Medicare Frequently Asked Questions

Table of Contents

  1. What is Medicare?
  2. What Does Medicare Part A Cover?
  3. What does Medicare Part B cover?
  4. What does Medicare Part A and B cost?
  5. What is not covered by Medicare Part A and B?
  6. Will I be automatically enrolled in Medicare Part A and Part B?(
  7. I have employer or union coverage should I get Part B?
  8. When can I join health or drug plan?
  9. How do I apply for Medicare?
  10. When Should I apply for Medicare?
  11. What is a Medicare Cost Plan?
  12. What is the cost of Medicare Part D?
  13. What is a Medicare Advantage Plan?
  14. Where can I find additional information about Medicare?
  15. How to replace a Medicare card


What is Medicare?

Introduction

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage Plans)

A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D (Prescription Drug Coverage)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Source: https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html

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What Does Medicare Part A Cover?

Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition. If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.

In general. Part A covers:

2 ways to find out if Medicare covers what you need

  • Talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that's usually covered and your provider thinks that Medicare won't cover it in your situation, you'll have to read and sign a notice saying that you may have to pay for the item, service, or supply.
  • Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors

  • Federal and state laws
  • National coverage decisions made by Medicare about whether something is covered.
  • Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

Source: https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html

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What does Medicare Part B cover?

What's Covered?

Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition. If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.

Part B covers 2 types of services

  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best. You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.

Part B Covers Things Like:

2 ways to find out if Medicare covers what you need

  • Talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that's usually covered and your provider thinks that Medicare won't cover it in your situation, you'll have to read and sign a notice saying that you may have to pay for the item, service, or supply.
  • Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors

  • Federal and state laws
  • National coverage decisions made by Medicare about whether something is covered.
  • Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

Source: https://www.medicare.gov/what-medicare-covers/what-part-b-covers

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What does Medicare Part A and B cost?

2020 costs at a glance
Part A premium Most people don't pay a monthly premium for Part A (sometimes called "premium-free Part A"). If you buy Part A, you'll pay up to $458 each month. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $252.
Part A hospital inpatient deductible and coinsurance You pay:
  • $1,408 deductible for each benefit period
  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $352 coinsurance per day of each benefit period
  • Days 91 and beyond: $704 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs
Part B premium Most people pay $144.60 each month.
Part B deductible and coinsurance $198 per year. After your deductible is met, you typically pay 20% of the Medicare-approved amountM for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.
Part C premium The Part C monthly premium varies by plan.
Part D premium The Part D monthly premium varies by plan (higher-income consumers may pay more).

Detailed Medicare Part B cost information for 2020

If your yearly income in 2018 (for what you pay in 2020) was

File individual tax return File joint tax return File married & separate tax return You pay (in 2020)
$87,000 or less $174,000 or less $87,000 or less $144.60
above $87,000 up to $109,000 above $174,000 up to $218,000 Not applicable $202.40
above $109,000 up to $136,000 above $218,000 up to $272,000 Not applicable $289.20
above $136,000 up to $163,000 above $272,000 up to $326,000 Not applicable $376.00
above $163,000 up to $500,000 above $326,000 up to $750,000 above $87,000 and less than $413,000 $462.70
above $500,000 above $750,000 above $413,000 $491.60

Source: https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html#collapse-4809

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What is not covered by Medicare Part A and B?

Medicare doesn't cover everything. If you need certain services that Medicare doesn't cover, you'll have to pay for them yourself unless you have other insurance or you're in a Medicare health plan that covers these services.

Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments.

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

Find out if Medicare covers a test, item, or service you need.

Source:https://www.medicare.gov/what-medicare-covers/not-covered/item-and-services-not-covered-by-part-a-and-b.html

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Will I be automatically enrolled in Medicare Part A and Part B?(Some people get Part A & Part B automatically

You may qualify for Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) if one of the following applies to you:

If you get Medicare automatically

If you're automatically enrolled, you'll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability.
Some people need to sign up for Part A & Part B
You need to sign up for Part A and Part B if:

  • You aren't getting Social Security or RRB benefits (for example, because you're still working).

Note

If you have coverage through a current or former employer, it's important to understand how your current coverage works with Medicare before making any decisions.

  • You qualify for Medicare because you have End-Stage Renal Disease (ESRD) .
  • You live in Puerto Rico and want to sign up for Part B (you automatically get Part A).You must already have Part A to apply for Part B. Complete an Application for Enrollment in Part B (CMS-40B). Get this form and instructions in Spanish.

Note

Learn more if you’re signing up for Medicare based on the work record of a same-sex spouse.

Learn how to sign up for Medicare if you have coverage through the Health Insurance Marketplace.

Source: https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-how-to-sign-up-for-part-a-and-part-b.html

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I have employer or union coverage should I get Part B?

If you or your spouse (or family member if you're disabled) are still working and you have insurance through that employer or union, contact your employer or union benefits administrator to find out how your insurance works with Medicare. This includes federal or state employment, but not military service (unless on active duty). It may be to your advantage to delay Part B enrollment.

Note

You can sign up for Part B without a penalty any time you have health coverage based on current employment. (COBRA and retiree health coverage don't count as current employer coverage.)

When employer/union coverage ends

Once your employment (or your employer/union coverage) ends, 3 things happen:

  • You may be able to get COBRA coverage, which continues your health insurance through the employer's plan (in most cases for only 18 months) and probably at a higher cost to you.
  • You have 8 months to sign up for Part B without a penalty, whether or not you choose COBRA. To sign up for Part B while you're employed or during the 8 months after employment ends, complete an Application for Enrollment in Part B (CMS-40B) and a Request for Employment Information (CMS-L564). If you choose COBRA, don't wait until your COBRA ends to enroll in Part B. If you don't enroll in Part B during the 8 months after the employment ends:
  • You may have to pay a penalty for as long as you have Part B.
  • You won't be able to enroll until January 1–March 31, and you'll have to wait until July 1 of that year before your coverage begins. This may cause a gap in health care coverage.
  • If you already have COBRA coverage when you enroll in Medicare, your COBRA will probably end. If you become eligible for COBRA coverage after you're already enrolled in Medicare, you must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have End-Stage Renal Disease (ESRD)). Learn more about how Medicare works with other insurance.

What if I don’t want Medicare Part B?

Source: https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-how-to-sign-up-for-part-a-and-part-b.html

If your Medicare hasn’t started yet, there are 2 ways to drop Part B:

  • If you were automatically enrolled in both Part A and Part B and sent a Medicare card, follow the instructions that come with the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.
  • If you signed up for Medicare through Social Security, contact Social Security.

Learn more about whether you should get Part B.

Note

You must pay your Part B premium every month for as long as you have Part B (even if you don’t use it).
If your Medicare has started and you want to drop Part B, contact Social Security for instructions on how to submit a signed request. Your coverage will end the first day of the month after Social Security gets your request.

Note

If you drop Part B, you generally won’t be able to enroll in Part B again until the next General Enrollment Period (January 1 – March 31st) and you may have to pay a late enrollment penalty

Source: https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-3156M

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When can I join health or drug plan?

When you decide how to get your Medicare coverage, you might choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D) .

There are specific times when you can sign up for these plans, or make changes to coverage you already have. You don’t need to sign up for Medicare each year. However, each year you’ll have a chance to review your coverage and change plans.

When you first get Medicare

What can I do?

Sign up for a Medicare Advantage Plan and/or a Medicare Prescription Drug Plan.

I am newly eligible for Medicare because I turned 65.

When?

During the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you turn 65, your coverage will begin the first day of the month you turn 65.

I am newly eligible for Medicare because I have a disability (under 65).

What can I do?

Sign up for a Medicare Advantage Plan or a Medicare Prescription Drug Plan. Your Medicare coverage begins 24 months after you get Social Security or Railroad Retirement Board (RRB) disability benefits.

When?

During the 7-month period that starts 3 months before your 25th month of getting Social Security or RRB disability benefits and ends 3 months after your 25th month of getting disability benefits. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you first get Medicare, your coverage will begin the first day of your 25th month of entitlement to disability payments.

I am already eligible for Medicare because of a disability, and I turned 65.

What can I do?

  • Sign up for a Medicare Advantage Plan and/or a Medicare Prescription Drug Plan.
  • Switch from your current Medicare Advantage Plan or Medicare Prescription Drug Plan to another plan.
  • Drop a Medicare Advantage Plan or a Medicare Prescription Drug Plan completely.

When?

During the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
If you sign up for a Medicare Advantage Plan during this time, you can drop that plan at any time during the next 12 months and go back to Original Medicare.

I do not have Medicare Part A coverage, and I enrolled in Medicare Part B during the Part B General Enrollment Period (January 1–March 31).

What can I do?

Sign up for a Medicare Prescription Drug Plan.

When?

April 1–June 30

I have Medicare Part A coverage, and I enrolled in Medicare Part B during the Part B General Enrollment Period (January 1–March 31).

What can I do?

Sign up for a Medicare Advantage Plan (with or without drug coverage).

When?

April 1–June 30

During certain times each year (yearly enrollment periods for Part C & Part D)

Each year, you have a chance to make changes to your Medicare Advantage or Medicare prescription drug coverage for the following year. There are 2 separate enrollment periods each year.

Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage.

What can I do?

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn't offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn't offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare drug plan to another Medicare drug plan.
  • Drop your Medicare prescription drug coverage completely.

When?
October 15–December 7

Source: https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html

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How do I apply for Medicare?

How can I sign up for Part A & Part B?

Note

Medicare is managed by the Centers for Medicare & Medicaid Services (CMS). Social Security works with CMS by enrolling people in Medicare.

Note

You don’t need to sign up for Medicare each year. However, each year you’ll have a chance to review your coverage and change plans.

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When Should I apply for Medicare?

You should sign up for Medicare three months before reaching age 65, even if you are not ready to start receiving retirement benefits. You can opt out of receiving cash retirement benefits now once you are in the online application. Then you can apply online for retirement benefits later.

With our online application, you can sign up for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Because you must pay a premium for Part B coverage, you can turn it down.

If choose not to enroll in Medicare Part B and then decide to do so later, your coverage may be delayed and you may have to pay a higher monthly premium for as long as you have Part B. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didn’t sign up for it, unless you qualify for a "Special Enrollment Period."

Special Enrollment Period (SEP)

If you have medical insurance coverage under a group health plan based on your or your spouse's current employment, you may not need to apply for Medicare Part B at age 65. You may qualify for a "Special Enrollment Period" (SEP) that will let you sign up for Part B during:

  • Any month you remain covered under the group health plan and your, or your spouse's, employment continues; or
  • The 8-month period that begins with the month after your group health plan coverage or the employment it is based on ends, whichever comes first.

Source: https://www.socialsecurity.gov/medicare/apply.html#&a0=1

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What is a Medicare Cost Plan?

Medicare Cost Plans are a type of Medicare health plan available in certain areas of the country.
Here's what you should know about Medicare Cost Plans:

  • You can join even if you only have Part B.
  • If you have Part A and Part B and go to a non-network provider, the services are covered under Original Medicare. You would pay the Part A and Part B coinsurance and deductible.
  • You can join anytime the plan is accepting new members.
  • You can leave anytime and return to Original Medicare.
  • You can either get your Medicare prescription drug coverage from the plan (if offered), or you can join a Medicare Prescription Drug Plan (Part D).

Another type of Medicare Cost Plan only provides coverage for Part B services. These plans never include Part D. Part A services are covered through Original Medicare. These plans are either sponsored by employer or union group health plans or offered by companies that don't provide Part A services.

Source: https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/other-medicare-health-plans

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What is the cost of Medicare Part D?

Most Medicare Prescription Drug Plans charge a monthly fee that varies by plan. You pay this in addition to the Medicare Part B premium . If you belong to a Medicare Advantage Plan (Part C) or a Medicare Cost Plan that includes Medicare prescription drug coverage, the monthly premium you pay to your plan may include an amount for drug coverage.

How much does Part D cost?

Most people only pay their Part D premium. If you don't sign up for Part D when you're first eligible, you may have to pay a Part D late enrollment penalty.
If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain limit, you may pay a Part D income-related monthly adjustment amount (Part D-IRMAA) in addition to your monthly plan premium. This extra amount is paid directly to Medicare, not to your plan. The chart below lists the extra amount costs by income.

Social Security will contact you if you have to pay Part D-IRMAA, based on your income. The amount you pay can change each year. If you have to pay a higher amount for your Part D premium and you disagree (for example, if your income goes down), use this form to contact Social Security. If you have questions about your Medicare prescription drug coverage, contact your plan.

Part D premiums by income

The charts below show your estimated prescription drug plan monthly premium based on your income as reported on your IRS tax return from 2 years ago and last year. If your income is above a certain limit, you'll pay an income-related monthly adjustment amount in addition to your plan premium.

If your filing status and yearly income in 2018 was

File individual tax return File joint tax return File married & separate tax return You pay (in 2020)
$87,000 or less $174,000 or less $87,000 or less your plan premium
above $87,000 up to $109,000 above $174,000 up to $218,000 not applicable $12.20 + your plan premium
above $109,000 up to $136,000 above $218,000 up to $272,000 not applicable $31.50 + your plan premium
above $136,000 up to $163,000 above $272,000 up to $326,000 not applicable $50.70 + your plan premium
above $163,000 up to $500,000 above $326,000 up to $750,000 above $87,000 and less than $413,000 $70.00 + your plan premium
above $500,000 above $750,000 above $413,000 $76.40 + your plan premium

Source: https://www.medicare.gov/part-d/costs/premiums/drug-plan-premiums.html

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What is a Medicare Advantage Plan?

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare . You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Covered services in Medicare Advantage Plans

Medicare Advantage Plans cover all Medicare services. Medicare Advantage Plans may also offer extra coverage. Learn more about what Medicare Advantage Plans cover.

Rules for Medicare Advantage Plans

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.

Drug coverage in Medicare Advantage Plans

You usually get prescription drug coverage (Part D) through the plan. In some types of plans that don't offer drug coverage, you can join a Medicare Prescription Drug Plan.
You can't have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you're in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you'll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

Source:

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Where can I find additional information about Medicare?

You can contact Tim Schatz or Sandra Juetten with MNHI.net, visit www.medicare.gov or by calling Social Security at 1-800-772-1213.

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How to replace a Medicare card

Your Medicare card is proof of your Medicare insurance. If your Medicare card was lost, stolen, or destroyed, you can ask for a replacement by using your online my Social Security account.

If don’t already have an account, you can create one online. Go to Sign In or Create an Account.

Once you are logged in to your account, select the "Replacement Documents" tab. Then select “Mail my replacement Medicare Card.”

Your Medicare card will arrive in the mail in about 30 days at the address on file with Social Security.

If you can’t or prefer not to use the online service:

Source: https://faq.ssa.gov/en-us/Topic/article/KA-01735

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