7 Popular Medicare Questions Asked During National Medicare Education WeekPosted by Medicare Made Clear
Medicare can seem like a daunting topic to cover. Last Monday, we hosted an online presentation during National Medicare Education Week to provide an overview of Medicare basics and give viewers the chance to ask questions. We received great questions and decided to share the answers with you. Here are the top seven Medicare questions asked during National Medicare Education Week 2018.
Question 1: I’ll be turning 65 soon, when should I start the process of applying for Medicare?
Answer: Your Medicare journey begins three months before the month of your 65th birthday. This marks the beginning of what is called your Initial Enrollment Period. This period last seven months total, including the three months before the month you turn 65, the month in which you turn 65, and the three months after.
If you are receiving Social Security or Railroad Retirement Board benefits when you first become eligible for Medicare, then you’ll be automatically enrolled in Part A and Part B and will get your Medicare card in the mail.
If you aren’t receiving Social Security benefits when you become eligible for Medicare, you may enroll online or by visiting your local Social Security office.
It’s a good idea to start learning about Medicare in the months leading up to your Initial Enrollment Period so you are ready to make your coverage choices. Your coverage will begin on the first of your birthday month if you enroll during the three months before. If you enroll later, then your coverage start date will be later, too.
Question 2: I’m retiring soon and do not have Medicare yet. What do I need to do between now and my retirement? [OR I am covered by my spouse’s employer’s health coverage, but he/she is retiring soon. What should I do?]
Answer: If you retire or lose employer coverage before age 65, you’ll need other health coverage until you reach Medicare eligibility age and have your seven-month Initial Enrollment Period.
If you are 65 or older when you retire or lose coverage, you may qualify for what is called a Special Enrollment Period (SEP. [Find your SEP dates with our SEP finder tool.] During this time, you have up to eight months to enroll in Part B without incurring a late enrollment penalty. You may also enroll in Part A, if you haven’t already. You may enroll online or by visiting your local Social Security office.
In addition, there are two important things to note:
- First, during this same time period you only have two months to enroll in a prescription drug plan (Part D). If you miss it, you could end up paying a late enrollment penalty that’s added to your monthly premium for as long as you have Part D. That can really add up, so pay attention to this timing. You can get drug coverage through a Medicare Advantage plan or by adding a standalone Part D plan to Original Medicare.
- Second, it’s important to talk with your employer plan benefits administrator before you make Medicare decisions. You’ll need a written notice of “creditable coverage” from the plan to qualify for a SEP and avoid late penalties. The notice certifies that the plan provides coverage at least as good as Medicare.
Question 3: I’m over 65 and retiring in the next 3 to 6 months. I have Medicare Part A, but how do I get Part B?
Answer: When you’re over 65 and retiring soon, getting Part B is fairly simple. If you qualify for a Special Enrollment Period (see question 2 above), you’ll have up to eight months to enroll in Part B. Don’t forget either, that during this eight month period, you’ll only have the first two months to enroll in a Medicare Advantage (Part C) or prescription drug plan (Part D).
You may want to enroll in additional coverage.
Additional coverage could be choosing a Medicare Advantage plan instead of Original Medicare (could provide added benefits such as vision, dental or hearing and prescription drugs), or adding a standalone Part D prescription drug plan, or adding a Medicare supplement plan (Medigap) to help with the costs of Original Medicare. You have to be enrolled in Parts A and B to be eligible for either a Medicare Advantage or Medicare supplement plan. You can enroll in a Part D plan if you have Part A, Part B or both.
If you will have coverage under an employer retirement plan, you’ll want to understand how that plan works with Medicare. Talk with your employer benefits administrator before making any Medicare decisions.
Question 4: I’ll be 65 soon but plan to keep working full-time. Is it better to keep my employer’s health insurance or to get Medicare?
Answer: First you need to know if you are able to stay on your employer coverage. You are required to take full Medicare benefits – both Parts A and B – at age 65 if your company has less than 20 employees. And some larger employers may have requirements as well. Talk with your employer plan administrator to understand how Medicare might work with your current coverage.
Even if you’re not required to, you may want to go ahead and enroll in Medicare Part A when you become eligible (your Initial Enrollment Period begins 3 months before the month of your 65th birthday). Why? Because, assuming you or your spouse has worked and paid taxes for at least 10 years, you will qualify for premium-free Part A, and it may provide additional hospital coverage if you need it.
You may, however, want to delay enrolling in Medicare Part B – and paying the monthly premium – until you retire or lose your employer coverage.
But you’ll need to ensure that your employer coverage is “creditable” and that you will qualify for a Special Enrollment Period if you want to enroll in Part B later. You may owe a late enrollment penalty otherwise.
Question 5: Which is better – a Medicare Advantage plan (Part C) or a Medicare supplement plan (Medigap)?
Answer: First, these are two very different types of plans. A Medicare Advantage plan (Part C) is an alternative to Original Medicare (Parts A & B) that offers all the same coverage and often also includes prescription drug coverage (Part D) and other additional health services and benefits. A Medicare supplement plan is coverage you can add to Original Medicare that helps pays some of the out-of-pocket costs that come with it. So you really need to compare a Medicare Advantage plan to Original Medicare plus a Medicare supplement plan.
The main pros of a Medicare Advantage plan include:
- A $0 or low monthly plan premium (you continue to pay your Part B premium to Medicare)
- Prescription drug coverage (Part D) is included with most plans
- Many plans offer additional benefits such as coverage for dental, vision, and hearing care, and health and wellness programs such as gym memberships
- All-in-one plan to cover your health care needs
By comparison, when you add a Medicare supplement plan to Original Medicare, you’ll need to buy a separate standalone Part D prescription drug plan in order to get this coverage, which is included with most Medicare Advantage plans. Both Medicare supplement plans and prescription drug plans come with premiums and other costs, and you continue to pay your Part B premium to Medicare. The advantages might be low point-of-service costs, such as copays, and the ability to select doctors and hospitals without a plan network or referrals.
Question 6: Am I limited on the doctor I can choose? Are referrals required with Medicare?
Answer: Your choice of doctor depends on what Medicare coverage you have. You can see any doctor that accepts Medicare if you have Original Medicare (Parts A & B). Most Medicare Advantage plans have provider networks, and some plans may require referrals to specialists. Both Original Medicare and Medicare Advantage plans cover most emergency care when and where it’s needed.
Question 7: What does Medicare Part A cover? (Does Part A cover custodial care? Does Part A cover outpatient visits?)
Answer: Medicare Part A covers the hospital charges and most of the associated services received while you’re admitted as an inpatient.
Medicare Part A coverage includes:
- A semi-private room
- Hospital meals
- Skilled nursing services
- Care on special units such as intensive care
- Drugs, medical supplies and medical equipment used during your inpatient stay
- Lab tests, X-rays and medical equipment when you’re an inpatient
- Operating room and recovery room services
- Some blood transfusions (in a hospital or skilled nursing facility)
- Rehab services such as physical therapy received through home health care
- Skilled health care in your home if you’re homebound and only need part-time care
- Hospice care.
Medicare Part A does not cover custodial care such as help with bathing, dressing and eating, but due to new Medicare regulations, some Medicare Advantage plans (Part C) may begin offering some of these services in the home starting in 2019.
Medicare Part B covers doctor visits, even when you’re in the hospital, and outpatient services. Learn more about what Part B covers here.