Common Questions About Medicare

  • Medicare is a federal health insurance program for eligible U.S. citizens and legal residents. It is funded in part by taxes you pay while working.

  • U.S. citizens and legal residents. Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare.  

    You must also meet one of the following requirements:

    • Age 65 or older

    • Younger than 65 with a qualifying disability.

    • At any age with a diagnosis of end-stage renal disease or ALS.

  •  You may be able to delay, or you may have to enroll age age 65. Get in touch to determine the best option for you.

    Generally, you can delay Medicare past age 65 without penalty if:

    •  The employer has 20 or more employees.

    • The employer health coverage is considered "credible."

    You will need to enroll at age 65 if:

    • Your employer has fewer than 20 employees.

    • Your coverage is not considered "credible."

  •  Original Medicare:  Parts A & B

    • Part A  (hospital insurance) to help pay for hospital and inpatient care.

    • Part B (medical insurance) to help pay for doctor and outpatient care.

  • OPTION 1

    • Medicare Part D Plan to help pay for prescription drugs.

    • Medicare Supplement Insurance (Medigap) to help pay some or all out-of-pocket costs not paid by Original Medicare.

    OPTION 2

    • Medicare Advantage (Part C) Plan

    • Part C- Combines Part A (hospital insurance and Part B (medical insurance) in one plan.

    • Part D - Usually includes prescription drug coverage.

      • May include additional benefits like vision and dental coverage

  • Premium: A fixed amount that you pay for coverage, usually monthly.

    Deductible: A set amount that you pay for covered services before your plan begins to pay.

    Copay: A fixed amount you pay at the time you receive a covered service.

    Coinsurance: An amount you pay when the plan splits the cost of a covered service with you by percentage, such as 80/20.

  • -Medicare Initial Enrollment (IEP)

    • For those who become eligible due to age, generally, 3 months before and 3 months after your 65th birthday.

    -Annual Enrollment Period (AEP) October 15 - December 7

    • During AEP, you can add,  drop or switch your Medicare coverage.

    -Medicare Advantage Open Enrollment Period (OEP) January 1 - March 31.

    • If you already have a Medicare Advantage plan, you may disenroll from your current plan and either switch to a different Medicare Advantage plan one time only, or go back to Original Medicare during this period.

    -Special Enrollment Period

    • Depending on certain circumstances, you may be able to enroll in a Medicare plan outside the annual enrollment period (AEP) from October 15- December 7 if you:

      • retire and lose your employer coverage

      • move out of the plan's service area

      • qualify for extra help

      • have been diagnosed with certain qualifying chronic health conditions