Common Medicare Questions Answered

1. When does Medicare become effective for me?

In general, Medicare part A starts on the first day of your birth month as you turn 65 or when you have qualified for Social Security for 24 months. Medicare part B usually starts at the same time as part A, assuming you have signed up for part B.

 

2. Does Medicare cost me any money?

Assuming you worked 40 quarters, your payroll deductions paid for part A and you have to pay monthly for part B. The cost for part B is based on income and starts at $99.90 per month and graduates up to $319.70 per person.

 

3. What do the parts of Medicare such as A, B, C, D, pertain to?

Medicare Part A

Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care.

Medicare Part B

Helps cover medically-necessary services like doctors’ services, outpatient care, durable medical equipment, home health services, and other medical services. Part B also covers some preventive services. Check your Medicare card to find out if you have Part B.

Medicare Part C

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare Part D

Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty.

To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

 

4. What does Medicare cover or does it cover everything?

Medicare was never designed to cover 100% of everything. It was designed to cover roughly 80% of what Medicare considers reasonable and what the American Medical Association has approved. The exposure of the remaining balances can be substantial and most people limit the exposure with a Medicare Supplement or Medicare Advantage plan.

 

5. Can I sign up for Medicare whenever I want?

No. You must sign up for Medicare within 6 months of your 65th birthday or when you became eligible based on Disability. If you miss this window, you are considered a “Late enrollee” and must wait until the next open enrollment window the fallowing calendar year, and the late enrollee will normally pay a penalty.

 

6. I have heard about Medicare Supplements and Medicare Advantage plans. Do I need both?

No, and although there are circumstances that could allow someone to have both, the coverage will not allow for double payments which means the enrollee is paying for something that will not have any benefit.

 

7. Does Medicare cover me outside the US?

No. Medicare works only inside the US.

 

8. Do Medicare Supplements and Medicare Advantage plans cover me when I am outside the US?

Certain Medicare supplements have very limited coverage outside the U.S., for up to 60 days, and then the coverage ends. Medicare Advantage plans have some allowances for limited coverage in the case of life threatening situations while outside the US.