844-427-7526

FAQ

 

*Below are common questions about Medicare. If you don’t see an answer to a question you still have, please call us at (844) 427-7526 (Gap Plan)

Can I get a Healthcare Reform Plan in addition to Medicare?

No, it is against the law. The Affordable Care Act was put into place for individuals, families and employees of small businesses to get health insurance. If you are 65 or over and not working, your only choice is Medicare as your health insurance.

Do I need to get a referral to see a specialist?

The answer is NO, if you keep original Medicare A&B as your primary insurance. You can go to any specialist as long as they accept Medicare.

Do I need to chose a primary care doctor?

The answer is NO, if you keep original Medicare A&B as your primary insurance. You can choose your own doctor as long as they accept Medicare.

Can I get health care from any doctor, healthcare provider or hospital?

The answer is YES, if you keep original Medicare A&B as your primary insurance and go to any doctor, health care provider, hospital, or facility that accepts original Medicare.

What preventative services are covered by medicare?

Medicare generally covers the following services at 100% to keep you healthy:

What is not covered by Medicare A&B and supplement?

Long term care, routine dental, dentures, vision care, elective cosmetic surgery, acupuncture, hearing aids and exams for fitting them.

Why does Medicare use my Social Security number on my Medicare card?

The short answer is that the government has dragged its feet and it will be very expensive to change it. The government never thought when they first put the Social Security number on the card in 1966, all the fraud there could be down the road. Since there are over 48 million Americans that carry a Medicare card, estimates are it could cost over $800 million to issue new card numbers and upgrade computer systems. As of now there is nothing in the foreseeable future to change it.

What is my Medicare Claim Number?

The Medicare Claim Number is your Social Security number with a letter after it. It is needed to file all your Part A(Hospital) & B (Medical) bills with Medicare. The insurance company that you will choose for the Medicare Supplement will need this as well. The most common letters after a Social Security number is A, B, D and T. (A) signifies you are drawing Social Security benefits under your information, and (T) signifies you are taking Medicare but holding off on your Social Security benefits. (B) signifies that you are qualified because your spouse paid into Medicare taxes. (D) signifies you are qualified under a deceased spouse paying into Medicare taxes.

Am I required to purchase a Part D (Drug Plan)?

The answer is No and Yes. No, you don’t have to purchase a plan, but you will probably want to even if you are not taking any prescriptions. If you don’t purchase a Part D (Drug Plan) when first Medicare Eligible for your Part B you will have a 1% penalty and can only select a plan during the Annual Enrollment in October 15th– December 7th. The Part D drug plans are very reasonably priced as low as around $12.

Does Medicare cover prescriptions?

Original Medicare A(Hospital)&B(Medical) does not cover prescription drugs. If you want or need prescription drug coverage, you will need to join a Part D (Drug Plan).

Can a Medicare Supplement company drop me for any reason after my Open Enrollment or Guaranteed Issue Period?

No. The only way you can lose your coverage is for lack of paying your monthly premium or calling the insurance company and cancelling your policy. A Medicare Supplement plan is month to month and you are not stuck in a long term contract. As long as you pay, you stay.

Are Medicare (Medigap) Supplement plans all the same?

Yes!! Medicare (Medigap) Supplement plans are standardized and the benefits are the same no matter what insurance company you choose. The only difference is the rating (quality) and pricing the company is charging.

What is the General Enrollment Period?

If you didn’t sign up for your Medicare A&B when you were first eligible and aren’t eligible for a Special Enrollment you can sign up from January 1st-March 31st of every year. Your coverage will not start until July 1st and you will have a penalty.

What is the Annual Enrollment Period?
  • This period runs every year between October 15th-December 7th.
  • During this period someone on a Medicare Part D (Drug Plan) can chose to change their prescription drug plan to any other plan for a January 1st start date.
  • During this period someone on a Medicare Advantage Plan (Part C- Private Insurance), can chose to go back to original Medicare A&B for January 1st, pick a Part D (Drug Plan), and if they can medically qualify purchase a Medicare Supplement plan.
  • Important Note- Someone on a Medicare Supplement plan does not have to wait until the Annual Enrollment to change to a different company. You can change anytime during the year. Since the plans are federally regulated and the benefits are the same with every company you can change if you can medically qualify for a lower rate with another company. The Annual Enrollment period for someone on a Medicare Supplement only applies to making changes to their Part D (Drug Plan).
What is the Medicare Open Enrollment Period?
  • This is the best time to purchase a Medicare Supplement!! An insurance company cannot ask you any medical questions or turn you down for any preexisting conditions. You are guaranteed to get the Medicare Supplement with whichever company you decide to go with. The Open Enrollment starts 6 months before your Part B is effective, the month your Part B starts, and 5 months thereafter. After this period ends, your option to purchase a Medicare Supplement can be very limited. An insurance company is allowed to ask medical questions after the Open Enrollment period and opt not to offer you coverage.
  • Important- Word of advice. Sign up as early in your 6 month Open Enrollment as possible. This allows you to be able to guarantee and ensure the pricing for your start date with the insurance company you choose to go with. The longer you wait to sign up, you could end up paying more for the same coverage. Here is an example of how early you can sign up for your Medicare Supplement:

(Example: You are turning 65 on 08/14/1949. You can sign up for the Medicare Supplement as of 02/01/2014 to secure and guarantee the rate for the start date on 08/01/2014).

How do I pay for Medicare?
  • Part A is typically free as you or a spouse has paid into the Medicare taxes while working.
  • Part B does have a premium which for most people is $134. If you are drawing Social Security the monthly premium will be withdrawn out of your Social Security check each month. If you are not drawing Social Security, you will be billed quarterly until such time you start drawing your Social Security.
Do I need to go on Medicare if I am still working at 65?
  • No, as long as you or your spouse is still working and you have group health insurance through you or your spouse’s employer. You can hold off on starting your Part B and not have to worry about a penalty.
  • Once the employment or coverage ends after 65, most people want to sign up for Medicare Part B right away. You can sign up as early as 90 days prior. You technically have 8 months to sign up for your Part B without a penalty after employment or coverage ends. If you wait longer than 8 months, you will have to pay a penalty even if you have chosen COBRA.
  • If you or a spouse is still working and you can keep the coverage, check to see if going on Medicare with a Medicare Supplement will save you money to do so. You may find it would be beneficial to drop the group employment insurance and sign up for Medicare and purchase a Medicare Supplement.
Can I still get Medicare at 65 if I am not drawing Social Security?
  • Absolutely!! Remember, you automatically get your Medicare A&B if you are drawing Social Security when you turn 65. However, if you want to hold off on drawing Social Security payments but still what to get your Medicare A&B card, you can apply 90 days prior to your 65th birth month.

(Example: You turn 65 on 08/14/1949, you can apply for Medicare online through Social Security at the following link http://www.ssa.gov/medicareonly/ or in person at your local Social Security office any time after 05/01/2014).

When does my Medicare start?
  • Your Medicare will start on the 1st day of your 65th birth month. (Example: If your birthday is 08/14/1949, your Medicare A&B will start on 08/1/2014.)
  • If you are born on the 1st day of the month, you get to start Medicare A&B the 1st day of the prior month.

(Example: If your birthday is 08/01/1949, your Medicare A&B will start on 07/1/2014.)

Who is eligible for Medicare?
  • Generally, people are eligible for Medicare if they meet the following requirements:

    • They or their spouses worked for at least ten years (40 quarters) in Medicare-covered employment. (Medicare-covered employment means employment that requires paying FICA taxes to Social Security and Medicare.)
    • They are 65 years old. A person can also qualify for coverage if he or she is a younger person with a disability or with chronic kidney disease.
    • They are citizens (by birth or naturalization), permanent residents of the United States, or they are legal resident aliens who have lived in the United States for at least five years.
Do I receive a notice about Medicare when I turn 65?

If you are already receiving Social Security benefits, you will get information about Medicare in the mail three months before you turn 65. If you are not receiving Social Security benefits, you will not receive a notice in the mail letting you know that you are eligible for Medicare. You must enroll in Medicare yourself by contacting Social Security at 800-772-1213 or by going online at www.ss.gov or www.medicare.gov to sign up for Parts A and B of Medicare. Our Client Experience Group can help walk you through the enrollment process as we are committed to providing expert support to Medicare Beneficiaries by simplifying the Medicare process from start to finish.

Do I have to pay for Medicare?

Part A is free if you or your spouse has worked and paid taxes to Medicare for at least 40 quarters (10 years). If you do not have enough working quarters, you will have to pay a premium for Part A. Part B always has monthly premium. If you have a Medigap or Part D plan you may have to pay a monthly premium for these as well. Keep in mind that Medicare Advantage (MA) plans have different costs than Original Medicare. If you have a low income, you may qualify for programs that can help pay your Medicare premiums and other costs.

Do I need both Parts A and B?

Whether you need Medicare Part A and Part B depends on whether Medicare will be your primary or secondary insurer. Part A is hospital insurance and Part B is medical insurance. If your current employer insurance is primary, you do not need either Part A or Part B. However, most people choose to take Part A because it is free for them. If your Medicare is primary because, for example, you have retiree insurance or COBRA coverage you need both Part A and Part B. It is important to speak to one of our Client Enrollment Specialists to make sure you are making the right decision.

If I wait to take Part B, will I face a penalty?

You will have to pay a monthly Part B late enrollment penalty if you do not sign up for Part B when you first become eligible for Medicare or during a Special Enrollment Period (SEP). If you do have insurance from a current employer, you must enroll within eight months of retiring or losing coverage, or you will have to pay a penalty. It is important to speak to one of our Client Enrollment Specialists to make sure you are making the right decision.

Will money be taken out of my Social Security check for Medicare?

Part A is free for most people. You only pay a premium for Part A if you or your spouse have not worked and contributed to Social Security for 40 work quarters (10 years). Most people pay a monthly premium for Part B. You can either write a check to Social Security or have the Part B premium automatically taken out of your Social Security check. If you have a Medicare Savings Program (MSP) that pays your Part B premium, your state pays the premium and it should not be deducted from your Social Security check.

How do I pay for Medicare if it is not automatically taken out of my Social Security check?

If your Part B premium is not automatically taken out of your Social Security check, you can mail a check to your local Social Security office. However, it is a good idea to have your Part B premium taken out of your Social Security check automatically. If you’re not drawing Social Security but still take your Medicare Part B you will receive a “Medicare Premium Bill” in the mail.  The “Medicare Premium Bill” (CMS-500) is a bill for people who pay Medicare directly for their Part A premium, Part B premium, and/or Part D IRMAA (an extra amount in addition to the Medicare Part D premium). Your bill pays for next month’s coverage. Your bill lists the dates you’re paying for. If you have any questions our Client Experience Group will make sure to assist you.

What should I do if I get a “Medicare Premium Bill” (CMS-500)?

Follow the instructions on the bill to pay the total amount due, so Medicare gets your payment by the 25th of the month. If your bank offers an online bill payment service, you can use it to pay your Medicare premiums electronically. You can also pay by check, money order, or credit card/debit card. The best thing to do is sign up for Medicare Easy Pay. Medicare Easy Pay is a free, electronic payment option that allows people to have their Medicare premium payments automatically deducted from a savings or checking account each month. You can download the form Authorization Agreement for Pre-authorized Payments form (SF-5510) and mail it to the Medicare Premium Collection Center, PO Box 979098, St. Louis, MO 63197-9000 and you will be set up on reoccurring draft payments for your Medicare which is simple and easy. If you have any questions our Client Experience Group will make sure to assist you.

I’m thinking of not taking Part B. Who do I need to talk to?

Before making any decisions about enrolling in or opting out of Part B, talk to one of our experienced Client Enrollment Specialists. You may not have any medical coverage if you do not have other primary insurance. If you do have another form of health insurance, contact the plan’s benefits administrator to find out how that plan works with Medicare.

My income is low. Are there programs that can help me afford my Medicare premiums?

Yes. Every state has Medicare Savings Programs (MSPs) that can help pay your Part B premium. A Medicare Savings Program may also pay Medicare copays and deductibles. You can also see if you are eligible for Extra Help. Extra Help is a federal program that can help pay your Part D prescription drug costs.

Is there additional insurance I can buy to pay for the deductibles and coinsurance that Medicare does not pay for?

Yes. Supplemental insurance called Medigap policies can help pay for your Medicare copays and deductibles. Medigap policies only work with Original Medicare. You can only buy Medigap policies at certain times in some states. Check with one of our Client Enrollment Specialists to find out when you have the right to buy a Medigap plan.

When is the best time to purchase a Medigap Supplement Plan?
The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This 6-month period begins on the first day of the month in which you’re 65 or older and enrolled in Part B. (Some states have additional Open Enrollment Periods.) After this enrollment period, you may not be able to buy a Medigap policy. Check with one of our Client Enrollment Specialists to find out when you have the right to buy a Medigap plan.
Do I need to get a referral to see a specialist with Medicare?

No. If you keep original Medicare A&B as your primary insurance you can go to any specialist as long as they accept Medicare. It is important to talk to one of our Client Enrollment Specialists to make sure you have Medicare as your primary insurance and are making the right decision.

Do I need to choose a primary care doctor with Medicare?

No. If you keep original Medicare A&B as your primary insurance you can choose your own doctor as long as they accept Medicare. It is important to talk to one of our Client Enrollment Specialists to make sure you have Medicare as your primary insurance and are making the right decision.

Can I go to any hospital with Medicare?

Yes. If you keep original Medicare A&B as your primary insurance, you can go to any hospital or facility that accepts original Medicare. It is important to talk to one of our Client Enrollment Specialists to make sure you have Medicare as your primary insurance and are making the right decision.

Is a Medicare Advantage Plan a Supplement?

No, a Medicare Advantage plan is not a supplement. For those that choose this option, they will now receive their healthcare coverage from a private insurance company and no longer from Medicare. It is important to talk to one of our Client Enrollment Specialists to make sure you have Medicare as your primary insurance and are making the right decision.

What services does Medicare not cover?

Some of the items and services that Medicare doesn’t cover include:

  • Long-term care (also called custodial care)
  • Most dental care
  • Eye examinations related to prescribing glasses
  • Dentures
  • Cosmetic surgery  
  • Acupuncture  
  • Hearing aids and exams for fitting them
  • Routine foot care
I’m 65, but my spouse is 60. Can my spouse get Medicare, too?

Your spouse cannot get Medicare based on your eligibility. To qualify for Medicare, an individual must be:

  • age 65
  • or have received Social Security Disability Insurance (SSDI) for 24 months,
  • or have End-Stage Renal Disease (ESRD),
  • or have ALS (Lou Gehrig’s disease).
I’m 63 and I just lost my job. Can I get Medicare early?

Unlike Social Security retirement benefits, you cannot take Medicare early. Unless you have been receiving Social Security Disability Insurance benefits (SSDI) for 24 months or have ESRD or ALS, you must wait until you are 65 to receive Medicare.

NOT SURE WHAT MEDICARE PLAN IS RIGHT FOR YOU?