MEDICARE FREQUENTLY ASKED QUESTIONS
Explore commonly asked Medicare Insurance questions below. To view the answers, simply click on the question and it will open up.
Do I Get My Medicare Card Automatically When I Turn 65?
If you are not collecting Social Security, you will need to go online and apply. If you do not do this your Medicare will not start at 65 and you will not be able to get Medicare coverage on time. This is a very common mistake. I advise my clients to apply for Medicare three months in advance of the month you turn 65. As an example, if you turn 65 on December 27, your Medicare should start on December 1st. Under this scenario, I would advise my client to apply for Medicare, on-line, on September 1st.
*** If your birthday is the first day of any month, your Medicare will start the month before. As an example, if you were born on July 1st, your Medicare would start on June 1st.
How Much Does Medicare Part A and Part B Cost?
There are two parts of Medicare. Part A and Part B. Most people pay nothing for Part A because you have paid taxes for over the time you have worked and completed the number of working quarters (40 quarters; 10 years) required to receive Part A for $0.00.
Part B premium in 2023 is $164.90 each month. This amount is deducted from your Social Security check each month (if you’re collecting Social Security). If you are not collecting Social Security, you will be every quarter (3 months). The amount you will be billed is $164.90 x 3 months= $494.70. This will be paid quarterly. If you don’t pay it, they will cancel your Medicare Part B and you will also lose your Medicare Advantage coverage if that’s the plan you have. If you have a Medicare Supplement policy, you can still be billed for it, but the supplement will not work.
The amount of Part B you pay is determined by income. Social Security also uses a 2 year look back period on income. Your 2023 Part B premium is determined by your income in 2021.
These are the income limits for people that are single and for married couples filing taxes jointly:
Single and your income is less than $94K: $164.90.
Single and income is between $97K and $123K: $230.80.
Single and income is between $123K and $153K: $329.70.
Single and income is between $153K and $183K: $428.60.
Single and income is between $183K and $500K: $527.50.
Single and income is over $500K: $560.50.
If you are married and filing jointly, here the numbers:
Income is below $194K: $164.90
Income is between $194K-$246K: $230.80
Income is between $246K -306K: $329.70.
Income is between $306K -$366K: 428.60.
Income is between $366K-750K: 527.50.
Income is over $750K: $560.50
In some instances, there are ways to appeal these decisions. For example, if your income in 2021 was high because you were still working and you have recently retired or lost your employment, you can appeal the decision on how much you will have to pay. There is an appeal form to fill out and submit. If you call my office, I can help you with this and provide you with the necessary form that you will need to appeal the Part B premium amount.
How Much Does Part D IRMAA Costs?
Just like with Part B, if you have substantial income, they will impose a surcharge on your drug coverage based on your income. The income thresholds are the same as Part B but the dollar amounts are different.
If you are single:
Your income is less than $94K: $0.00.
Income is between $97K and $123K: $12.20.
Income is between $123K and $153K: $31.50.
Income is between $153K and $183K: $50.70.
Income is between $183K and $500K: $70.00
Your income is over $500K: $76.40
If you are married and file jointly:
Income is below $194K: $0.00
Income is between $194K-$246K: $12.20
Income is between $246K -306K: $31.50
Income is between $306K -$366K: $50.70
Income is between $366K-750K: $70.00
Income is over $750K: $560.50; $76.40
***Even if you receive drug coverage through a zero premium Medicare Advantage plan, the IRMAA charge on drug coverage will still apply.
I moved to Florida from another state, do I have to change my Medicare Advantage Plan and Part D prescription drug plan?
Yes. If you move from a different state, you will have to change your drug coverage or your Medicare Advantage plan. You must live in the service area where the plan is being offered.
When it comes to drug coverage, you should work with a, local broker and take the opportunity to have a fresh set of eyes to evaluate your drug coverage. Having the opportunity to change drug plans outside of the Annual Election Period (October 15 through December7) Most people I work with are wasting money on drug coverage. Either they are paying too much premium or drug the costs are too high based on the prescriptions they are taking or sometime both. If it turns out you have the right plan, we would re-enroll you in the Florida version of the plan you have now.
If you have a Medicare Advantage plan from a different state, you should, once again, work with a local broker and have them evaluate your coverage based on where you are living. This is especially crucial if you are going g to reside in 2 states, but you are making Florida your primary residence. You would need to find a Medicare Advantage plan that your doctors in both states accept, in-network, and that your prescriptions are covered affordably.
Many people do not realize that Medicare Advantage Plans are county specific in Florida. This means you may have to change plans if you move from one county in Florida to another county in Florida. Once again this can be an opportunity to change plans and have your coverage re-evaluated outside of the Annual Election Period.
***Also, if you move to a new state or county in Florida and have a Medicare Advantage plan, and that Medicare Advantage plan is not available in your new state or county, you have Guaranteed Issued rights to purchase a Medicare Supplement policy with no medical underwriting. Call me and I can walk you through the process.
I am retiring and have to start my Part B
If you are over age 65 and you only have Part A because you are working for a company, and they provided you (and in most cases your spouse) group health insurance coverage. But now because you are retiring or you have lost employment, you will need to get Part B so you can get coverage under Medicare.
There are two forms that will need to fill out (If you call me, I will email these forms to you.) One set needs to be filled out by your employer and the other set needs to be filled out by you (if you’re married and your spouse only has Part A, he or she will need to the same) Once completed, these forms need to be faxed into your local Social Security office (Often times I will do this for my clients)
These forms will ensure that you can get Part B to start when your work coverage ends, and it also eliminates any late enrollment penalty for signing up for Part B. These forms prove that you have had credible coverage through your employer’s group health insurance plan.
Ideally you should get these forms completed and faxed into Social Security 2 to 3 months of when you know you will be retiring or losing employees coverage. In some instances, people do not have the luxury of knowing that far in advance. If you work with me, I will work expeditiously to make the best use of the available time we have to try to get you your Part B started when you need it to be.
What Medicare Advantage Plan is Best for Me.
When you are looking for a Medicare Advantage plan as a cover option, there are several factors you should consider.
The one factor I think is most important is whether you want to deal with referrals or not. If you don’t mind having to get referrals from your primary care doctor, then an HMO plan might work for you. If you do not want to deal with referrals, then your best option would be a PPO. Most Medicare Advantage plans available in most markets around the country are HMO’s. If you don’t want to deal with HMOs, that eliminates the majority of plan options in your area. The problem with most HMO’s is that in a general sense, they have smaller provider networks than PPO’s and because of the referrals you might have limited options when it comes to seeing Specialists.
The second factor that is very important is the drug coverage component. Most Medicare Advantage plans are termed MAPD plans. The ‘PD” means prescription drug coverage. When selecting MAPD coverage, you need to make sure that your prescriptions are covered affordably.
If you can find a plan that all your doctors are in-network and that same plan covers your prescriptions affordably, that you might have found yourself winning coverage. If there is more than one plan that provides this type of good coverage, the other determining factors to use to narrow down your choices would be the co-pay dollar amounts under each plan and the extra benefits that these plans provide. For choices example, most MAPD plans will offer dental benefits, vision benefits, hearing benefits, over the counter medicine benefits, Silver Sneakers etc…
The one major mistake I do see a lot of people make is that they select a plan based on the extra benefits and not the strength of the network. In my opinion, you need to look at your plan options as health insurance first and the extra benefits should only be icing on the cake.
What Are Some of Things That Medicare Does Not Cover
Long Term Care: Medicare does not cover long term care. Long term care is needed when people can perform activities of daily living, like eating, bathing, dressing etc… Long term care is paid either by long term care insurance policy or it is paid out of pocket. Many people confuse long term care with home health. They are not the same. Home health is prescribed under doctors orders and is covered by Medicare.
Dental: Medicare does not cover dental. However, many Medicare Advantage Plans do offer dental benefits. Dentures are not covered by Medicare, as well.
Hearing Aids: Hearing aids are not covered by Medicare but may be covered under a Medicare Advantage plan. The good news is that hearing aids are now deemed to be over the counter. This is has provided more affordable options for hearing aids than in the past.
Routine Physical Exams: These are not covered under Medicare. However, many Medicare Advantage plans offer a free annual physical.
How Do I Choose The Right Part D Prescription Plan
I have been working in the Medicare space for almost 20 years and where I generally see people waste a lot of money is when it come to their drug coverage (Part D).
Drug coverage needs to be evaluated each year. This is done each year between October 15 and December 7. This time is referred to as the Annual Election Period.
There are 2 factors to consider. The most obvious factor is the monthly premium. This can be very misleading. The most important factor is the cost of your prescriptions.
My formula is to advise my clients is go with the plan with the lowest overall cost when you add premium plus the cost of prescriptions. The factors that determine this are your prescriptions and the pharmacy or pharmacies you are willing to go to. Preferred pharmacies offer better pricing than “standard” pharmacies. Retailers have relationships with drug plans to offer more competitive pricing.
But just because your drug coverage was the most affordable this year, that may not be the case next year. Drug plans change their formularies (list of covered drugs by Tier level) and retail pharmacy relationships change, as well. That is why you must evaluate your drug coverage each year (We do this for our clients free of charge each year). This is especially important if you are taking expensive prescriptions. If you don’t evaluate your coverage, it can really costs you and it’s completely unnecessary.