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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 is medical insurance. Part B covers certain medical expenses like doctor's office visits, blood tests, x-rays. diabetic screenings and supplies, Medicare approved preventive care services, and outpatient care.

*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. Note: In New York, the most a physician who does not accept assignment can charge for services covered by Medicare is 105% of the Medicare allowable expense 115% for routine office visits covered by Medicare. This additional charge is referred to as “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 at any time.

If you have to 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 between January 1 and March 31 (the "general enrollment period") and coverage will start July 1. There's a late enrollment penalty if you don't sign up for Medicare Part B when first eligible.

Note: If you enrolled for Part A or B of Medicare during the general enrollment period, you need to enroll between April 1 and June 30 for a July 1 effective date for a Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan. If you delay until July 1 or later, you can only enroll in one of these types of plans if you have a Special Enrollment Period or during the Annual Enrollment Period that runs between October 15 and December 7.

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.

You can enroll for a 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 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 providing 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.

You can purchase Part A if you are a U.S. citizen or lawful resident. In 2020 you may have to pay up to $458 each month; premiums are determined based on your quarters of Medicare credit. In most cases you must also enroll in Part B and pay monthly premiums for both.

You pay a monthly premium for Part B of Original Medicare. The fee can be higher for people with high incomes. A different government program, Medicaid, can help cover Medicare Part B premiums for low-income beneficiaries.

Beneficiaries new to Medicare in 2016 and later pay $144.60 for Part B in 2020, an increase of $9.10 from the $135.50 paid in 2019. (This is called the "standard" Part B premium.)

Because of what is called 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. Social Security has announced a 1.6% increase in cost of living increases for 2020; the average increase is estimated to be $24. 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.

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 $87,000 and joint filers with income over $174,000 (note: beginning in 2020 these numbers are indexed annually for inflation; they were formerly $85,000 and $170,000 respectively) pay additional premiums both for Medicare Part B and for Part D Prescription Drug plans. These additional premiums are called the "Income Related Monthly Adjustment Amount" (or "IRMAA") and are adjusted annually. Estimates are that about 7% of all Medicare beneficiaries are affected.

 

IRMAA Premiums for 2020

See these charts for 2020 IRMAA Part B premiums and for 2020 IRMAA Part D premiums.

IRMAA payments affect about 7% of all Medicare beneficiaries. The government is shifting increasing amounts of Medicare Part B and D funding to high-income Medicare beneficiaries, and IRMAA calculations have changed significantly each year over the past several years.

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

If you have more than one life changing event, have any questions, or need help in applying for a reduction, call Social Security at 800-772-1213.

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 buy a Medicare Supplement plan. If you're buying a plan during open enrollment or have a guaranteed issue right, there are no health questions to answer. Otherwise, you must pass the carrier's medical underwriting requirements to be eligible. You can buy a Medicare Supplement Plan any time during the year. LEARN MORE ABOUT MEDICARE SUPPLEMENT 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, except a question about end stage renal disease. Generally, if you have ESRD, you can't buy a plan from a carrier unless you’ve had continuous coverage from that carrier prior to applying for a Medicare Advantage plan from that carrier. 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.

2020 Schedule
Affordable Care Act Open Enrollment
November 1, 2019 Open Enrollment begins.
December 15, 2019 is the last day to enroll for 2020 on the federal facilitated marketplace.
January 1, 2020 Coverage starts.

2020 Schedule
Medicare Annual Enrollment Period
October 1, 2019 Pre-enrollment period starts. 2020 plans can be discussed.
October 15, 2019 Enrollment starts.
December 7, 2019 is the last day to enroll for a 2020 plan.
January 1, 2020 Coverage starts.

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