I was not automatically enrolled; may I sign up at any time?

 Once your Initial Enrollment Period commences, you may sign up for Part A, if you are entitled for free Part A. Coverage will commence six months back from the date you applied, but not earlier than the first month you became eligible for Medicare. Remember, you can only sign up for Part B during your Initial Enrollment Period, General Enrollment Period, or a Special Enrollment Period.

 

Should I get Part B?

If you are still working, or if your spouse is still working and you have health coverage through your employer your spouse’s employer or union, it is a good idea to

 

If you or your spouse (or family member if you’re disabled) is still working and have health coverage through that employer or union, communicate with your employer or union benefits administrator to find out how your coverage works with Medicare. Whether you’re employed by the federal government, the state, and/or active-duty military service it is wise to contact the benefits administrator. If you have coverage through the Health Insurance Marketplace Small Business Health Options Program (SHOP), It might be advantageous to delay Part B enrollment. Current employment coverage does not include COBRA, VA coverage, retiree coverage, or Individual health coverage.

 

If you obtained individual coverage through the Marketplace, it is recommended that you terminate your marketplace coverage on the last day of the month prior to your 65th birthday. Of course, you want to make sure that you enroll in Medicare Parts A and B during your Initial Enrollment Period to avoid any delays in coverage and avoid obtaining a late enrollment penalty.  Be aware that once you become eligible for Part A, you will not be eligible for government subsidies to help pay for the cost of individual insurance. If you do not cancel your individual Marketplace coverage, but continue enrolled in a subsidized plan, you may have to pay back the amount of subsidies you received at the time of filing your taxes.

 

How does other insurance work with Medicare?

When you have other insurance besides Medicare, it is important to know which insurance will pay firs and which insurance will pay last. This is important because the insurance that pays first, generally pays the largest portion. 

 

  • If you have Medicare as well as retiree insurance, Medicare will pay first and your retiree insurance will pay second.

  • If you’re 65 or older, and have coverage through your employer’s group health plan where the employer has at least 20 employees, the group health plan pays first. This also applies if you are covered by your spouse’s group coverage.

  • If you’re 65 or older, and have coverage through your employer’s group health plan where the employer has less than 20 employees, Medicare pays first. This also applies if you are covered by your spouse’s group coverage.

  • If you’re under 65 and disabled, and have coverage through your employer’s group health plan, through your spouse’s group health plan, or through a family member’s group health plan, and the employer has 100 or more employees, your group health plan pays first.

  • If you’re under 65 and disabled, and have coverage through your employer’s group health plan, through your spouse’s group health plan, or through a family member’s group health plan, and the employer has less than 100 employees, Medicare pays first.

  • If you have End-Stage Renal Disease (ESRD) and have coverage through your employer’s group health plan, through your spouse’s group health plan, or through a family member’s group health plan, your group health plan will pay for the first 30 months after your become eligible to enroll in Medicare. Medicare will pay first after this 30-month period.

  • Multiple employer plans can be formed by the joining of more than on employer or union. In this case, the size of the largest employer or union determines if the employer or Medicare pays first.

 

Facts to keep in mind:

  • The primary payer pays up to the limits of its coverage.

  • The secondary payer only pays if there are costs the primary payer did not cover.

  • The insurance that pays second, might not pay all the uncovered costs.

 

How much does Part A coverage cost?

Many people think that Part A is FREE. That is incorrect. If you or your spouse worked and paid Medicare taxes while working, then you are, usually, eligible for Part A at no cost.  In essence, you paid for Medicare Part A during your working years.  This is often referred to as premium-free Part A. If you did not pay Medicare taxes during your working years, then you are not eligible for premium-free Part A. In this case, you may be able to buy it. Keep in mind that if you elect to buy Part A, you will also have to buy Part B.  The cost for Part A and Part B may change annually. To obtain the most recent price, call 1-800-633-4227.

 

Is there a Part A late enrollment penalty?

Like Part B, Part A also has a late enrollment penalty if you don’t enroll when you first become eligible to enroll, even if you have to buy Part A because you are ineligible for premium-free Part A. The penalty is 10% for every 12 months that you were eligible to enroll and you didn’t. The difference between Part A penalty and Part B penalty is that for Part A you will have to pay the higher premium for two times the number of years that you could have been enrolled in Part A, but you weren’t; whereas for Part B, you are stuck with the higher premium for all the years that you are enrolled in Part B.

 

Example: If you were eligible for Part A for three years but didn’t sign up, you’ll have to pay a 30% higher premium for 6 years.

 

What is the cost for Part B?

Part B cost may or may not change annually. In 2016, the standard cost for  Part was $121.80 (higher for individuals with high incomes).

 

What is the Part B late enrollment penalty?

The penalty for failing to enroll in Part Part B when you first become eligible is 10% for every full 12- month period.  You will have to pay this higher premium for as long as you have Part B coverage. However, if you are

 

If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Part B  Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had part B, but didn’t sign up for it.  If you’re permitted to enroll in Part B during a special enrollment period, you may not have to pay a late enrollment penalty.

 

Example: Mr. Jones’ initial enrollment period ended on July 30, 2014.  He waited to sign up for Part B until January 2017 during the General Enrollment Period.  Mr. Jones waited a total of 30 months to sign up. This resulted in only two full 12-month periods. His Part B premium penalty is only 20%. Unfortunately, he’ll have to pay this penalty for as long as he has Part B.

 

I have an emergency situation. What hospital can I go to and receive treatment?

By law, any hospital that you go to is required to treat you. Go to your nearest hospital. 

What is a limiting charge?

Medicare has a limit on what providers can charge for certain services. This limit is called “the limiting charge.” 

What is the general Open Enrollment Period?

Open Enrollment begins on October 15th and ends on December 7th of each year.  Coverage starts on January 1st of the following year.

What is occupational therapy?

Occupational therapy is a form of therapy for those recuperating from physical or mental illness. Occupational therapy  aids rehabilitation through the performance of activities required in daily life.

What is a Medicare MSA Plan?

It is a plan in which incorporates Medicare and private insurance companies working together to offer you options in how you obtain your health care coverage. These companies may offer a consumer-directed Medicare Advantage Plan, called a Medicare MSA Plan. These plans are similar to Health Savings Account Plans available outside of Medicare. You have flexibility in choosing your health care services and providers

How does medicare define terminal illness?

For Medicare purposes, terminal illness means that you are expected to live no more than six months.

 
 
 
 
 
 
 
 
 
 
 
 
Frequently Asked Questions