FAQ

I am eligible for Medicare, how do I enroll?

If you are turning 65 and you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically get Part A and Part B starting the first day of the month you turn 65. (If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.) If you are not automatically enrolled, you can enroll by calling Social Security at (800) 772-1213, visit their website www.ssa.gov, or apply at your local Social Security office. The best time to do this is three months before your 65th birthday that way you can make the correct insurance decisions in plenty of time.

If you’re under 65 and disabled, you’ll automatically get Part A and Part B after you get disability benefits from Social Security for 24 months or certain disability benefits from the RRB for 24 months.

If you have ALS (Lou Gehrig’s Disease), you’ll get Part A and Part B automatically the month your disability benefits begin.

If you’re automatically enrolled, you’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or 25th month of disability benefits.

Is Part B required?

No Part B is optional.

If you or your spouse (or family member if you’re disabled) is still working and you have health coverage through that employer or union, contact your employer or union benefits administrator to find out how your coverage works with Medicare. This includes federal or state employment, and active duty military service. It may be to your advantage to delay Part B enrollment. You can sign up for Part B without paying a penalty any time you have health coverage based on your (or your spouse’s) current employment. COBRA and retiree health coverage don’t count as current employer coverage.

Once the employment or coverage based on current employment ends (whichever happens first):

You have 8 months to sign up for Part B without a penalty. This period will run whether or not you choose COBRA. If you choose COBRA, don’t wait until your COBRA ends to enroll in Part B. If you don’t enroll in Part B during the 8 months after the employment ends, you may have to pay a penalty after you enroll for as long as you have Part B. You won’t be able to enroll until the next General Enrollment Period, and you’ll have to wait until July 1 of that year before your coverage begins. This may cause a gap in your health care coverage.

How much do I pay for Medicare?

Part A costs:
1. You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. This is sometimes called premium-free Part A. If you aren’t eligible for premium-free Part A, you may be able to buy Part A if:

  • You’re 65 or older, and you have (or are enrolling in) Part B and meet the citizenship and residency requirements.
  • You’re under 65, disabled, and your premium-free Part A coverage ended because you returned to work. (If you’re under 65 and disabled, you can continue to get premium-free Part A for up to 8 1/2 years after you return to work.)

2. In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you have limited income and resources, your state may help you pay for Part A and/or Part B

Part B costs:
You pay the Part B premium each month. Most people will pay the standard premium amount, which is $104.90 in 2015.

Some people may pay a higher Part B premium
If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount ($85,000 if you file individually or $170,000 if you’re married and file jointly), you may pay more. This doesn’t affect everyone, so most people won’t have to pay a higher amount. Your modified adjusted gross income is your adjusted gross income plus your tax exempt interest income.

Paying your Part B premium

If you get Social Security, RRB, or Office of Personnel Management (OPM) benefits, your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments and choose to sign up for Part B, you’ll get a bill.

What is the charge for your services?

There is never a charge for our services for any insurance decisions. Simply put, brokers are compensated from the insurance company you choose to go with.

Can I get a Marketplace plan instead of Medicare, or can I get a Marketplace plan in addition to Medicare?

Generally, no. It’s against the law for someone who knows you have Medicare to sell you a Marketplace plan, because that would duplicate your coverage.

However, if you’re employed and your employer offers employer-based coverage through the Marketplace, you may be eligible to get that type of coverage.

Note: The Marketplace doesn’t offer Medicare Supplement Insurance (Medigap) policies, Medicare Advantage Plans, or Medicare drug plans (Part D).
To get more information visit healthcare.gov or medicare.gov.

What if I become eligible for Medicare after I join a Marketplace plan?

You can get a Marketplace plan to cover you before your Medicare coverage begins. You can cancel the Marketplace plan when your Medicare coverage starts. When you’re eligible for Medicare, you’ll have an Initial Enrollment Period to sign up. In most cases it’s to your advantage to sign up when you’re first eligible because:

  • When you’re considered eligible for Medicare Part A, you won’t qualify for Marketplace tax credits to help pay your premiums or reductions in cost-sharing that may be available through the Marketplace.
  • If you enroll in Medicare after your Initial Enrollment Period ends, you may have to pay a late enrollment penalty for as long as you have Medicare.

Note: You can keep your Marketplace plan after your Medicare coverage starts. However, once your Part A coverage starts, any premium tax credits and reduced cost-sharing you get through the Marketplace will stop.

To get more information visit healthcare.gov or medicare.gov.

What is Extra Help?

If you have limited income and resources, you may qualify for help to pay for some health care and prescription drug costs. Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs, like premiums, deductibles, and coinsurance. If you have Extra Help which includes versions of Medicaid as well, there are Medicare plans designed specifically that are available to you as well.

To apply for Extra Help and see if you qualify call Social Security at (800)-772-1213, TTY (800)-325-0778 7am-7pm, Mon-Fri

What is the Part D enrollment penalty?

The late enrollment penalty is an amount that’s added to your Part D premium. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Part D or other creditable prescription drug coverage.

To avoid incurring this additional fee, make sure to sign up for either a Medicare Advantage Plan that offers drug coverage or a stand-alone Part D plan during your Initial Enrollment Period. Please note that if you have employer coverage, you may not need to enroll until that coverage ends. When your employer coverage ends, you caould have a Special Election Period to enroll in a Medicare Plan and may not be subject to an additional Part D premium.

Note: If you get Extra Help, you don’t pay a late enrollment penalty.

What is the Donut Hole?

Most Medicare drug plans have a coverage gap (also called the “donut hole”). The coverage gap begins after you and your drug plan together have spent a certain amount for covered drugs.

In 2015, once you enter the coverage gap, you pay 45% of the plan’s cost for covered brand-name drugs and 65% of the plan’s cost for covered generic drugs until you reach the end of the coverage gap. Not everyone will enter the coverage gap because their drug costs won’t be high enough.

Once you get out of the coverage gap, you automatically get “catastrophic coverage.” With catastrophic coverage, you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

Note: If you get Extra Help, you won’t have some of these costs.