed in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, or Vermont.

See this guide that explains Medicare Part B Excess Charges.

3. When Is Enrollment In Medicare Automatic?

Enrollment in Parts A and B is automatic when you're 65 and receiving Social Security or Railroad Retirement benefits (of if you have Lou Gehrig's disease or have received Social Security disability benefits for 24 months). If you're automatically enrolled, you'll receive your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability.

4. What Must I Do If I'm Not Automatically Enrolled In Medicare?

You need to sign up for Parts A and B if you aren't already receiving Social Security or Railroad Retirement benefits.

HOW TO SIGN UP FOR PART B IF YOU'RE NOT AUTOMATICALLY ENROLLED. 

We recommend you start the process the first of the month three months before your birthday month (your birthday month is always considered the first of the preceding month if your 65th birthday is on the first of the month).

When you're first eligible for Medicare, you have a 7-month Initial Coverage Enrollment Period ("ICEP") to sign up for Part A and/or Part B. This period begins three months before your 65th birthday month and ends the last day of the third month after your birth date month. Unless you're enrolled in a group plan there will be a penalty and also a restricted enrollment period between January 1 and March 31 if you don't enroll during the ICEP.

5. When Am I Eligible For Medicare?

Use this CALCULATOR to get an estimate of when you're eligible for Medicare.

6. What Can I Do If I Didn't Sign Up For Medicare When First Eligible?

If you're eligible for premium-free Part A (see question 8 for a definition of "premium free" Part A) because you or your spouse have paid Medicare taxes for at least 40 quarters (10 years), you can sign up for Part A at any time.

If you must buy Part A and/or Part B, you can only sign up during a valid enrollment period. If you don't enroll when you're first eligible [generally three months before and up to three months after your 65th birthday month (there are special rules for individuals who don't enroll because they had group coverage)], in most cases you can only enroll in Parts A and/or B between January 1 and March 31 (the "general enrollment period"), and coverage will begin the first of the month following the month you enrolled during the general enrollment period.

You cannot use the annual open enrollment period that runs from October 15 to December 7 to enroll in Medicare Part A or Part B. That enrollment period can only be used by people with Medicare to sign up for drug coverage or Medicare Advantage coverage, or switch coverage that you already have.

There's a late enrollment penalty if you don't sign up for Medicare Part B when first eligible.

There are special rules to sign up for Medicare for anyone who wasn’t able to contact the Social Security Administration because of problems with Social Security’s telephone system between January 1, 2022 and December 30, 2022. Call us at 877-734-3884 (TTY: 711) or go to www.medicare.gov for more information.

You have six months from your Part B effective date to enroll for a Medicare Supplement plan without having to answer medical questions. Otherwise, you can enroll at any time, but you will need to pass medical underwriting rules for the specific carrier you are applying for.

You can enroll in a Medicare Advantage or Medicare Advantage Prescription Drug Plan three months before and up to three months after the later of your Part A or Part B effective date. Otherwise, you can enroll in one of these types of plans ONLY if you have a Special Enrollment Period or during the Annual Enrollment Period.

You can enroll for a stand-alone Part D drug plan three months before and up to three months after the month of your Part A OR Part B effective date, whichever is earlier. Otherwise, you can enroll in a Part D plan ONLY if you have a Special Enrollment Period or during the Annual Enrollment Period.

See the Medicare Supplement, Medicare Advantage (Part C) and/or Part D Prescription Drug plan pages for additional details or call us at 877-734-3884 (TTY: 711) for more information because the rules for enrolling in one of these plans when you've enrolled for Part A or B during general enrollment (or when leaving an employer group plan) are unique and not well understood.

7. What If I Didn't Sign Up For Medicare Because I Had Group Coverage Based on Current Employment?

If you didn't sign up for Parts A and/or B because you had employer group coverage based on current employment and your employer has more than 20 employees, you can enroll in Parts A and/or B any time as long as you or your spouse are working and are covered under group coverage. (If your employer has 20 or fewer employees you should sign up for Part B when first eligible or you will be assessed a late enrollment penalty when you finally sign up.)

If your employer provides group coverage and you are enrolled in an employer group plan, you also have an 8-month period to sign up for Part A and/or B that begins the month after employment ends or the group health plan insurance based on current employment ends. There's no penalty provided you sign up within 8 months after the loss of group coverage.

LEARN MORE about signing up for Medicare Part B. Most individuals of employers with 20 or more employees who are about to retire and have had employer coverage will have been enrolled in Medicare Part A but not Part B, and it's important to sign up through your local Social Security office before the first of the month of retirement and to request that effective date in order to avoid a gap in coverage. You'll need to:

  • Complete an Application for Enrollment in Part B (Form CMS-40B); AND
  • Complete the top portion and have your employer complete and sign a Request for Employment Information (Form CMS-L564).

8. How Much Are Medicare Premiums?

Most Medicare Part A beneficiaries don't have to pay a monthly premium to receive coverage under this part of Original Medicare; this is called "premium-free Part A." Generally, if you've worked at least 10 years (40 quarters) and paid Medicare taxes while you worked, you're eligible for premium-free Part A. Otherwise, you pay a monthly premium.

About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment. Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium to voluntarily enroll in Medicare Part A. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $278 in 2023, a $4 increase from 2022. Certain uninsured aged individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium, which will be $506 a month in 2023, a $7 increase from 2022.

You pay a monthly premium for Part B of Original Medicare. The fee can be higher for people with high incomes (see FAQ 9 below.)

Beneficiaries new to Medicare in 2016 and later pay $164.90 for Part B in 2023, a decrease of $5.20 from the $170.10 paid in 2022. (This is called the "standard" Part B premium.) The decrease for 2023 resulted from Medicare having to set aside lower contingency reserves in 2022 for an Alzheimer’s drug called Adulhelm.

Because of the "hold harmless" provision, increases in Medicare premiums can't cause a person's Social Security benefits to decline from one year to the next. Unless an individual has or ever had to pay IRMAA payments (see question 9), an individual’s net Social Security benefit can’t decrease because of an increase in Part B premiums.

Beneficiaries with Modified Adjusted Gross Incomes (MAGI) above a certain amount (see answer to question 9) pay a higher amount.

Social Security cost of living (COLA) benefit increases are 5.9% in 2022. Click here for more information. Social Security cost of living benefit increases are projected to be much higher for 2023 and will be posted here when the 2023 COLA adjustment is announced.

New Part B Benefit And Premium For Beneficiaries With Kidney Transplants

Beginning in 2023, certain Medicare enrollees who are 36 months post-kidney transplant, and therefore are no longer eligible for full Medicare coverage, can elect to continue Part B coverage of immunosuppressive drugs by paying a premium. For 2023, the immunosuppressive drug premium is $97.10.

9. What Are Part B and Part D Premiums For People With High Incomes?

Individuals filing single returns (as well as married individuals who file separate returns) with income over $91,000 and joint filers with income over $182,000 (these numbers are indexed annually for inflation) in 2020 (note: IRMAA is calculated using income figures two years’ previously) pay additional premiums both for Medicare Part B and for Part D Prescription Drug plans. Learn more about how IRMAA is calculated.

 

IRMAA Premiums for 2022 and 2023

IRMAA is calculated annually based on income reported on the tax return from two years’ previously. If no return has been filed, then they’re based on the most recent income return that is on file with the IRS. The income levels upon which IRMAA is based are adjusted for cost of living, and the various levels in the charts are periodically changed legislatively as well.

See these charts for 2022 IRMAA Part B premiums and for 2022 IRMAA Part D premiums.

See these charts for 2023 IRMAA Part B premiums and for 2023 IRMAA Part D premiums.

Individuals who have experienced one of the following life changing events can file a form SSA-44 to request a reduction in their IRMAA if one of the following events occurs:

  • Marriage
  • Divorce/annulment
  • Death of a spouse
  • Work stoppage
  • Work reduction
  • Loss of income-producing property
  • Loss of pension income
  • Employer settlement payment

The Social Security cost of living (COLA) increase was 5.9% in 2022. The 2023 COLA increase is projected to be significantly higher and will be announced in November 2022.

This table shows the total 2023 IRMAA Part B premium for high-income beneficiaries with immunosuppressive drug only Part B coverage as described in FAQ 8:

10. How Can I Estimate My Medicare Part B Premium If I Have High Income?

Use this CALCULATOR to determine your Medicare Part B Premium.

11. What Are Part A and B Enrollment Requirements For Medicare Supplement, Medicare Advantage, And Part D Prescription Drug Plans?

You must be entitled to Part A AND enrolled in Part B to enroll in a Medicare Advantage plan. There are no medical requirements.

You can buy a Medicare Advantage plan only (1) when you are first eligible; (2) between October 15--December 7 for a January 1 effective date; or (3) during a Special Enrollment Period. You can change to a different Medicare Advantage or Medicare Advantage Prescription Drug Plan between January 1--March 31 during what is called the Open Enrollment Period if you already have a Medicare Advantage or Medicare Advantage Prescription Drug Plan. (If you enroll in a Medicare Advantage or Medicare Advantage Prescription Drug Plan during your initial coverage election period, you can change to a different Medicare Advantage plan during the first three months starting with the month you became eligible for Parts A and B.) LEARN MORE ABOUT MEDICARE ADVANTAGE (PART C) PLANS.

You must be entitled to Part A OR enrolled in Part B (whichever occurs first) in order to buy a Part D Prescription Drug plan. There are no medical questions. You can only buy a Part D Prescription Drug plan when you're first eligible, between October 15--December 7 for a January 1 effective date, during a Special Enrollment Period, or, if you have a Medicare Advantage or Medicare Advantage Plan and elect to go back to Original Medicare during the open enrollment period [(1/1-3/31 or the first three months after enrolling in a Medicare Advantage or Medicare Advantage Prescription Drug Plan during your initial coverage election period (i.e. starting with the month you first became eligible for Parts A and B of Medicare)]. LEARN MORE ABOUT PART D PRESCRIPTION DRUG PLANS.

12. How Can Someone Save Money On Health Care Or Drug Costs?

You may qualify to save money on health care and/or drug costs if you are eligible for any of these programs.

2022 Schedule
Affordable Care Act Open Enrollment

Affordable Care Act open enrollment began November 1, 2021 and ended January 15 on the Federal Facilitated Marketplace (healthcare.gov).
You can only buy an Affordable Care Act plan for the remainder of 2022 if you have a Qualifying Life Event.

Call us at 561-734-3884 or 877-734-3884 to determine
what kind of plan you may be eligible for.


2023 Schedule
Medicare Annual Enrollment Period

Marketing for 2023 plans runs from October 1, 2022 through October 14, 2022.

The Medicare Annual Enrollment Period runs from October 15 through December 7, 2022 for a January 1, 2023 effective date.

Otherwise, you’re eligible to enroll if you’re first becoming eligible for Medicare or are eligible for another type of enrollment period. Enrollment rules differ between Medicare Supplement plans and Medicare Advantage, Medicare Advantage Prescription Drug, and stand-alone Prescription Drug Plans.

Call us at 561-734-3884 (TTY: 711) or 877-734-3884 (TTY: 711) for details.

family consulting

We offer a comprehensive set of Affordable Care Act (“Obamacare”) plans

to individuals and families qualified to buy health (tax- and non-tax subsidized) insurance and dental/vision and/or hearing plans through the Federal marketplace (this is called buying “on-exchange” or “on-marketplace”) or directly from insurance carriers (this is referred to as buying “off-exchange or -marketplace”). Our Affordable Care Act policies comply with the Affordable Care Act and contain all of the “essential health benefits” required by that law.

The dental/vision and/or hearing insurance

products are available both on an insured or discount basis

We offer short-term health insurance policies

for those who are looking for more inexpensive coverage and shorter term alternatives.

We offer Medicare Supplement, Medicare Advantage, and Part D Drug plans

to Medicare beneficiaries. Our site is compliant with federal, state, and carrier guidelines in selling these policies. See the Medicare section of this site for details.

We represent many carriers that offer supplemental benefits

to both individuals and families and Medicare beneficiaries, and the site contains information about hospital indemnity, cancer, critical illness, gap, accident, and international medical insurance offered by many different carriers. This section of the site also contains valuable information and tools about lowering the cost of prescription medications. Call us if you want more information about or would like to enroll in one of these products.

We also offer Short- and Long-Term Disability products

and can also help you meet the costs of long-term care, nursing home, or short-term (recovery) care needs.

Finally, we have a complete array of Life, Final Expense, and Annuity products

and offer pre-need services in Florida, as we have both life insurance and pre-need licenses in that state.

You pay nothing for our services:

we’re paid directly from the carriers we represent, Premiums are NEVER EVER marked up to include paying us for our services: you pay the same whether you order directly from the carrier or the marketplace on your own or directly through us or from our site.

We ONLY offer alternatives that are suitable for you and for which we feel meet YOUR needs.
When or if we feel a product or service is not appropriate for you from either a cost or benefit point of view we will tell you so.

We’re fully compliant with privacy and security guidelines, have signed all required privacy and security agreements, have developed a privacy and security policy, and take extraordinary steps to safeguard your protected health and personal information.
In short, we’re experts in all aspects of health and life insurance and also have relationships with professionals who can help you with very specialized situations.

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