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 my options in Maryland for Medicare?

This depends on a few factors, mainly your zip code.  Although Medicare Supplement plans are statewide, Advantage plans are offered by county location.  What you find in one county, you may not find in another. The state of Maryland has dozens of different insurance carriers offering Supplement Plans (also known as Gap or MediGap plans) as well as Medicare Advantage Part C Plans and Prescription Drug Plans (Part D). 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 CheckPartD.com to find your Part D plan, this is my free service that I offer.  I will use your medications to determine which plan is most beneficial to you, with lowering costs as being the primary goal.  Part D plans change each year so this should be assessed each fall. The other options is to use Medicare.gov’s Rx plan finder.

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 ($505 for 2023), co-payments or co-insurance and possible dispensing charges at your local pharmacy. Every medication is placed into a Tier to determine its price by each individual insurance carrier. 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 $130 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). These amounts change yearly, so 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 $165 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.

What is Medicare?
Medicare is a federal health insurance program primarily for individuals aged 65 and older, but it also covers some younger individuals with specific disabilities or conditions.

Who is eligible for Medicare?
Generally, individuals aged 65 or older who are U.S. citizens or permanent residents are eligible for Medicare. Additionally, people under 65 with certain disabilities, or those with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), can also qualify.

How many parts does Medicare have and what do they cover?
Medicare is divided into four parts:

• Part A covers inpatient hospital stays, skilled nursing facilities, hospice, and some home health care.
• Part B covers outpatient care, preventive services, doctors' services, and some home health care.
• Part C (Medicare Advantage) offers health plan options run by private insurance companies that combine both Part A and Part B benefits.
• Part D covers prescription drugs.

How do I enroll in Medicare?
If you're already receiving Social Security benefits, you'll be automatically enrolled in Medicare Part A and Part B when you turn 65. If not, you can manually enroll during your Initial Enrollment Period, which starts three months before your 65th birthday and ends three months after the month you turn 65.

Is there a premium for Medicare Part A?
Most people don't pay a premium for Part A because they or their spouse paid Medicare taxes while working. If you don't qualify for premium-free Part A, you can buy into it.

How much does Medicare Part B cost?
The cost for Part B varies based on your income. The standard Part B premium amount is set annually by the Centers for Medicare & Medicaid Services (CMS). The amount varies each year, but typically the base rate is less than $200 per month.

What's the difference between Medicare Supplement (Medigap) and Medicare Advantage plans?
Medicare Supplement (Medigap) policies are designed to help cover the "gaps" in Original Medicare, like copayments and deductibles. Medicare Advantage (Part C) plans are an alternative to Original Medicare and typically include both Part A and Part B coverage and often Part D as well.

How do I choose a Medicare Advantage plan?
Consider factors like the monthly premium, out-of-pocket costs, network restrictions, added benefits, and the plan's star rating, which is based on its quality and performance. Advantage Plans are also offered by counties, so what you may see available in one county may not be available in all counties. These plans change each year so it’s advisable to review your options with your Medicare broker.

When can I change my Medicare coverage?
You can adjust your coverage during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year.  You may be able to make changes year round if you have any type of Special Enrollment Period (SEP), or if you qualify for Medicaid or any type of “Extra Help” from Medicare due to low income.

What is the Late Enrollment Penalty for Part D?
If you don't sign up for Part D when first eligible and go 63 consecutive days without creditable drug coverage, you might pay a late enrollment penalty added to your monthly premium. This amount can only be determined by CMS (Medicare), but is calculated by multiplying the average monthly premium by 1%.  You can estimate by basing your math on a $35 per month average premium and then multiply by the number of months you went without Part D coverage.  This penalty is assessed monthly for as long as you carry any type of Medicare Part D coverage and will be taken directly out of your Social Security check.

Do I need a separate prescription drug plan if I have a Medicare Advantage plan?
It depends. Some Medicare Advantage plans include prescription drug coverage (MAPD), but if yours doesn't, you'll need to have Creditable Coverage for your medications from another source, like a Union plan, or VA Benefits.

Can I have both a Medigap policy and a Medicare Advantage Plan?
No. If you have a Medicare Advantage Plan, it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare.

Do I still need Medicare if I have employer health insurance?
It depends on the size of the employer and your specific circumstances. It's essential to compare the costs and benefits of Medicare to your employer's plan.  If your employer has less than 20 employees, then you are required to enroll into Medicare A & B when you first turn 65. You do not need to purchase a Supplement Plan or Advantage Plan if you choose to keep your employer’s coverage, but you do need Parts A & B or you will face a late enrollment penalty.

What services are considered preventive under Medicare?
Services like flu shots, mammograms, bone density tests, and certain screenings for conditions like diabetes or cancer are considered preventive under Medicare.

How does Medicare cover skilled nursing facilities?
Medicare Part A covers skilled nursing facility care under specific conditions, typically after a qualifying hospital stay.  There are limits to the amount of time you can spend in a skilled nursing facility as Medicare does not cover long-term care.

Are dental and vision covered under Medicare?
Original Medicare does not cover routine dental or vision care. However, many Medicare Advantage plans offer these benefits.

Can I travel with my Medicare coverage?
Original Medicare covers you anywhere in the U.S. and its territories. For overseas travel, Medicare's coverage is limited, but some Medigap policies offer foreign travel emergency benefits. We recommend purchasing additional travel insurance. You can get quotes and enroll directly online at: https://www.geobluetravelinsurance.com/product_overview.cfm?link_id=80686&personalized=y&header=y

How is Medicare different from Medicaid?
Medicare is a federal program based primarily on age, while Medicaid is a state and federal program based on income and certain conditions.

How do I appeal a Medicare decision?
If Medicare refuses to pay for a service or item you think should be covered, you can file an appeal. The decision notice you receive will provide detailed instructions on how to appeal.

How can I get help with Medicare costs?
Programs like Medicare Savings Programs (MSP) or Extra Help can assist eligible individuals with Medicare premiums, deductibles, and other out-of-pocket expenses.