FAQ's

Additional Information

  

Q What should I do if I keep working past age 65?
 

If you waited to enroll in Part B because you or your spouse were working and had group health Coverage through an employer or union, you can enroll during a Special Enrollment Period.
If this applies to you, you can sign up for Part B:  

  •  Any time you’re still covered by an employer or union group health plan, through your or your spouse’s current or active employment; 
  • or During the 8-month period that begins the month after the employer or union group health plan coverage ends, or when the employment ends (whichever is first). 

Note: If you’re still working and plan to keep your employer’s group health coverage, you should talk to your benefits administrator to help you decide when you should enroll in Part B. When you sign up for Part B, you automatically begin your Medigap Open Enrollment Period. Once your Medigap Open Enrollment Period begins, it can’t be changed or restarted. For more information on Medigap, visit www.medicare.gov/publications to view the booklet “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.” 

  

Q How do I know if I’m eligible for Medicare?
You are eligible for Medicare if:
You are at least 65 years of age, and: 

  •  Have worked 10 or more years in Medicare-covered employment, and paid (or a spouse paid) Social Security for at least 40 quarters. 
  • Are a citizen or permanent resident of the United States. 
  • Have been diagnosed with ESRD or ALS. 
  • You are not yet 65 years of age, and: 
  • Have received 24 months of Social Security Disability income. 
  • Have been diagnosed with ESRD or ALS. 

Q How do I apply for Medicare?
 
If you’re planning to retire at 65, you first you need to apply for Social Security. You can do this up to three months before your 65th birthday, unless you’re already receiving Social Security benefits. You have three months before and three months after you reach age 65 to sign up for Medicare without paying a late enrollment penalty.
 

You can sign up at your local Social Security office, online or by phone. Once you have filed for Social Security, you should receive your Medicare card by mail within three to six weeks. You do not need to apply for Medicare if you are already receiving Social Security benefits. Social Security will send you the card and information about Medicare approximately three months before your 65th birthday.
 

Q. I’m 65 years old and going onto Medicare, but I have a pre-existing medical condition, what will happen?

  •  This is not an issue when you initially become eligible for Medicare whether by aging in (age 65) or being under 65 and meeting your 24-month wait period. In both instances you have a 7-month window as discussed earlier to enroll, without underwriting.
  • However, if you enroll outside of your initial enrollment window you could be underwritten.

Q. Is Original Medicare Part A & B adequate coverage, or do I need a supplemental plan?

 No. Original Medicare Part A & B only covers 80% of your hospital and medical services (i.e. doctor, labs, etc.). The remaining 20% can add up to $1,000’s. It also does not cover your Part D pharmacy coverage.


Q. What options do I have in a supplemental plan?

  •  Medicare Supplemental plans, which have several plan options. These plans do not require use of a network, they can be used in anywhere in the greater USA – if the Dr or facility accepts Medicare payment.
  • Medicare Advantage plans, require a primary care physician (PCP) and the use of a network. You would have coverage outside your “network” thru an Emergency Room only. Any other treatments outside of your network would be at your cost 100%.
  • Pharmacy plans are available through many different insurance companies. Clients will have a full evaluation of their pharmacy needs and provided with the most cost-effective plan. An annual review of the pharmacy coverage is crucial, as the plans change their “Formulary” and “Pharmacy Store” annually.

Q What is the difference between a copay, coinsurance and a deductible?
A copay is a fixed amount you pay out of pocket for covered medical services and prescription medications. Usually, a copay is a small amount which you pay at the point of service. Coinsurance is a percentage of the total cost of your care for which you are responsible; for example, in some cases your plan might pay 80 percent of the total cost, and you would be responsible for the remaining 20 percent. Coinsurance can apply to medical services and prescription drugs. A deductible is the amount you must pay out of pocket for health care or prescriptions before the plan begins to pay.