Learning Center > 10 Medicare Frequently Asked Questions

10 Medicare Frequently Asked Questions

If you have questions about Medicare like, "Can I keep my doctor with my plan?" Or, "Does Medicare cover my medical procedure or service?" you’re in good company. Understanding and signing up for Medicare can be confusing, whether it's Original Medicare or a Medicare Supplement plan.

But fear not: We have the answers you’re looking for. Let's dive into 10 frequently asked questions and answers about Medicare, so you can learn how Medicare plans work and determine what's right for you.

1. What is Medicare?

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Medicare typically covers the costs of emergency, preventative, and long-term healthcare.

Medicare is funded by the federal government, but various related programs, like Medicare Supplements, have state oversight. The two main categories of Medicare coverage include Original Medicare (with optional Medicare Supplement and prescription drug insurance) and Medicare Advantage.

2. Who qualifies for Medicare?

There are three groups who qualify to receive Medicare:

  • People who are 65 and older.
  • People under 65 years old who are disabled and who have been receiving Social Security Disability benefits for at least 24 months.
  • Qualified people with End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis, also known as ALS or Lou Gehrig’s disease.

3. What does Medicare cover?

A wide variety of healthcare services are covered by Medicare, depending on the type of policy you choose, including:

  • Ambulance services
  • Anesthesia
  • Artificial eyes & limbs
  • Bariatric surgery
  • Blood processing & handling
  • Cardiac rehabilitation programs
  • Cardiovascular disease screenings
  • Cervical & vaginal cancer screenings
  • Chemotherapy
  • Depression screenings
  • Diabetes prevention programs
  • Diagnostic tests (laboratory and non-lab)
  • Eye exams (routine)
  • Eyeglasses & contact lenses
  • Flu shots
  • Foot care
  • Hearing aids
  • Hepatitis B and HIV screenings
  • Inpatient hospital care
  • Kidney transplants
  • Lung cancer screenings
  • Mammograms
  • Mental health care (inpatient and outpatient)
  • Occupational therapy
  • Opioid use disorder treatment services
  • Organ transplants
  • Pain management
  • Prescription drugs (outpatient)
  • Preventive & screening services
  • Radiation therapy
  • Sexually transmitted infections screenings & counseling
  • Sleep studies
  • Surgery
  • Urgently needed care
  • X-rays
  • Yearly "wellness" visits

4. Am I automatically enrolled in Medicare when I turn 65?

Many people automatically get Original Medicare - also known as Part A and Part B - especially if they’re receiving Social Security retirement benefits when becoming eligible for Medicare coverage. Other people may need to sign up for Medicare.

If you're aging into Medicare, you have a seven-month Initial Enrollment Period (IEP) to apply for Medicare: three months before you turn 65, the month you turn 65, and three months after you turn 65. And you must sign up individually for the parts of the program - Parts A, B, C and/or D - that you want.

5. Do I need Medicare if I already have health insurance?

It depends. You may need Medicare even if you already have other health insurance coverage, or if your current plan doesn’t meet the minimum coverage requirements.

Most plans that employers offer meet these standards. So if you have insurance through your job, you probably don't need Medicare. However, by staying on an employer plan, you can delay enrolling in Part B without a penalty and avoid paying Part B premiums.

An important note: When you have Medicare plus additional insurance policies, each provider becomes a "payer." The policy that pays for your specific medical services first depends on the coordination of benefits rules for your plans.

In other words, the primary payer will pay what it owes on your medical bills first, then the provider will send the remaining amount to the secondary payer to pay the rest.

6. What's the difference between Original Medicare, Medicare Advantage, and Medicare Supplement plans?

Medicare is divided into two categories, with Medicare Part D as an additional option for prescription coverage.

When signing up for Medicare, Part A is mandatory but Parts B, C, and D are optional. But keep in mind that you will incur a late penalty if you don't enroll in Parts B and D when you’re first eligible.

Here's a breakdown of the different Medicare parts and plans:

Part A (Original Medicare Plan)

Covers inpatient care in a hospital, inpatient care in a skilled nursing facility (not custodial or long-term care), hospice care, skilled nursing home care, and other types of home health care.

Part B (Original Medicare Plan)

Covers medically necessary services, preventative care, clinical research, mental health care, inpatient and outpatient services, partial hospitalization, and more.

Part C (Medicare Advantage Plan)

Combines Parts A and B into bundled coverage through an approved private insurance company that uses the Medicare network.

Part D (Prescription Drug Coverage)

Pays for several tiers of name brand and generic medications, sometimes up to a limit.

Medicare Supplement Insurance

Extra coverage through an approved private insurance company that fills gaps or "supplements" what Original Medicare doesn't cover. Also known as a Medigap plan.

You can typically buy Medigap insurance online to help you cover the out-of-pocket costs and additional services that are not covered by your primary plan As examples, a Medicare supplement plan may be used to cover copays, coinsurance fees, and deductibles.

A Medicare supplement plan is a standalone policy, so you’ll pay an additional cost for the plan outside of your primary Medicare premium. You must also have Medicare Part A and Part B to qualify for Medigap insurance.

Lastly, Medigap policies are guaranteed renewable, which means your insurance company can't cancel your policy if your health conditions change. You just have to pay your premiums on time.

7. Does Medicare cover dental and vision services?

Not usually. Original Medicare (Parts A and B) plans don't cover most dental services or vision care. But if you're already in the hospital, some dental or vision services may be covered.

Certain Medicare Advantage Plans (Part C) may cover dental and vision services, so make sure to check your policy before you enroll.

8. Can I have both Medicare and Medicaid at the same time?

In many cases, yes. Medicaid is a federally-supported program that helps states provide medical coverage for individuals with a limited income. So you may qualify for both if you meet the economic requirements for Medicaid and the age or disability requirements for Medicare.

Some states also provide expanded Medicaid access to individuals (including those with Medicare) who meet economic qualifications after subtracting their out-of-pocket medical expenses from their income.

For example: If you're a single person who earns $26,000 a year, you probably won’t qualify for Medicaid under normal program requirements. But if you live in a state with expanded access, you can subtract your medical expenses from your salary to come to a new income. So if you spend $7,000 on medical expenses, then your final income for your Medicaid application would be $19,000, so you might qualify for coverage.

Note: If you qualify for both programs, Medicare is automatically designated as your primary insurance provider while Medicaid becomes the secondary payer.

9. Which medications does Medicare Part D cover?

Medicare Part D coverage varies based on your insurance company, but all plans must include a minimum amount of medication coverage that's approved by Medicare.

So qualifying Part D plans must offer at least two medication options from each class of drug category on their formulary to treat common health issues. But not all health conditions are covered.

Check your insurance company's formulary (a list of generic and brand name prescription drugs covered by your specific health plan) to see what prescription drugs are covered. And fortunately, there are lots of other ways to reduce your prescription costs.

If you don't have a Part D plan, it can be added to any Original Medicare policy, Medicare Savings Account (MSA) Plan, some Medicare Cost Plans, and some Medicare Advantage Private Fee-for-Service (PFFS) Plans.

10. How do I check the status of my Medicare application?

The short answer is, "It depends."

If you applied for a standard Medicare Part A or Part B plan, you can check the status of your application by logging into your account on the Medicare website. Your application should show up in your profile within 24 hours of submission.

Get Help With Medicare

Though we covered some common Medicare questions, you might still need help choosing the best Medicare plan for your needs and budget.

Just call 800-620-4519 to reach one of our licensed insurance agents, or you can find and compare Medicare plans to see available options in your area.

Get a Free Quote

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What you should read next

If you’re approaching your 65th birthday or caring for an older relative, you may be wondering how to apply for Medicare. Do you have to apply specifically, or is coverage provided automatically? What form(s) do you need? The answer depends on your unique situation and medical needs. In this article, we’ll help you understand how to apply for Medicare in a variety of situations. How To Apply For Medicare Part A and B? Medicare Part A is hospital insurance, while Medicare Part B is medical insurance. For most Americans with sufficient work history, there’s no monthly premium associated with Part A coverage. There is a monthly cost for Medicare Part B. Curious how to apply for Medicare Part A? You may not need to! You’ll receive Medicare Part A and B automatically without applying if you’re receiving Social Security or Railroad Retirement Benefits (RRB) for at least four months before you turn 65. If you’re not receiving Social Security benefits before you turn 65, you’ll have to enroll with Social Security to get the coverage you need. If you’re still working and have a group health insurance plan when you become Medicare-eligible, you can choose to delay enrollment in Medicare Part B without later paying a penalty when you enroll. When your group health insurance plan ends, you can apply online or by using the Part B enrollment form. If you have qualifying disabilities and you’re under 65, you’ll receive Part A and Part B automatically after you’ve received Social Security disability benefits for 24 months. If you have ALS (Lou Gehrig’s Disease), you’ll automatically get Medicare Parts A and B the month your disability benefits begin. Finally, if you have End-Stage Renal Disease, Medicare benefits are optional. If you want them, you will need to sign up by contacting Social Security. How To Apply For Medicare Part C & D Medicare Part C, also known as Medicare Advantage, is an all-in-one replacement for Original Medicare and includes additional benefits. For instance, most Medicare Advantage plans include prescription drug coverage, and some include vision, dental, and other benefits. You can purchase Medicare Advantage plans directly from private insurance companies. The plans vary in terms of price, benefits, and medical network. That’s why it’s important to get multiple quotes and compare your options before you make a decision. Medicare Part Dis an optional add-on that you can have in addition to Parts A and B. Part D, also known as a Medicare drug plan, provides prescription drug coverage and costs an additional monthly premium. How to Apply for Medicare Part D You can apply for Medicare drug plans using the Medicare Plan Finder tool or by calling the provider directly. Applying For Medicare FAQs As you review your Medicare options, you may find that you have a few questions. Here are some of the most common concerns we hear. What Documents Do I Need To Apply For Medicare? If you’re automatically enrolled in Medicare Part A and B, you won’t need any additional documentation. However, if you enroll yourself, you will need to provide your date and place of birth and information on any current health insurance, whether that’s Medicaid, private coverage, or group coverage from your employer. How Do I Sign Up For Medicare Online? Signing up for Medicare online is the easiest option if you aren’t automatically enrolled. Find and compare Medicare plans online. Learn More About How to Apply for Medicare With its various parts and enrollment dates, navigating Medicare can be a challenge. We’re here to make it easier for you. Contact us to speak to a licensed insurance agent who can answer all of your Medicare application questions.
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Medicare was originally designed for individuals who had retired from the workforce. As a result, the standard was set that you qualify for Medicare when you’re 65 years old. However, there are now additional ways to qualify for Medicare. Younger people with qualifying disabilities can also be eligible, along with individuals with end-stage renal disease. If you meet certain qualifications, you can get Medicare Part A for free, but Medicare Part B comes with a monthly premium. It’s important to understand who is eligible for Medicare Part A and Part B and who is not eligible for Medicare so you get the benefits you understand your medical benefits and costs. Medicare Eligibility Requirements There are a variety of requirements to be eligible for Medicare, especially if you want Part A with no monthly premium. Below are some of the more specific details on Medicare eligibility requirements. To qualify for Medicare you need to: Be a U.S. citizen or permanent legal resident who has been in the U.S. for at least five years Be 65 or older You can qualify for Medicare if you’re under 65 but have a qualifying disability or end-stage renal disease Who Qualifies for Premium-Free Medicare Part A? You can get Medicare Part A without a premium if: You are 65 or older and you or a spouse worked and paid Medicare taxes for at least 10 years You receive benefits from Social Security or the Railroad Retirement Board You or your spouse had government employment that was Medicare-covered Who Can Apply For Medicare Part A and Part B? Anyone who meets the eligibility requirements can apply for Medicare coverage. Your initial enrollment period begins three months before your 65th birthday and lasts seven months. If you sign up during the first three months of your enrollment period, your Medicare coverage will go into effect the first day of the month you turn 65. If you qualify for premium-free Medicare Part A and you are receiving Social Security benefits when you become eligible for Medicare, your Part A coverage will begin automatically when you turn 65. . If you’re not receiving benefits, you can still get Medicare Part A on time by enrolling online or contacting Medicare directly. While Part A may be automatic for some, all individuals must apply to enroll in Part B. You can sign up for Part B during your initial enrollment period that occurs around your entitlement to Part A, and then generally only between January 1 and March 31 of each year (unless you have delayed because you continue to work). . If you don’t apply for Medicare Part B when you’re eligible, you’ll most likely have to pay a late enrollment penalty. If you have to pay for Medicare Part A, it follows the same rules as Medicare Part B. You can only enroll at specific times, and you have to sign up. Who can Apply for Medicare Online? Any qualifying individual can apply for Medicare online, however, you can only sign up during the initial enrollment period and then between January 1 and March 31 of each year. Medicare Eligibility FAQs Here are a few common questions we hear about Medicare eligibility: Can I Get Medicare at 62? Some people begin to claim retirement benefits from social security at age 62 and might wonder if they can also get Medicare benefits at that time. Generally, the answer is no. You can only get Medicare before age 65 if you have been on Social Security disability for at least two years, have ALS (Lou Gherig’s disease), or suffer from end-stage renal disease. Can You Get Medicare If You’ve Never Worked? If you haven’t worked, you can still qualify for Medicare, but you may have to pay a monthly premium for both Medicare Part A and Part B. You may still be able to get Medicare Part A premium-free if your spouse worked, or if you have specific disabilities or medical conditions. Who Can Get Premium-Free Medicare Part A? You can qualify for premium-free Medicare Part A if you qualify for Original Medicare and have the appropriate work history as described above (i.e. paid Medicare taxes for 10 years). Generally, you have to pay a premium for Medicare Part B, but there are options for those with limited income and limited assets. The Medicare Savings Program (MSP) can help pay your Medicare Part A and B premiums if you qualify. Learn More About Medicare Eligibility Requirements If you’re curious about your Medicare eligibility and want to talk to a licensed insurance agent, we’re here to help. Simply give us a call at 1-866-955-0898 (TTY 711) or visit our website to review your options today!
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Medicare is a health insurance program provided by the federal government. Medicare is provided for individuals who are 65 and older, as well as younger people with disabilities or end-stage renal disease. Medicare includes several parts, each of which provides coverage for specific medical needs. Original Medicare includes Part A (hospital coverage), Part B (medical coverage), and Part D (prescription medication coverage). Medicare Part C is known as Medicare Advantage. Who Qualifies for Medicare? As we mentioned above, an individual qualifies for Medicare if he or she is 65 or older. Younger individuals can qualify for Medicare if they are permanently disabled or diagnosed with end-stage renal disease. What Is The Purpose Of Medicare? Medicare is available to make health coverage accessible to older Americans age 65 and over, including those who are traditionally retired and no longer have access to employer-based health insurance. Medicare also provides coverage to those under 65 with certain disabilities to cover their health needs and associated expenses. These Americans often cannot work and don’t have access to employer coverage or other health insurance. Types of Medicare Medicare is divided into several parts, labeled from A to D: Medicare Part A is known as hospital insurance. It offers coverage for inpatient hospital care, lab tests, and surgery, as well as home health care and skilled nursing facilities. These services must be deemed medically necessary to be covered by Medicare. You may have to pay a deductible or coinsurance Medicare Part B is used for medical visits to a doctor. Medicare covers medically necessary services and preventive services. Each Medicare participant pays a monthly premium for Medicare Part B and there may also be deductibles and coinsurance that apply, depending on the care you receive Medicare Part C is known as Medicare Advantage. This isn’t part of Original Medicare but instead is an all-in-one replacement plan. Medicare Advantage plans include hospital coverage and doctor’s visits, along with prescription drug coverage. Many also offer additional benefits Original Medicare doesn’t cover, such as vision and dental care. However, you will often need to use medical professionals within the provider’s network. You’ll pay different copayments and deductibles with Medicare Advantage than with Original Medicare, which may allow you to save money. You may also have an additional monthly premium Medicare Part D is prescription drug coverage. It helps you pay for both brand-name and generic drugs, depending on your needs. The drug plans for Medicare are offered by insurance companies and other approved private companies. If you choose Medicare Part D, you will have a separate Part D premium each month Medicare FAQ In addition to the different types of Medicare, qualified individuals, caregivers, and loved ones often have questions about Medicare coverage. Here are some additional Medicare FAQ and answers. What Does Medicare Cover? Medicare covers a wide variety of healthcare services. The specific coverage depends on the Medicare policy you choose. Services covered by Medicare include: Ambulance services Anesthesia Artificial eyes & limbs Bariatric surgery Blood processing & handling Cardiac rehabilitation programs Cardiovascular disease screenings Cervical & vaginal cancer screenings Chemotherapy Depression screenings Diabetes prevention programs Diagnostic tests (laboratory and non-lab) Eye exams (routine) Eyeglasses & contact lenses Flu shots Foot care Hearing aids Hepatitis B and HIV screenings Inpatient hospital care Kidney transplants Lung cancer screenings Mammograms Mental health care (inpatient and outpatient) Occupational therapy Opioid use disorder treatment services Organ transplants Pain management Prescription drugs (outpatient) Preventive & screening services Radiation therapy Sexually transmitted infections screenings & counseling Sleep studies Surgery Urgently needed care X-rays Yearly "wellness" visits Do I Need Medicare if I Already Have Health Insurance? Whether or not you need Medicare if you already have health insurance depends on your individual medical needs. You may need Medicare even if you already have other health insurance if your current plan doesn’t meet the minimum coverage requirements. Most plans offered by employers meet these standards. So if you have insurance through your job, you probably don't need Medicare. However, by staying on an employer plan, you can delay enrolling in Part B without a penalty and avoid paying Part B premiums. An important note: When you have Medicare plus additional insurance policies, each provider becomes a "payer." The policy that pays for your specific medical services first depends on the coordination of benefits rules for your plans. In other words, the primary payer will pay what it owes on your medical bills first, then the provider will send the remaining amount to the secondary payer to pay the rest. What is the Difference Between Medicare and Medicaid? Medicare is a federal health insurance program for older Americans and those with disabilities regardless of income. Medicaid is a state-based health insurance program for lower-income Americans that need help paying for medical care. To learn more about costs, eligibility, and coverage, visit this guide to Medicare vs. Medicaid. Who Do You Call for Medicare Questions? If you have additional questions about Medicare and what it covers, you can call 1-866-955-0898 (TTY 711) to speak with one of our licensed insurance agents. Agents are available Monday - Friday from 8am - 9pm and Saturday - Sunday 10am - 5pm ET. Where Can I Get Free Medicare Advice? For information on Medicare coverage, open enrollment, the different types of Medicare, and more, visit our Medicare learning center. For specific Medicare questions, contact us to speak with a licensed insurance agent. Learn More About Medicare Medicare is a valuable way to cover your healthcare costs if you are older or disabled. To compare your options and find the right Medicare plan in your area, visit our Medicare plans page today!
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