Medicare Questions & Answers

There is a lot of misinformation about Medicare, and it takes years of experience to learn all the little rules and regulations. I've put together some of the more common Medicare questions and answers for you. If you have other questions, I encourage you to contact me directly at peterpalmiotto@gmail.com or call me at (410)896-1212.

Feel free to share this information with your friends and family. Or have them call me for a free Medicare consultation.

What are the Medicare plans in Maryland?  According to MarylandMedicareOptions.com, the state of Maryland has several insurance carriers offering Supplement Plans (Gap / MediGap), Medicare Advantage Part C Plans and Prescription Drug Coverage Plans. There are several levels and pricing options for each category. It's best to work with an independent Medicare insurance broker to decide which plan works best for your needs.

Where is the Mediare Part D Plan Finder?   You can use Medicare.gov to find your Part D plan, or you can use the free services of a Broker / Agent to help you find the best plan for your medication needs. 

What are the Medicare Part D costs?  Medicare Part D costs vary each year but primarily consist of a monthly premium payment for your plan, a deductible ($480 for 2022), co-payments or co-insurance and possible dispensing charges at your local pharmacy. Every medication is placed into a Tier to determine its price. It's best to contact and work with a Medicare insurance broker to help you find the best PDP plan for you.

How do I get a Medicare number?   A Medicare number is issued to you by the Social Security Administration when you are eligible for Medicare coverage. Typically, you'll be automatically enrolled into Medicare Part A when you turn 65 and may receive your card up to 90 days prior to your 65th birth month. You must enroll into Medicare Part B through SSA (depending on your eligibility and current coverage). Contact a Medicare insurance broker to ensure you don't miss any critical dates.

Is there a Social Security Office near me?  There is a good chance you live near a Social Security office. To find one, simply go to https://secure.ssa.gov/ICON/main.jsp and enter your zip code.

What drugs are covered by Medicare Part D? Most medications are covered by Medicare Part D, but this is normally determined by the type of Prescription Drug Coverage you have. Typically, a PDP Plan (Part D) will cover in excess of 3,500 different medications including generics and brand name drugs.  We recommend you work closely with a Medicare broker in order to determine which Medicare Drug Plan best fits your medication requirements.

What Medicare Advantage Plans are there in Maryland? In Maryland, you'll find a variety of Medicare Advantage Plans (known as Part C Plans). These include HMO's, PPO's, MSA's, and Special Needs Plans. There are about a dozen different insurance companies that offer these plans throughout the state. Contact your local independent Maryland Medicare agent to discuss which MAPD plans are the best fit for your lifestyle and medical needs.

How do I find a Medicare application form? Depending on what you want to accomplish, almost all Medicare application forms can be found online at https://www.medicare.gov/forms-help-resources/medicare-forms

Do I have to apply for Medicare Part B? It depends. If you are already collecting your Social Security benefits when you turn 65, then you should automatically receive your Medicare card with both Medicare Part A and Medicare Part B already activated.  However, if you have chosen to delay your Social Security benefits, and you want to enroll into Medicare, then you'll need to take action and apply for Medicare Part B. This can be done with a short form CMS 40B from CMS. Here's the Medicare Part B application https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-E.pdf

How long does it take to get Medicare Part B after applying? About 10 to 20 days, but this can vary greatly by the time of year you apply, how you apply and your current situation. CMS can even backdate the start date in certain situations, so if you apply on March 30th and ask for an April 1st start date, your application won't be approved for at least 10 days, but your official start date would be April 1st. This is all assuming that you are eligible for Medicare.

When is the Medicare Part D enrollment period? This depends on your personal situation but is typically at the same time as Medicare Advantage Plans which is during the Annual Enrollment Period (AEP) which occurs October 15th through December 7th. As long as your application is submitted by midnight on 12/7, your coverage will start on January 1st.  There are exceptions to this rule like when your Part B goes into effect, if you lose coverage at work, or if you're on Medicaid (dual eligible). It's best to discuss your current situation with a licensed Maryland Medicare insurance broker.

Can you sign up for Medicare at anytime?  No. There are many enrollment rules surrounding Medicare enrollment and working with a certified Broker will help you navigate all these rules and regulations. Most consumers qualify for Medicare on the first day of their 65th birth month. Others may enroll into Medicare at any age if they are permanently disabled after a 2 year waiting period or have End-Stage Renal Disease (ESRD) at any age.

Do you have to renew a Medicare supplement every year? No. Medicare Supplement insurance plans are month-to-month contracts and do not need to be renewed. If you simply do nothing, your plan will automatically renew each month. Work with a Medicare insurance broker to obtain the best pricing possible when shopping for Medicare Supplemental insurance, otherwise known as MediGap Plans.

How long before you turn 65 do you apply for Medicare? Three months prior to turning 65 is the earliest you can apply to enroll in Medicare. You do this by applying with the Social Security Office. Original Medicare, or any additional Medicare insurance products that you apply for will not start until the 1st day of your 65th birth month. There are different rules and deadlines that surround Medicare, so it's best to connect with a Medicare insurance broker to discuss your unique situation.

What is the average cost of Supplemental insurance for Medicare? This depends on your state, county, sex, age and smoking history. Typically a Medicare Supplement Plan G for a 65 year old non-smoking male averages about $150 per month and $135 for females, in Anne Arundel County, Maryland. There are also discounts for two people living in the same house on the same plan, so contact your local Medicare insurance agent to discuss which companies offer the best rates for your situation.

Is everyone eligible for Medicare? No. Only those 65 and older qualify. Additionally, you can qualify for Medicare at any age if you are permanently disabled after a two-year waiting period, if you have ALS or if you have End-Stage Renal Disease (ESRD). Some people mistake Medicare for Medicaid.  Medicaid is based on income (usually for lower income individuals) and has nothing to do with Medicare insurance.

What are the income limits for Extra Help with Medicare? This varies by state. In Maryland, the threshold is $1,486 per month in income for a single person. However, this can go as high as $30,000 for help with Medicare Part D assistance or also known as a Low Income Subsidy (LIS).  In order to understand all the rules surrounding Medicare assistance, you should contact a licensed Medicare Insurance Broker familiar with your state's rules and regulations.

How much is taken out of your Social Security check for Medicare? Typically about $170 each month is removed to cover Medicare Part B premiums and this amount changes each year. However, you could have more removed if you're a high-income earner or less if you qualify for Medicaid. For the most recent information on these fees visit: https://www.medicare.gov/your-medicare-costs/part-b-costs

When is the Medicare enrollment period? This depends on your situation, but the Annual Enrollment Period (AEP) is October 15th through December 7th each year. The Open Enrollment Period is from January 1st through March 31st.  There are also many different Special Election Periods (SEPs) throughout the year that you may qualify for. There are different rules for each period so it's best to work with an experienced Medicare insurance broker to determine the best plan of action for your situation.

Do you have to sign up for Medicare when you are 65? Yes, unless you have credible coverage from your current employer, or coverage from a Union, Retirement Plan, Government etc. You might automatically receive your Medicare Part A card, this is normal and does not mean that you are enrolled into Medicare fully. As long as you have credible coverage elsewhere, you do not need to enroll in Part B or additional coverage like Rx or a Supplement plan. If you don't have credible coverage and decide NOT to enroll into Medicare Part B, then you will start accruing penalties and you might delay your coverage when you finally need it. It's best work with a Medicare insurance broker to navigate all of the complexities of Medicare. Check out my Should I Enroll Into Medicare matrix - it's a free download.