FAQs about Medicare Plans
As you move into the retirement chapter of your life, Medicare is an important step in maintaining your health and wellness. Yet with all of the many parts and rules of Medicare, choosing the right option can seem daunting to even the most savvy retirees.
But understanding the basics of Medicare can help you make use of your benefits—and we’re here to help you do just that. From eligibility and enrollment deadlines to costs and coverage, stay with us as we answer all your Medicare questions.
Can I Be Enrolled in Medicare if I’m Enrolled in Medicaid?
Your eligibility for Medicaid largely depends on your income. If you meet certain financial requirements, you may be considered dual eligible, which means that you’re eligible to enroll in Medicare and Medicaid.
If you’re dual eligible, most of your health care costs will likely be covered. You may have original Medicare (parts A and B) or a Medicare Advantage plan (Part C), and Medicare will cover your prescription drugs under Part D. Medicaid may also cover other care and drugs that Medicare doesn’t. Dual enrollees tend to use Medicare as their primary form of coverage while Medicaid serves as their supplemental insurance.
Even if you aren’t considered dual eligible, you may still be eligible for one of the federally funded Medicare Savings Programs. Simply check with your state’s Medicaid office to determine if you are eligible.
Will I Be Automatically Enrolled in Medicare or Do I Need to Sign Up?
Here are the instances in which you will be automatically enrolled in Medicare:
- If you’re already receiving Social Security or Railroad Retirement Board benefits: In most cases, if you are already receiving benefits from Social Security or the Railroad Retirement Board you will be automatically enrolled in Medicare Part A (hospitalization) and Part B (doctor’s visits) on the first day of the month when you turn 65. Social Security will send you sign-up instructions at the beginning of your initial enrollment period, three months before the month of your 65th birthday.
- If you have ALS (Amyotrophic Lateral Sclerosis, also known as Lou Gehrig’s disease): You’ll be automatically enrolled in Medicare Parts A and B and will receive a Medicare card the month your disability benefits begin.
- You’re under 65 and have a disability: You’ll automatically receive parts A & B after you’ve received disability benefits from either Social Security or the RRB for 24 months. You’ll receive your Medicare card in the mail three months before your 25th month of disability.
If none of the above apply to you, you will need to enroll manually. Your initial enrollment period has a seven-month window. This includes the month of your birthday, as well as the three months before and the three months after it. To ensure that you’ve got coverage by the time you turn 65, make sure to sign up in the first three months of the enrollment period. You won’t need to sign up each year. However, each year you’ll have a chance to review your coverage and change plans if necessary.
What Is Open Enrollment for Medicare?
Medicare offers an open enrollment period from October 15th through December 7th every year.
During this time, you can change your Medicare health plans and prescription drug coverage plans. Here are some important tips to help you make the most of the open enrollment period:
- Check your email. Be on the lookout for important notices from Medicare or Social Security. Medicare enrollees will receive an Annual Notice of Changes (ANOC) regarding any changes in coverage, costs, or service area.
- Consider your healthcare needs for the upcoming year. Take the time to review your current Medicare coverage and decide if it will meet your needs for the year ahead. If you like your current coverage, and it’s still available for the upcoming year, you won’t need to take any action to keep it.
- Explore health and prescription drug plans for the upcoming year. Want to compare coverage options and prices or shop for a new health plan? You can get a personalized search by logging in or creating an account where all your relevant information will be kept.
Do I Have to Be on Social Security to Get Medicare?
You do not have to be on Social Security before you can get Medicare. However, you will have to enroll on your own. This means applying for Medicare during your initial enrollment period. This is a seven-month period including your 65th birth month plus the three months before and after it. If you miss that window, you may be responsible for a permanent surcharge on your Medicare Part B and Part D premiums.
If you don’t collect Social Security benefits, you’ll need to pay the Part B premium directly. Then, once you begin taking benefits, you can have the premium deducted from your social security check. You can enroll in Medicare through the Social Security website.
Can I Enroll in Medicare if I Have a Health Savings Account?
A health savings account (HSA) is a great opportunity to set aside money on a tax-free basis to pay for healthcare costs during your working years and retirement. However, once you sign up for Medicare, you’re no longer eligible to contribute to a health savings account (HSA). That’s why, if you’re approaching your 65th birthday and still have access to a group health plan, you may want to hold off on enrolling in Medicare. If you decide to delay enrollment until you stop working, be sure to stop contributing to your HSA six months or more before you plan to sign up for Medicare. This will help to avoid a tax penalty.
Am I Eligible for a Medicare Supplement (Medigap) Plan?
A Medicare supplement insurance plan is a great way to help save money on your medical expenses. Also known as a Medigap policy, it helps fill the”gaps” of your remaining healthcare costs, such as deductibles, coinsurance, and copayments.
In order to be eligible for Medicare supplement (Medigap) coverage, you must already be enrolled in Medicare (Medicare Part A and B). However, you are not able to purchase both a Medigap and a Medicare Advantage (Part C) plan.
You can purchase Medigap coverage during the six-month open enrollment window, beginning on the date your Medicare B becomes effective. If you wait until the open enrollment period passes, it may cost more to buy a Medicare supplement insurance plan in the future.
How Much Does Medicare Cost?
Generally, you pay a monthly premium for Medicare coverage and part of the costs each time you get a covered service. There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage, like a Medicare Supplement Insurance (Medigap) policy, or you join a Medicare Advantage Plan.
The amount you’ll pay depends on the coverage you choose, the health care services and benefits you use during the year, and if your plan has rules about network vs out-of-network costs. Here’s a rundown of what you should expect to pay for Medicare coverage:
Cost of Medicare Part A (Hospitalization): If you have worked 40 qualifying quarters (10 years), you don’t have to pay a Part A premium, since you already paid Medicare payroll taxes during your working years. If you have not worked 40 qualifying quarters, you will be required to pay full price for Medicare Part A health insurance, at $471 per month.
Another cost for Medicare Part A is the deductible, which runs at $1,484 per benefit period. However, this cost is usually covered if you enroll in a Medigap policy or Medicare Advantage plan.
Cost of Medicare Part B (Medical Insurance): The cost of Medicare Part B depends on your adjusted gross income. Typically, if you make less than $91,000 a year, then you would pay $170.10 per month—the standard cost in 2022. You’ll pay this standard 2022 cost if:
You enroll in Part B for the first time in 2022.
You don’t get Social Security benefits.
You’re directly billed for your Part B premiums.
You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium amount of $170.10 in 2022.)
If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above $91,000 a year, you’ll pay the standard Part B premium as well as an income-related monthly adjustment amount. You can find that amount according to your income threshold here.
In addition to the monthly premium, you’ll also be required to pay the deductible if you don’t have another policy — such as Medicare Supplement — that covers it. The Part B deductible for 2022 is $233, which means you would need to pay $233 before your coinsurance benefits would kick in.
Cost of Medicare Part C (Medical Advantage Plan): A Medicare Advantage plan covers everything that traditional Medicare covers, including Part A (hospitalization) and Part B (doctor’s visits). However, it also offers additional benefits such as coverage for prescription drugs, vision, dental, hearing and more.
Because part C is offered by private health insurance companies, your premium will depend on who you choose as your provider. You’ll also be responsible for co-payments, deductibles and other out-of-pocket costs. However, with Medicare Advantage, you don’t need to sign up for Part D (drug coverage). You can compare costs for Part C plans here.
Cost of Medicare Part D (Prescription Drug Coverage):
Medicare Part D helps pay for the medications your doctor prescribes. Costs for Part D are similar in nature to Medicare Part B costs, since the premium amount you’ll pay depends on your household income. It will also vary depending on the following:
- Whether your prescriptions are covered by your policy
- Which “tier” the drug is in.
- Which pharmacy you use
- Which insurance provider you choose
- Whether or not you are eligible for Extra Help to pay for your prescription drug coverage.
You can compare costs for Part D plans here.