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Medicare can be hard to understand, especially if this is your first experience with it. When you’re just starting out, you probably have a lot of questions. To get you started, we’ve provided answers to some of the most frequently asked Medicare questions.
Who Qualifies for Medicare?
To qualify for Medicare, you need to be a U.S. citizen or legal resident who is 65 or older or under 65 with a qualifying disability or End Stage Renal Disease.
You are eligible to receive Medicare Part A at no charge if:
You are 65 or older and receive retirement benefits from Social Security or the Railroad Retirement Board.
You are 65 or older and eligible for retirement benefits but have not filed for them yet.
You are 65 or older and had Medicare-covered government employment.
You are under 65 and have received disability benefits for 24 months.
You are under 65 and have Lou Gehrig’s Disease (amyotrophic lateral sclerosis) or have received kidney dialysis or a kidney transplant.
Many people do not have to pay a premium for Medicare Part A (hospitalization insurance). However, everyone must pay a premium for Medicare Part B (medical insurance).
Do I Automatically Get Medicare When I Turn 65?
If you are 65 and already receive Social Security, you will be automatically enrolled in Original Medicare (Medicare Part A and Part B). If you do not receive Social Security, you will need to sign up for Medicare with the Social Security Administration.
When Can I Enroll in Medicare?
You can sign up for Medicare during the 3 months prior to the month you turn 65 through 3 months after you’ve turned 65 for a total 7-months.
If you do not sign up for Medicare during your Initial Enrollment Period, you may have to wait until the General Enrollment Period that begins in January. Exceptions, or “Special Enrollment Periods,” may be granted if you’ve lost your employer group insurance coverage.
What Happens if I Don’t Sign Up for Medicare at 65?
If you do not have credible coverage and delay your Medicare enrollment, you may be subject to late penalties. There are two penalties you could be subject to:
1. The Part B late enrollment penalty can increase your monthly premium by 10% each year you delay your enrollment. In most circumstances, this penalty is imposed for as long as you have your Part B coverage.
2. The Part D late enrollment penalty can increase your monthly premium by 1% each month you delay your coverage.
Do I Need Medicare if I Have Group Coverage?
Whether you need Medicare if you have group coverage through your job depends on the size of your company. If there are 20 or fewer employees, you will need to enroll in Medicare for health coverage. If there are more than 20 employees, you will likely be able to keep your group coverage without incurring a late penalty if you switch to Medicare later. Talk to your benefits manager to make sure that you have qualifying coverage.
You can still enroll in premium-free Medicare Part A if you also have group coverage. In these cases, one type of coverage will pay your medical bill first and the other coverage will pay the remainder.
If you plan to delay your enrollment because of group coverage, contact Social Security to avoid having to appeal penalties in the future. It is also in your best interest to compare your group coverage against Original Medicare and Medicare Advantage options. You may find unexpected savings.
Can I Work Full-time While on Medicare?
Yes! You can work full-time while on Medicare. You can also carry both employer coverage and Medicare Part A coverage. When you retire or lose your group coverage, you can then enroll in Medicare Part B. You will also have the opportunity to enroll in Medicare Advantage or Medigap.
Do I Have to Sign Up for Medicare if I Have Private Insurance ?
You are not required to enroll in Medicare if you have private insurance. However, you may face late enrollment penalties. You could also end up paying more for similar (or better) coverage. In addition, if you have an Affordable Care Act (ACA) plan when you qualify for Medicare, you will no longer be eligible to receive ACA subsidies.
What Does Medicare Cover?
The Original Medicare program comes with hospitalization insurance (Part A) and medical insurance (Part B) for services such as doctor’s visits, lab tests, and outpatient services.
Does Medicare Cover Prescription Drugs?
Original Medicare doesn’t cover most prescription drugs you purchase at a pharmacy. Private insurance companies sell Medicare Part D drug coverage that you can add to Original Medicare. If you opt for Medicare Advantage coverage, most plans include prescription drug coverage. Be sure to evaluate the plan details for coverage information.
Is There an Alternative to Original Medicare?
Yes. Medicare Advantage plans (also called Part C) sold by private insurance companies combine Parts A and B. Most plans come with drug coverage and many offer other benefits Original Medicare doesn’t cover, such as routine dental, vision, and hearing exams.
Does Medicare Cover Everything?
No. Original Medicare (Parts A & B) has out-of-pocket costs such as deductibles, copays, and coinsurance. A Medicare Supplement Plan (also called Medigap) can help cover some of these costs. You can only buy a Medicare Supplement Plan if you get Parts A and B through Original Medicare and not Medicare Advantage.
What Is Medicare Part A?
Medicare Part A is health insurance that primarily covers inpatient hospital stays. It also covers hospice care, skilled nursing facility services, and—in some cases—home health care.
What Is Medicare Part B?
Medicare Part B is health insurance that covers medically necessary and preventive services, including doctor visits, lab tests, outpatient surgeries, ambulance services, and medical supplies.
What Is Medicare Part C?
Medicare Advantage plans (also known as Medicare Part C) are offered through private insurance companies as an alternative to Original Medicare. These plans bundle Medicare Parts A and B into a single plan and typically also include Part D drug coverage. Plans with dental, vision, and/or hearing coverage are also available.
What Is Medicare Part D?
Medicare Part D is prescription drug coverage purchased through private insurance companies. It can be used in conjunction with Original Medicare, but not with a Medicare Advantage plan that already includes drug coverage.
What Is Medigap?
Medigap (also known as a Medicare Supplement plan) is offered by private insurance companies to help cover some of the out-of-pocket costs of Medicare Parts A and B, such as copayments, coinsurance, and deductibles. There are several plans to choose from with varying levels of coverage.