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Most Commonly Asked Questions

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Q: How much do you charge to help me?

A: Absolutely nothing! There is never a charge or any obligation to use our services. They are free.

Q: Do I have to take Medicare Part B and pay the premium?

A: Technically no, but if you do not sign up for Part B when first eligible and do not have creditable coverage through an Employer or elsewhere, you could face a late enrollment penalty (LEP) when you do sign up. Additionally, when signing up in this circumstance, there are usually considerable delays in getting the coverage in force. So, as a general rule, it is better to sign up when first eligible unless you have creditable coverage you are planing to keep.

Q: I am still working and covered at my job. Will I be fined if I don’t sign up for Medicare when I turn 65?

A: Once you become eligible for Medicare, as long as you are covered by a health plan that is considered to be “creditable” (meaning: at least as good as Medicare), you will not be fined for delaying signing up for Medicare. Once you decide you are going to drop your creditable coverage, you will need to sign up for Medicare Part B within a certain time frame (Special Election Period) to avoid a late enrollment penalty (LEP).

Q: I have always been a mother and homemaker and have not worked outside the home. My husband has always worked and paid taxes. Will I qualify for Medicare?

A: If your husband worked at least 40 quarters (10 years) and paid US taxes during that time, then you will likely qualify for Medicare based on his work history.

Q: I don’t take any medications and don’t need the coverage. Do I really need to sign up for Part D? What happens if I don’t?

A: This is a common question. It is hard to buy something you feel like you don’t need. Medicare Part D is voluntary. So, technically, you don’t have to sign up if you decide not to. However, if you don’t sign up when first eligible and do not have coverage at work acceptable to Medicare, you will face a Late Enrollment Penalty when you finally do sign up later.

The good news is that there are usually relatively inexpensive plans available for situations like this.

Another way to satisfy this need is to find a Medicare Advantage plan (that your DR accepts) that includes Part D coverage within the plan structure.

Q: My income is low and I cannot afford Part B of Medicare. What do I do?

A: If you are having trouble paying your Part B premium, you might consider checking with your state’s Medicaid program to see if you qualify for additional support.

Q: My 65th birthday is coming up but I am planning to work a few more years. Do I have to sign up for Medicare or can I just stay on the company plan?

A: The full answer to this depends on certain circumstances (type of plan, number of employees, etc). Generally speaking however, you can always elect to stay on your Company plan. Employer group insurance, if offered, must be offered to all employees. That being said, you are not required to take it. We highly encourage you to investigate your Medicare Rights. You paid taxes for many years and might be surprised by how good these plans are! Many people over 65 drop employer coverage in favor of Medicare and continue to work for many years.

Q: I am turning 65 next month, am covered by an ACA policy, and am being treated for several conditions. Will I be covered?

A: Yes! Your conditions will be covered! When you enroll during your one-time open enrollment period, you do not have to worry about your pre-existing conditions being covered!

Note: One item you do want to pay close attention to is the type of coverage you choose. There are generally two options: Medicare supplement and Medicare Advantage. It is important you understand fully how each works so you can choose the right type of plan for you.

Q: How much does Part A cost?

A: For most Americans, Part A of Medicare is premium-free by virtue of taxes paid during working years. If you worked at least 40 quarters (10 years) and paid taxes during that time, you should not have a premium for Part A. However, if you did not work at least 40 quarters, there may be a premium. For example, if you worked less than 40 quarters but more than 30, your monthly premium would be $252. Less than 30 quarters and the monthly premium would be $458. If you have questions, call us!

Q: Will I have to change Doctors?

A: We know your DRs are important to you! Our goal is to find a plan that your DR accepts so you do not have to change.

Q: How can a Medicare Advantage plan premium be $0 and be any good?

A: Medicare Advantage plans are very popular and offer excellent coverage. They are not free…even the $0 versions! The taxes you paid all those years helped to fund these programs. In addition to payments from the federal government, your Part B premium is paid to the carrier providing your plan. So, while the plan may be $0 (or a low amount) to you, they are not free!

Q: Can I travel with my plan?

A: Yes! All Medicare Advantage plans are required to provide out-of-network emergency coverage and many are beginning to offer nationwide networks. Medicare supplements are generally accepted anywhere in the United States. Some plans may also offer limited coverage outside the United States.

Q: How do I get drug coverage?

A: Everyone that is eligible for Part A and/or enrolled in Part B can enroll in a Medicare Part D drug plan. These plans are issued by private companies that are contracted by the federal government to provide this coverage. The most common times to add or adjust Medicare Part D drug coverage is when you first turn 65 (or otherwise become eligible for Medicare), during the Annual Election Period that occurs each year from October 15- December 7th, and at certain other times during the year when you qualify for a Special Election Period (SEP). Contact us with additional questions or a free assessment.

Q: I take very expensive medications and it really eats into my monthly budget. What can I do?

A: You can apply for Extra Help from Medicare to help lower the costs. There are different levels available based on income and other circumstances. You can also check and see if your state has a pharmaceutical assistance program that might benefit. Finally, many drug companies have special programs to help those who are struggling to pay for medication.

Q: I heard I can get my $144 Part B premium back. What is that about?

A: In many areas, there are Medicare Advantage plans that offer a Part B premium reduction that essentially returns part of the Part B premium. Be aware that many of these plans offering a Part B reduction do not cover medications (MA only) and are actually intended for veterans who get medications from the VA or people who have creditable RX benefits as part of a retirement package. In recent years, however, more plans are being offered that include a Part B premium reduction and also drug coverage. Just be aware of which one you are considering. Contact us to see what is available in your area.

Q: I heard Medicare covers Long Term Care, is this true?

A: Unfortunately, no. Medicaid will cover long term care in many states, but Medicare does not. Medicare does not cover long term care and does not cover custodial care. To get information about how Medicaid covers long term care, contact your state’s Medicaid office.

Q: I am a veteran and use the VA, but I also have Medicare. Do I have additional options?

A: Thanks for your service! Yes! Many veterans choose to enhance the VA coverage they currently have by adding a Medicare plan. By utilizing both programs, additional benefits and flexibility is often possible.

Q: I have heard you can be fined by Medicare if you don’t sign up right away. Is this true?

A: Yes. They are called Late Enrollment Penalties (LEP) and are assessed by Medicare. They pertain to both Part B and Part D (RX drugs). These penalties are only assessed if you did not enroll in them when eligible AND did not have creditable coverage in place such as an employer group plan. In other words, you were either uninsured or were in a plan that Medicare did not consider creditable.

So, as long as you are covered by a creditable plan, it is perfectly fine to delay Parts B and/or D of Medicare until you are either dropped from the Employer plan or decide to retire.

When assessed, The Part B premium is 10% of the premium for each year you did not have Part B and were not otherwise covered. The Part D penalty is 1% of a benchmark premium for every month you did not have coverage without creditable coverage. These penalties remain in place for as long as you are in the program.

Q: Does Original Medicare cover dental?

A: Original Medicare does not cover dental. Options for dental coverage would include purchasing a “stand alone” plan offered by an insurance coverage or by enrolling in a Medicare Advantage plan which includes dental as an extra benefit.

Q: Does Medicare cover vision and hearing?

A: Unlike dental, Medicare will cover some aspects of both vision and hearing. For anything that is caused by a medical issue (like glaucoma or cataracts or an inner ear issue), Medicare will treat like a medical issue and will cover as such. However, Medicare will NOT cover routine vision and routine hearing exams. Additionally, in most cases, Medicare will not cover glasses or hearing aids. Options to cover these services would include, like dental, a “stand alone” plan or to enroll in a Medicare Advantage plan that offers these benefits.

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