10 Frequently Asked Medicare Questions




Nearly 100% of all Americans over the age of 65 are covered by Medicare, or will be, once they come off their employer health plans during retirement. But the vast majority of them do not understand Medicare, because quite frankly it’s confusing!

Here are 10 of the most frequently asked questions about Medicare.

1. Is there a difference between Medicare and Medicaid?

YES! A big difference! Medicare is the health insurance program designed for older Americans, and covers virtually all senior citizens over the age of 65. Medicaid, on the other hand, is designed for low-income and disabled individuals of any age.

2. Who qualifies for Medicare?

The short answer is- most American citizens that are 65 years or older, are Medicare eligible. Of course there are some instances when this is not true.  Also, eligibility depends on whether you (or your spouse) have earned enough Social Security credits.

3. Is enrollment in Medicare automatic? Or do I have to enroll myself?

If you are collecting social security benefits, you will automatically be enrolled in Medicare Parts A & B. You will NOT be enrolled in a Supplement Plan, however, which you will need to cover the remaining 20% that Medicare does not cover. If you are not collecting Social Security, then you will need to enroll yourself.

4. When can I sign up for a Medicare Supplement Plan?

You can enroll in a Medicare Supplement and Prescription Part D Plan, during your initial enrollment period, which is 3 months prior to and 3 months after your 65th birthday. If you miss that window, you can enroll (or switch plans if you are unhappy), during the annual enrollment period which runs every year from October 15th– December 7th.

5. Can you explain the different “parts” of Medicare?

Medicare is comprised of 4 parts:

  • Medicare Part A is hospital insurance. This covers things like hospital stays and care at skilled nursing facilities
  • Medicare Part B is medical insurance. This covers doctors’ visits, preventative care, and outpatient procedures.
  • Medicare Part C is a Medicare Advantage Plan. These are plans run by third-party insurance companies that provide Medicare benefits. Medicare Advantage plans replace Medicare coverage, which means Medicare is no longer your primary insurance.
  • Medicare Part D is prescription drug coverage. These are plans that help cover the costs of medications.

6. What is Original Medicare?

Original Medicare refers to Medicare Parts A and B — Hospital Insurance and Medical Insurance. Generally, the term “Medicare” is used to refer to just Parts A and B, not to Medicare Advantage, Medicare Supplement or Prescription Drug Coverage.

7. What is a Medicare Supplement Plan?

A Medicare Supplement Plan, (also known as Medigap) is insurance for the remaining 20% that Original Medicare does not cover. Supplement Plans are offered by a variety of insurance companies and allow individuals to keep Medicare as their primary insurance, and get help covering the remaining costs.

8. What does Medicare not cover?

Seniors should be aware that there are some healthcare services that are generally not covered by Medicare. Some of these include:

  • Eye exams, glasses, and related services
  • Chiropractic care
  • In-home health aides
  • Longer nursing home stays
  • Dental care (with a few emergency exceptions)
  • Hearing aids

9. How much does Medicare cost?

For the vast majority of seniors, Medicare Part A has no premium. Medicare Part B has a monthly premium, but it the amount varies based on the individual. In 2018, new beneficiaries pay a standard premium of $134 per month, although retirees whose payments have been paid through their Social Security benefits for several years may pay less. And higher-income retirees can pay much more than these amounts.

The costs of Medicare Supplement, Advantage and Prescription Drug Plans, vary considerably depending on location and coverage amounts.

10. When can I make changes to my Medicare if I’m already enrolled?

You can make changes to your coverage during the annual election period (also known as the open enrollment period), which runs every year from Oct. 15 through Dec. 7. During this time, you can make changes such as changing from Original Medicare to Medicare Advantage or vice versa, or add prescription drug coverage.

If you are like most Americans, who find Medicare very confusing, call the licensed specialists at Plan Medicare to review your Medicare options. 516-900-7877.