Medicare Frequently Asked Questions

Does Medicare Insurance cost anything? 

If you have worked for 40 quarters ( 10 years) or more then you are entitled to Part A and do not have a monthly premium to pay for it. However, Part B has a monthly premium under $200 – you may pay more if you’re income is higher or the State may pay the premium for you if you qualify for assistance.

I missed annual enrollment.. can I still change my plan?

There are many circumstances that allow a person to change their plan outside of the annual enrollment period. Losing employer group coverage, moving to a new area, receiving federal or state assistance are just a few! People often qualify to change their plan but don’t realize it. Give us a call and we can help you see if you have a special circumstance that allows you to change or enroll.

I have Medicare Insurance and Medicaid. Aren’t I fully covered?

In many cases your medical costs are paid for if you have both. However, there are additional benefits you may be eligible for in a Dual Special Needs Plan. Such as extra dental and access to more dentists, extra vision credit for glasses or contacts, help with everyday over the counter items and more! If you have both, please contact us or call and agent you trust to help you look at the benefits of a Dual SNP.

Can I get Medicare Insurance before I’m not 65?

If you’re under 65 you can still qualify for Medicare if you’ve been on SSDI for 24 months or through certain disabilities, such as End Stage Renal Disease (ESRD).

Can I have a Medicare Advantage Plan and a Medicare Supplement Plan?

No. Medicare only allows you to have one or the other. Only one would pay at a time so you wouldn’t want both plans even if you could have them.

I have heard about these dual plans.. how do those work?

A Dual Special Needs Plan (DSNP) is a Medicare Advantage plan designed for someone who has Medicare insurance AND Medicaid. They are often loaded with extra benefits to help provide you benefits beyond Medicare.

So if I have Original Medicare then it pays for all of my costs?

Not really. Under your Part A benefits, if you’re admitted into the hospital you’re responsible for a deductible of $1,632 per benefit period before Medicare begins to pick up any of the costs. Under your part B benefits, such as a doctor’s office visit or outpatient procedure, you’re responsible for an annual deductible of $240. Once that has been met then Medicare will pay 80% and you will be billed from your provider for the remaining 20%.

What doesn’t Medicare cover? 

Original Medicare doesn’t include prescription drug coverage (known as Part D) that’s something you have to get from a private insurance company. Additionally, Original Medicare doesn’t cover routine dental, routine vision or hearing. It also doesn’t give you coverage for any over-the-counter health items (such as vitamins, bandages, cold/flu medicines, etc), gym memberships, etc. In addition, there is no maximum out of pocket (MOOP) limit on what your costs can be for a calendar year – leaving you at risk of high costs if you experience large healthcare bills in a year.

The Good News? There are plans designed to help cover some or all of the gaps that leave you exposed. You could save more money, have more predictable costs and get extra benefits that cover some or all of what Medicare doesn’t cover. Better yet, some of these plans are available for an additional $0 cost per month! Contact us to find out more.