Question 1

What is the difference between Medicare Advantage and Medigap?

Accepted Answer

Medicare Advantage and Medigap are two different types of plans that serve as an alternative to traditional Medicare.

Medicare Advantage plans are offered by private insurance companies and provide all Medicare Part A and Part B benefits. Many Medicare Advantage plans include prescription drug coverage and other benefits such as dental, vision and hearing coverage.

Medigap plans help cover the costs that traditional Medicare does not cover. Medigap plans can be used anywhere that accepts Medicare. Medigap plans offer flexibility, convenience and predictability. Medigap plans are generally more expensive than Medicare Advantage plans.

Question 2

What is Medicare?

Accepted Answer

Medicare is a Federal health insurance program comprised of four parts: A, B, C, and D.

When discussing Medicare, many people refer to Traditional or Original Medicare which is a fee-for-service health plans comprised of parts A (hospital insurance) and B (medical insurance).
 
Many individuals look at other options to Traditional Medicare such as Medicare Advantage or a Medigap plan.

Question 3

When can I enroll in Medicare?

Accepted Answer

If this is your first time enrolling in Medicare, you can enroll in a plan during what is known as your Initial Coverage Election Period (ICEP), which is comprised of:
 The three (3) months before you turn age 65
The month of your 65th birthday
The three (3) months after you turn age 65

There are certain exceptions to enrolling in Medicare including those on disability or those with other creditable healthcare coverage. It is important to carefully review your options with a licensed insurance agent to ensure that you do not have any coverage gaps or penalties.

Question 4

What does Medicare cover?

Accepted Answer

Traditional Medicare is comprised of Medicare Parts A and B.

Medicare Part A covers:
Inpatient hospital care
Skilled nursing facility care
Hospice care
Home health care
 
Medicare Part B covers services from providers outside of the hospital such as:
Outpatient doctor and other health care provider visits
Outpatient care
Home health care
Durable medical equipment (DME) such as wheelchairs and walkers
Preventive care such as screenings, vaccines, and imaging

It is important to note that Traditional Medicare does not include prescription drug coverage. Medicare Part D, which is offered by private health insurance companies, provides prescription drug coverage. There can be lifetime penalties accrued for failure to have creditable prescription drug coverage even if you do not take any prescriptions!

Question 5

Are there plans tailored to veterans?

Accepted Answer

Yes! There are several plans tailored and available to veterans with healthcare coverage through the VA including those with VA benefits, Tricare, Tricare for Life and CHAMPVA.

Our team can help you navigate your plan options to ensure your maximizing your benefits while maintaining your VA coverage.

Question 6

Are there plans available for those with chronic conditions?

Accepted Answer

Yes! While many plans can help meet your healthcare needs, there are certain specialized Medicare Advantage plans tailored to those with specific chronic conditions. These plans are called Chronic Special Needs Plans (C-SNP).

C-SNP plans are not available in all areas and not all C-SNP plans cover all types of conditions. Some examples of chronic conditions covered by C-SNP plans include:
Chronic alcohol or drug dependence
Autoimmune disorders
Cancer
Cardiovascular disorders
Chronic heart failure
Dementia
Diabetes mellitus
End-stage liver disease
End-stage renal disease (ESRD) requiring dialysis
Severe hematologic disorders
HIV/AIDS
Chronic lung disorders
Chronic and disabling mental health conditions
Neurologic disorders
Stroke

Note: Limitations and restrictions apply. Our team of licensed agents is trained to review your specific healthcare needs to ensure that you enroll in the coverage that best meets your needs.

Question 7

How does Medicare work with those on Medicaid?

Accepted Answer

There are specialized Medicare Advantage plans called Dual Eligible Special Needs Plans (D-SNP) available to individuals eligible for Medicare who also received state assistance through Medicaid.

These specialized plans work with your State Medicaid level to cover some Medicare costs depending on the individual and state's eligibility.

In addition to medical and prescription drug coverage, some D-SNP plans include additional resources to help with expenses such as health food allowances, over-the-counter and wellness products, utility bills and transportation.

Our team of licensed professionals can help you review your state-specific eligibility criteria.

Question 8

What is a premium?

Accepted Answer

A premium is a monthly cost you pay for coverage regardless of whether you receive care.

Most individuals have a $0 premium for Medicare Part A.

If you enroll in a Medicare Advantage or Medigap plan, your plan may have a monthly premium due to the insurance carrier.

Question 9

What is a deductible?

Accepted Answer

A deductible is the amount you pay for covered services before your plan starts to pay. You must meet your deductible before your plan pays for covered services and care.

A plan may have a deductible for medical expenses and a separate deductible for prescription drugs.

Question 10

What is a copay or copayment?

Accepted Answer

A copayment is a fixed dollar amount that you pay when you receive covered services.

A copayment may be based on a visit or a per-day amount.

Example: A plan may have  a $0 copay for in-network primary care office visits and a $15 copay for in-network specialist office visits.

Example: A plan may have a $100 copay per day for the first 4 days of inpatient hospital admission.

Question 11

What is coinsurance?

Accepted Answer

Coinsurance is a fixed percentage of costs that you pay. For Medicare Part B, you typically pay 20% for covered services.
 
Example: If a covered service costs $100, you pay a 20% coinsurance amount. In this example, Medicare pays $80 and you pay $20 ($100 x 20%).

Question 12

Can I defer my Medicare enrollment?

Accepted Answer

You may be able to defer your enrollment depending on your circumstances.

This may be done for a variety of reasons such as having current employer coverage.

It is important to note that there can be life-time penalties or gaps in coverage if you do not enroll in Medicare within certain timeframes after you stop working or lose eligible, creditable coverage. Not all employer coverage may be creditable. Our team of experts can help you review your specific circumstances and related criteria.

should carefully review the criteria and your individual circumstances. Contact us at (833) 379-1951 (TTY 711). for a free assessment of your coverage and options.

Question 13

Will I automatically be enrolled in Medicare when I turn 65?

Accepted Answer

Not necessarily.

If you are receiving Social Security benefits or Railroad Retirement benefits at least 4 months before you enroll in Medicare, you will automatically be enrolled at age 65.

If you are not receiving Social Security or Railroad Retirement Board benefits, you will need to enroll in Medicare by contacting your local Social Security Office. You can complete the enrollment online at www.ssa.gov or by going to your local office in person.

Question 14

If I plan to keep working, do I need to enroll in Medicare when I turn 65?

Accepted Answer

It depends.

If you will maintain employer coverage, it is important to check that it is creditable health coverage! If your employer's coverage does not count as creditable, you may have to pay life-time late enrollment penalties.

Generally, we recommend enrolling in Medicare as soon as you become eligible, particularly if you qualify for premium free Part A coverage.

Our team provides specialized consultations for individuals new to Medicare. We can help you assess your options, plan costs and healthcare needs to ensure you make an informed decision.

Question 15

Can I enroll in both a Medicare Advantage and Medigap plan?

Accepted Answer

No. It is illegal to enroll in both a Medicare Advantage and Medigap (Medicare Supplement) plan.

If you're confused about your options, our licensed agents can help you determine the options suited for your needs based around your budget.

Question 16

Do I need to re-enroll or renew my Medicare plan each year?

Accepted Answer

Original Medicare automatically renews each year if you remain eligible.

Medigap (Medicare Supplement) plans automatically renew if you remain current on your monthly plan premium.

Medicare Advantage plans automatically renew; however, you have the option to change your plan each year during open enrollment if your needs change or you do not like the benefits of your current plan.

Our licensed agents can help you review your current plan and available options. There are also specialized circumstances and situations that may allow you to change your plan outside of open enrollment. If you are dissatisfied with your plan or simply curious about your options, contact us to review.

Question 17

What happens to my Medicare plan if I move?

Accepted Answer

If you move, you will need to update your address with Social Security.

Because Original Medicare is a federal fee-for-service health program, your coverage is nationwide.

Medicare Advantage plans cover a specific service area as outlined in the plan's Evidence of Coverage. If you are moving, please contact us as soon as possible to review options in your new area. Our team serves all 50 states and Washington, D.C. so you can rest assured your transition will be seamless.

Medigap (Medicare Supplements) are accepted nationwide, anywhere that accepts Medicare.

Frequently asked questions