Frequently Asked Questions

I’m turning 65 this year and I plan to retire. When am I eligible to enroll in Medicare?

You can enroll in Medicare when you turn 65, specifically during your Initial Enrollment Period. This 7-month period begins three months before the month you turn 65, includes your birthday month, and ends three months after. If you're already receiving Social Security benefits, you'll be automatically enrolled in Part A.

What is creditable coverage?

Creditable coverage is health insurance or prescription drug coverage that provides benefits equal to or better than those offered by Medicare. It's a key concept for Medicare Part D enrollment, as it can allow individuals to delay or avoid enrollment without incurring late enrollment penalties.

Where do I go to get signed up for Medicare Parts A & B?

Online at SSA.gov or in person at a local Social Security office.

What is Part D?

Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. It helps cover the cost of both brand-name and generic medications.

Key Features:

• Optional Coverage: You can enroll in Part D if you have Medicare Part A or Part B.

• Private Plans: Part D is provided through stand-alone drug plans (PDPs) or Medicare Advantage plans (MAPDs) that include drug coverage.

• Costs: Includes monthly premiums, deductibles, copayments, and coinsurance, which vary by plan.

• Late Enrollment Penalty: If you don’t enroll when first eligible and don’t have other creditable drug coverage, you may face a permanent penalty.

Starting in 2025, Medicare Part D will have a $2,000 annual cap on out-of-pocket costs.

Should I have both a Medicare Advantage Plan and a Medicare Supplement Plan?

No, you cannot have both a Medicare Advantage Plan and a Medicare Supplement Plan at the same time. Medicare Advantage (Part C) replaces Original Medicare, while Medicare Supplement (Medigap) works in conjunction with Original Medicare.

What is Medicare Supplement or MediGap?

Medigap, also known as Medicare Supplement Insurance, is extra insurance sold by private companies to help cover the out-of-pocket costs you'll pay with Original Medicare (Parts A and B). It helps to bridge the "gaps" in Original Medicare coverage, such as deductibles, copayments, and coinsurance.

What happens if I miss my designated enrollment window into Medicare?

If you miss your Initial Enrollment Period (IEP) for Medicare, you still have options, but you may face late enrollment penalties and delayed coverage. What happens if you miss your enrollment window?

• General Enrollment Period (GEP): If you didn’t enroll during your IEP, you can sign up during the GEP (January 1 – March 31) each year, but coverage won’t start until July 1, and you may have to pay a late enrollment penalty.

• Special Enrollment Period (SEP): If you had qualifying employer coverage, you may be eligible for an SEP, allowing you to enroll without penalties when your job-based insurance ends.

• Late Enrollment Penalties:

  • Part A: If you don’t qualify for premium-free Part A, you may pay higher premiums for twice the number of years you delayed enrollment.

  • Part B: You’ll pay a 10% penalty for each year you delayed enrollment, added to your monthly premium for life.

  • Part D: If you go 63+ days without creditable drug coverage, you’ll pay a permanent penalty added to your Part D premium.

If you missed your enrollment window, it’s best to act quickly to avoid penalties and gaps in coverage.

What is Part C?

A Medicare Part C plan, also known as a Medicare Advantage plan, is a type of Medicare-approved health plan offered by private insurance companies. It combines Original Medicare Part A (hospital insurance) and Part B (medical insurance) into one plan, and usually includes Part D (prescription drug coverage). Part C plans can offer additional benefits beyond what Original Medicare covers, such as dental, vision, and fitness.

Does Medicare cover me if I’m in a nursing home?

Yes, for up to 100 days, after a required three-day hospital stay. Medicare does not cover long-term nursing home stays, but it does cover short-term, medically necessary care in a skilled nursing facility (SNF) under certain conditions.

What Medicare Covers:

• Short-term skilled nursing care after a qualifying hospital stay (at least 3 consecutive inpatient days).

• Physical therapy, occupational therapy, and speech therapy if needed for recovery.

• Medical services like wound care, medication management, and injections.

• Semi-private room, meals, and nursing care for up to 100 days per benefit period (with cost-sharing).
  

What Medicare Does Not Cover:

• Long-term custodial care, including help with daily activities like bathing, dressing, and eating.

• Permanent residence in a nursing home, unless covered by Medicaid or private insurance.

If you're considering long-term care, you may want to explore Medicaid, long-term care insurance, or other financial assistance programs.

Do I need to enroll in Part A and Part B of Medicare?

Most people enroll in Medicare Part A (hospital insurance) and Part B (medical insurance) when they turn 65, but whether you need to enroll depends on your situation.

• Part A: If you've worked and paid Medicare taxes for at least 10 years, you likely qualify for premium-free Part A, so most people enroll in it right away. If you still have employer coverage and contribute to a Health Savings Account (HSA), you may want to delay Part A to avoid tax penalties.

• Part B: This covers doctor visits, outpatient care, and preventive services. If you have employer-sponsored health insurance, you may be able to delay enrolling in Part B without penalties. However, once you stop working, you’ll have an 8-month Special Enrollment Period to sign up.

Can I just have Original Medicare A and B as my health insurance at retirement?

Yes, you can choose to have Original Medicare (Parts A & B) as your sole health insurance in retirement, but there are important considerations:

• Coverage: Original Medicare covers hospital stays (Part A) and medical services (Part B), but it does not include prescription drugs, dental, vision, or hearing care.

• Costs: You’ll have deductibles, copayments, and co-insurance, and there’s no out-of-pocket maximum, meaning you could face high costs if you need extensive care.

• Supplemental Options: Many retirees add Medigap (Medicare Supplement) to help cover costs or enroll in Medicare Advantage (Part C) for additional benefits.

• Prescription Drugs: If you want drug coverage, you’ll need to enroll in Medicare Part D separately.

Some people do stick with just Original Medicare, but it’s wise to compare options based on your health needs and budget.

Can I keep all my same doctors when I’m on Medicare?

Yes, you can likely keep your current doctors when you transition to Medicare, but it depends on the type of Medicare plan you choose and whether your doctors accept Medicare. With Original Medicare and a MediGap plan, you can generally use any doctor or hospital that accepts Medicare in the U.S. However, with Medicare Advantage plans, your doctor may need to be within the plan's network, so it's important to verify.

Can I keep my employer coverage?

Turning 65 is a big milestone, and it comes with important decisions about health insurance! Whether you can keep your employer-sponsored coverage depends on several factors, including your company's policies and Medicare rules.

• If your employer has 20 or more employees, your job-based insurance can continue, and Medicare will act as secondary coverage.

• If your employer has fewer than 20 employees, Medicare typically becomes your primary insurance, and your employer coverage may change.

• You may delay enrolling in Medicare Part B if your employer coverage is considered "creditable," meaning it meets Medicare’s standards.

• Once you stop working, you’ll have an 8-month Special Enrollment Period to sign up for Medicare without penalties.

It’s a good idea to check with your HR department to understand how your specific plan interacts with Medicare.

Can my dependent spouse be on my Medicare plan?

No, a dependent spouse cannot be covered under your Medicare plan. Medicare is an individual insurance program, meaning each person must enroll in their own plan based on their eligibility and needs. Spouses cannot be added to each other's Medicare coverage.

What’s the difference between Medicare and Medicaid?

Medicare
Think of Medicare as health insurance mainly for older adults.

• Who qualifies? People 65 and older, or younger folks with certain disabilities or conditions (like end-stage kidney disease).

• What it covers? It helps pay for hospital stays, doctor visits, and sometimes prescriptions, depending on the plan you choose.
  

Medicaid
Now, Medicaid is health coverage for people with low income, and sometimes for those with certain disabilities or special situations.

• Who qualifies? Eligibility depends on income and family size, and can vary by state.

• What it covers? It often covers more things than Medicare, like long-term care or personal care services.
  

Quick way to remember:

• Medicare = care for the elderly.

• Medicaid = aid for those with lower incomes.