Information for you
This time of year we get a lot of questions about Medicare, how it works, and what your options are for coverage. Below I'm going to make a list of some of our most commonly asked questions. If you have any additional questions, please feel free to send us an email at firstname.lastname@example.org or call us at (573) 893-2110.
Why would I need more health insurance if I have Medicare?
It’s important to understand that Original Medicare, Part A and Part B, doesn’t include most prescription drug coverage. If you’d like Medicare prescription drug coverage, you can get it from a private health insurance company that contracts with Medicare.
Besides getting prescription drug coverage, you may have other options when you’re first eligible for Medicare.
Here’s a quick rundown of your Medicare coverage options beyond Original Medicare:
You typically continue paying your monthly Medicare Part B premium with any of these options.
If you’re content with Original Medicare, Part A and Part B, and you don’t need prescription drug coverage now, and you don’t want to add Medicare Supplement insurance–then you don’t have to make any coverage changes now. Do be aware that if you go without creditable prescription drug coverage for more than 63 days, you might have to pay a late-enrollment penalty if you decide to sign up for a Medicare drug plan later. Creditable prescription drug coverage is other coverage (such as a state pharmaceutical assistance prescription drug program, some employer group coverage, etc.) that provides prescription drug coverage that is as good as a standard Medicare prescription drug plan. If you have other prescription drug coverage, the company you get coverage from is required to inform you if it is considered creditable.
No matter how you decide to get your Medicare coverage, keep in mind that costs and benefits may change from one year to the next, so it’s a good idea to review your coverage annually to make sure it’s still meeting your needs. Premiums, cost sharing expenses, and specific benefits are all subject to change, whether you’re enrolled in Original Medicare, a Medicare prescription drug plan, or a Medicare Advantage plan.
If you’re enrolled in a Medicare Advantage plan or a Medicare Prescription Drug Plan, it’s a good idea to carefully review your plan’s Annual Notice of Change and Evidence of Coverage notices every fall to keep up with any coverage or cost changes. You can make coverage changes during the Annual Election Period (from October 15 to December 7).
What Is a Medicare HMO? What Are the Differences Between an HMO and PPO?
There are four main types of Medicare Advantage plans, but Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans are the most common types. Here is a comparison of the two varieties:
Should I Apply for Medicare or Keep My Employer’s Health Plan?
If you are turning 65 and still working, you might still be covered by your employer’s health insurance plan. Or, perhaps you get benefits through a spouse’s employer coverage.
Before you apply for Medicare, be aware that you might have several insurance options. For example, you may be able to:
It’s important that you contact your employer-based health plan administrator to find out how the plan works with Medicare.
To get the best value and health insurance coverage for your situation, learn about your employer coverage costs, and your costs if you apply for Medicare. You’ll need to do a little research to determine the best arrangement for you. An agent with Invictus Health and Wealth would be happy to sit down and discuss your options with you.
How Much Is the Medicare Late-Enrollment Penalty?
The Medicare program may charge a late-enrollment penalty if you don’t enroll in certain Medicare programs or plans when you’re first eligible. Delaying enrollment could increase your out-of-pocket costs for your coverage. There are late-enrollment penalties for Medicare Part A, Medicare Part B, and Medicare Part D plans.
It’s important to understand the period when you’re first eligible for Medicare. This period is called your Medicare Initial Enrollment Period (IEP), and if you qualify for Medicare by age, it starts three months before you turn 65, includes the month you turn 65, and ends three months later. It lasts for a total of seven months.
Original Medicare refers to Medicare Part A (hospital insurance) and Part B (medical insurance). It is the government-sponsored health care program for those who qualify by age (usually 65 and over). You may also qualify for Medicare before age 65 if you receive Social Security disability benefits. Medicare Part D is optional prescription drug coverage, available from private Medicare-approved insurance companies.
Note that another eligibility requirement for Medicare is U.S. citizenship or permanent legal residence for at least five years in a row.
Medicare enrollment penalty: Medicare Part A
Most Medicare beneficiaries get Medicare Part A premium-free. You won’t be charged a premium for Part A if you or your spouse worked at least 10 years (40 quarters) while paying Medicare taxes. And you’re automatically enrolled in Medicare Part A if you’re already collecting Social Security or Railroad Retirement benefits when you turn 65 or qualify through disability.
If you don’t qualify for premium-free Medicare Part A, and you’re not automatically enrolled, then you may be required to pay a 10% higher monthly premium if you do not enroll when you are first eligible. You will have to pay this higher premium for twice the number of years that you could have had Part A coverage, but did not enroll. The Part A premium can be as high as $458 in 2020 (without the penalty).
For example, if you delayed enrollment in Medicare Part A for one year after your IEP was over, you could pay a 10% higher monthly premium for two years.
Medicare enrollment penalty: Medicare Part B
Medicare Part B may also have a late-enrollment penalty if you don’t sign up when first eligible, depending on your situation. Your monthly premium may go up 10% for each full 12-month period that you went without Part B coverage after your IEP ended. You may have to pay this enrollment penalty for the remainder of the time that you are enrolled in Medicare.
For example, suppose your IEP ended August 6, 2017, and you delayed Medicare Part B enrollment until the Medicare General Enrollment Period (January 1-March 31) in 2020. This would only include one full 12-month period of delay, so in this case you’d pay a 10% penalty on top of your Medicare Part B premium — but you’d pay this penalty for as long as you’re enrolled in Medicare Part B.
Some people choose to defer enrollment in Medicare Part B — such as beneficiaries who are still working and covered by an employer’s group plan. This is an example of a situation that could qualify you for a special enrollment period for Part B, and you might not have to pay the late-enrollment penalty.
Medicare enrollment penalty: Medicare Part D
Medicare prescription drug coverage (Medicare Part D) is optional. If you decide to get this coverage:
The “national base beneficiary premium” may go up each year, so the penalty amount may also go up every year. In addition to your premium each month, you may have to pay this penalty for as long as you have a Medicare Prescription Drug Plan.
How Does Medicaid Help People with Low Incomes Pay Medical Bills?
Medicaid is a joint federal and state program that helps pay medical bills for people with low income and limited resources. Eligibility for Medicaid depends on income level and family size.
Medicaid coverage differs from state to state. In all states, Medicaid pays for basic home health care and medical equipment. Medicaid may pay for homemaker, personal care, and other services that are not covered by Medicare. There are Medicaid programs that pay some or all of Medicare’s premiums and may also pay deductibles and coinsurance for certain people who qualify for Medicare and need financial assistance.
What is a Low Income Subsidy (Extra Help) and how do I apply?
Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS).
Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $5,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
Apply for Extra Help HERE!
I hope this helps clear up some confusion on the complicated topic of Medicare! Please reach out to us if you have any questions!
Here's to an easy and stress free AEP!