Frequently Asked Questions

WHO CAN GO ON MEDICARE?

If you are turning 65, you are eligible for Medicare. A person under 65 can also be eligible if they have been receiving Social Security Disability Insurance (SSDI) for more than 24 months.

HOW DO YOU APPLY FOR MEDICARE?

There are 3 ways:
1) Call Social Security at their toll-free number (800) 772-1213. This is the most complicated way;
2) Apply online at www.SocialSecurity.gov/medicareonly;
3) In person at your local Social Security Office.

HOW MUCH IS MEDICARE? IS THERE A COST?

If you or your spouse worked for at least 10 years and paid Medicare taxes, you won’t pay a monthly fee, called a premium, for Part A. Now, for Part B your standard premium is $174.70 a month in 2024, unless your Modified Adjusted Gross Income is greater than $103K Single/$206K Married, then you will also pay an Income Related Monthly Adjustment Amount (IRMAA).

WHAT IS MEDICARE PART A?

Part A is coverage for inpatient hospital care, skilled nursing facility care, Hospice, and Nursing home care, depending on the circumstance.

WHAT IS MEDICARE PART B?

Part B is for Ambulance services, Clinical research, Lab work, Tests, Durable Medical Equipment, getting a second opinion before surgery and some limited Outpatient prescription drugs. Also, this part covers Mental Health – Inpatient, Outpatient and Partial Hospitalization.

WHAT IS MEDICARE PART C?

Medicare Advantage Plans are sometimes called Part C or MA Plans. These are offered by private insurance companies approved by Medicare. If you enroll in a Medicare Advantage Plan, you will get your Medicare Part A and Part B coverage from the Medicare Advantage Plan (the private insurance company approved by Medicare) and not Original Medicare. Note: If you go on a Part C plan for more than a year, you may have to go through underwriting in order to return to a Medicare Supplement plan.

WHAT IS MEDICARE PART D?

Part “D” is for Drugs. To avoid future penalties, everyone should enroll in a Part D Plan, or a prescription plan which is the same thing. Unless, you have a current prescription plan that is considered credible coverage, such as Veteran Benefits, credible Employer Group coverage. The benefits for 2024 have an allowance of $5,030.00 before falling into the Coverage Gap. Also, the maximum deductible is $545.00. If you fall in the catastrophic coverage stage: you will pay no more than 25% coinsurance for generic drugs or 25% coinsurance for brand name drugs. $8,000.00 G-$4.50, B-$11.20 or 5% of cost, whichever is greater.

WHAT IS THE DIFFERENCE BETWEEN ORIGINAL MEDICARE AND MEDICARE ADVANTAGE PLANS?

When you have Medicare Part A and Part B you are on original Medicare, which is the government or the traditional Medicare plan. Original Medicare usually doesn’t have a maximum out of pocket cost. Therefore, if you stay on original Medicare, you should also get a Medigap Plan for your financial protection. Medicare Advantage Plans can be chosen in place of Original Medicare. A Medicare Advantage Plan is regulated by the federal government (CMS), but administered and run by private insurers or insurance companies. Even if you chose to enroll on a MA Plan you are still in the Medicare Program and you still have the same Medicare Rights and Protections, but your benefits are paid through a private plan. These plans must have an Out-of-Pocket Maximum for your protection.

WHAT IS A MEDIGAP PLAN?

A Medigap Plan is the same as a Secondary Plan and a Medicare Supplement. All three are the same, just different names. If you stay on Original Medicare, then you should get a Medigap Plan to protect you from expensive Medical Bills. There are different Plans available. The plans that are considered Cadillac plans are the Plan G and F. These are the most popular. The plan F does not have a deductible, co-insurance or co-pay as long it’s a Medicare approved service offered by a Medicare assigned provider.

WHAT IS A DRUG FORMULARY?

A drug formulary is a list of Drugs provided by Plan D – Drugs. Each plan has its own formulary. It is very important to check your prescriptions against the formulary of the plan that you intend to enroll in.