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Medicare FAQs

Medicare Frequently Asked Questions

with Straight Forward Answers

Medicare 2021 Cost Changes & Medicare Plan Changes FAQs

MEDICARE 2021 CHANGES DURING COVID-19 PANDEMIC 

  • Medicare will cover coronavirus testing under Part B when ordered by a physician.
  • If a Medicare beneficiary is quarantined in the hospital, you will NOT have to pay an additional deductible for the cost of the quarantine.
  • Medicare Part B will fully cover a COVID-19 vaccine once it becomes available, should you wish to get one.

MEDICARE PART A 2021 CHANGES (HOSPITAL COVERAGE)

  • The Medicare Part A inpatient hospital deductible that beneficiaries will pay when admitted to the hospital will be $1,408 in 2020, an increase of $44 from $1,364 in 2019.
  • In 2020, beneficiaries must pay a coinsurance amount of $352 per day for the 61st through 90th day of a hospitalization ($341 in 2019) in a benefit period and $704 per day for lifetime reserve days ($682 in 2019). 

MEDICARE PART B 2021 CHANGES (MEDICAL INSURANCE)

Part B will cover treatment for opioid use disorder (OUD), including drug testing, medications, and individual and group therapy, including telehealth counseling.

 MEDICARE PART D 2021 CHANGES (MEDICARE PRESCRIPTION DRUG PLAN)


  • In 2020, you may also see a change in the percentage you pay for your medications during the coverage gap. 

  • The percentage for Medicare prescription drug plans in 2020 will be 25% for both brand-name and generic prescriptions.

  • This amount of the threshold includes all the money you pay for your prescriptions throughout the year, including what you pay during your coverage gap. When catastrophic coverage begins, Medicare will cover at least 95% of the cost of your medications for the rest of the year. The out-of-pocket threshold will change in 2020. In 2019, the threshold is $5,100. Medicare Part D 2020 increases the threshold to $6,350.

MEDIGAP 2021 CHANGES (MEDICARE SUPPLEMENT)

  • Plans C and F, both of which cover the Medicare Part B deductible, are no longer available to those who are Medicare-eligible after 2020. If you were already on Medicare BEFORE January 1, 2021, you can keep your current Plan F.  If you were not on Medicare BEFORE January 1, 2020, you cannot buy a Medicare Plan F policy.
  • There is a new high-deductible Plan G available this year. Plan G offers very similar benefits as the old Plan F did. So, you may want to consider this if you are looking for more comprehensive coverage.

Medicare Enrollment FAQs

WHAT IS THE DIFFERENCE BETWEEN INITIAL ENROLLMENT PERIOD AND OPEN ENROLLMENT PERIOD?

Initial Enrollment Period is for people that are enrolling in Medicare for the first time ever. This is based on your birthday. If your birthday is in April you can enroll in Medicare within 7 months (3 months before your birthday, your birthday month, and 3 months after your birthday.  If you are still working when you are 65, you STILL MUST register for Medicare so you don't face any late enrollment penalties. You can still keep your employer plan until you retire or stop working.

Open Enrollment Period is when most Medicare recipients choose their Medicare Advantage or Supplement plans. This is every year between October 15th and December 7th. This is a super important time to look for plans and comparison shop for the best plan for you. In many cases, people do not take advantage of this opportunity and spend too much money on subpar plans. Medicare has exciting new benefits every year and this is a great time to find a better plan at a more affordable price.

WHAT IS THE BIRTHDAY RULE WITH MEDICARE?

Most of the states have “birthday rules” that allow Medigap enrollees a 30-day window following their birthday each year when they can switch, without medical underwriting, to another Medigap plan with the same or lesser benefits.

HOW CAN I FIND OUT IF I QUALIFY FOR HELP?

People may qualify for help covering your Medicare benefits based on your income. Please check the latest guidelines on whether or not you qualify for Extra Help at Medicare.gov.

WHEN CAN I APPLY FOR MEDICARE PART B?

U.S. citizens and legal permanent residents of at least five continuous years may be eligible for Medicare coverage. You’re usually enrolled in Medicare Part A and Part B automatically when you turn 65 or qualify by disability at any age and you receive Social Security Administration (SSA) or Railroad Retirement Board (RRB) benefits. For details about how you qualify for automatic enrollment, see Medicare Enrollment. But also, you’re not automatically enrolled in Medicare Part B in all situations.

Enrollment into Medicare Part A & Part B is based on your birthday and when you turn 65. If your birthday is in April you can enroll in Medicare within 7 months (3 months before your birthday, your birthday month, and 3 months after your birthday.  If you are still working when you are 65, you STILL MUST register for Medicare so you don't face any late enrollment penalties. You can still keep your employer plan until you retire or stop working

HOW OFTEN CAN I CHANGE MEDICARE PLANS?

If you want to change Medicare Advantage or Medicare Part D Prescription Drug Plans , the best time to do so is during the Annual Election Period (also called Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage), which runs from October 15 to December 7 each year.

If you want to change your Medicare Supplement Plan, you can do that after you have had your current plan for at least 6 months. Once your plan has passed the six-month mark, you can change your Medicare Supplement plan at anytime. If you aren't happy with your plan, you should shop around and see if there is a better plan. Also, make sure to choose a trusted provider with positive reviews for customer service.

WHAT ARE MEDICARE LATE ENROLLMENT PENALTIES?

  • In most cases, if you don't sign up for Medicare when you’re first eligible, you may have to pay a higher monthly premium.
  • For Part A late enrollment penalty: You'll have to pay the higher premium for 4 years. 
  • For Part B late enrollment penalty: Your monthly premium may go up 10% for each 12-month period you could've had Part B. 
  • For Part D late enrollment penalty: Your penalty is calculated by multiplying 1% of the "national base beneficiary premium" ($32.74 in 2020, $33.06 in 2021) times the number of full, uncovered months you didn't have Part D or creditable coverage. For example, if you didn't enroll in 2020, it would be 1% of the $32.74 monthly premium or $.3274 (.33 cents).

Medicare in General FAQs

HOW DOES MEDICARE WORK?

Medicare is a federal health insurance program that provides benefits to American citizens and permanent legal residents (of at least five continuous years) aged 65 and older, or who have a qualifying disability or illness. Most people are automatically enrolled into Original Medicare, Part A and Part B, when they become eligible; however, some people need to manually enroll in Medicare. Medicare Part A is hospital insurance; Medicare Part B is medical insurance.

WHAT IS A MEDICAL HOME? 

Medical homes are typically team-based primary care medical practices that provide the majority of their patients’ health care either directly, or through coordination with other specialists and facilities. Medicare is testing several medical home models across the country to determine if greater investment in primary care through medical homes can lead to better quality of care and lower overall spending on health care.

HOW CAN I FIND OUT IF I QUALIFY FOR HELP?

People may qualify for help covering your Medicare benefits based on their income. Please check the latest guidelines on Medicare.gov.

DOES MEDICARE COVER PRE-EXISTING CONDITIONS?

Medicare Parts A & B don't care about pre-existing conditions. That goes away with the basic coverage provided with your Medicare. But if you get a Medicare Supplement or Medicare Advantage program, they may care, especially when you get up there in age. So, it is wise to always have some basic coverage while you in your younger 60's and 70's, even if you're healthy. That way you've always had coverage and you shouldn't have to go through an underwriting process.

WHAT TYPE OF MEDICARE PLANS DO I NEED IF I WANT TO BE COMPLETELY COVERED?

A&B is given. If you were a Medicare recipient before January 1, 2020, then you may already have a Plan F coverage. If you do not have Plan F today, then after January 1, 2020, you may want to consider a Plan C and Plan G. And don't forget to check your prescription coverage. If you want to make sure that you are covered for benefits and your drugs.

HOW DO I FIND OUT WHAT MEDICARE BENEFITS I QUALITY FOR?

You can login to www.ssa.gov to see your account. You can set this up at any time to see how much you have paid into Social Security and you will see what benefits you are eligible to receive. That is the source of where you can get the most reliable information about your Medicare benefits.

WHAT IF MY DOCTOR ISN'T IN MY MEDICARE PLAN NETWORK?

If you have an emergency, seek medical attention as soon as possible. The law mandates that both private and public hospitals treat you in an emergency, regardless if the Medicare doctors or hospitals are in your network. With some plans, you have the options of seeing non-network Medicare doctors for non-emergencies but just paying more.

MEDICARE RENEWAL: DO I HAVE TO SIGN UP FOR MEDICARE EVERY YEAR?

In most cases, yes you do have to re-enroll every year.  But that is not a bad thing. This gives you an opportunity every year to compare and shop for a better plan and in some cases find a better plan at a more affordable price.

You ALWAYS want to check with your insurance provider if there is a question of whether or not your plan will automatically renew. There are instances where your plan will not renew:

  • Your plan reduces its service area, and you now live outside of its coverage area.
  • Your plan does not renew its Medicare contract for the upcoming year.
  • Your plan leaves the Medicare program in the middle of the year.
  • Medicare terminates its contract with your plan.

If this is the case, you must enroll in a new plan.

HOW CAN I FIND OUT IF MY DOCTOR ACCEPTS MEDICARE?

Many doctors offices, practice groups, and networks have a website that states what insurance carriers they accept. If you don't have access to their website, call the office directly and ask them if they take Medicare. They should be able to answer the question right away or direct you to someone in their office that can answer that question for you.

WHEN DO I HAVE TO APPLY FOR MEDICARE IF I'M STILL WORKING?

If you’ve worked at least 10 years (40 quarters) under Medicare-covered employment and paid Medicare taxes during that time, you qualify for premium-free Medicare Part A and will be automatically enrolled at age 65 even if you’re still working. If your spouse has enough employment quarters, you can also qualify for premium-free Medicare Part A based on his or her work history.

IS SILVER SNEAKERS COVERED BY MEDICARE?

Silver Sneakers may be covered by certain Medicare Advantage or Medicare Supplement plans. When shopping for a plan, ask your broker which providers offer Silver Sneakers as a benefit.

WHAT IS THE MEDICARE AND MEDICAID PACE PROGRAM?

PACE (Programs of All-inclusive Care for the Elderly) is both a Medicare and Medicaid program that provides a wide range of social and medical services at adult day health centers, inpatient facilities, and at home. The program focuses on health care for older adults within a community and provides personalized, coordinated care for their specific needs. PACE’s overall mission is to help Medicare beneficiaries preserve their independence and delay nursing-home care as long as possible.

I RECEIVED A NOTICE THAT MY CURRENT PLAN WILL NO LONGER BE OFFERED NEXT YEAR. NOW WHAT DO I DO?

If you qualify for the full premium subsidy for your Medicare prescription drug plan, are enrolled in traditional Medicare, and your current prescription drug plan will not be offered next year, you will be automatically reassigned by Medicare to a new prescription drug plan for coverage in the next year. But you won’t be reassigned automatically if your current plan is terminating and you chose your current plan.

ARE MEDICARE ADVANTAGE PLANS, MEDICARE PART D DRUG PLANS, OR MEDIGAP POLICIES SOLD THROUGH THE MARKETPLACE?

No, Medicare Advantage plans (such as Medicare HMOs and PPOs), Medicare Part D prescription drug plans, and Medigap policies are not sold through the federal or state Marketplaces. You can enroll in a Medicare Advantage plan or a Medicare Part D plan on the Medicare website or by signing up directly with the company that offers the plan.

I’M UNDER 65 AND HAVE A DISABILITY. AM I ELIGIBLE FOR MEDICARE?

It depends on how long you have been receiving Social Security disability insurance (SSDI) payments. You are automatically enrolled in Medicare Part A and Part B after you have been receiving SSDI payments for two years. There are some diagnoses that will qualify you for Medicare early such as end stage renal failure or ALS. Other situations should be handled on a case by case basis.

Medicare Coverage FAQs

DO I NEED TO BUY A MEDICARE SUPPLEMENT AND PLAN D SEPARATELY?

You will always need to by a Prescription Drug Plan separate from a Medicare Supplement plan. You may be able to find a Medicare Advantage Plan that has prescription drug coverage benefits but make sure your drugs, dosages, and frequency are covered under that plan. Otherwise you may have to purchase a separate Medicare Prescription Drug plan. Also, keep in mind the Federal Government requires that ALL Medicare beneficiaries carry a Prescription Drug plan.

WHAT DRUGS ARE COVERED BY MEDICARE PART D?

Medicare Part D plans must cover all or substantially all drugs in six categories: antidepressants, antipsychotics, anticonvulsants, antiretrovirals (AIDS treatment), immunosuppressants and anticancer. But just because they are supposed to cover most drugs, doesn't mean your Medicare Prescription Drug Plan does. It is SUPER important to review the Formularies (fancy name for published list of drugs) covered under your plan to make sure your insurance company covers your drugs. This list changes year to year and varies by state, so please confirm you are looking at the right plan's formularies.

CAN I STILL BUY MEDICARE PLAN F?

Plan F (and Plan C), both of which cover the Medicare Part B deductible, are no longer available to those who are Medicare-eligible after 2020. If you were already on Medicare BEFORE January 1, 2020, you can keep your current Plan F. If you were not on Medicare BEFORE January 1, 2020, you cannot buy a Medicare Plan F policy.

DOES MEDICARE COVER HEARING AIDS?

Medicare does not care if you can hear, see, or chew UNLESS you have a disease that has caused the problem with your vision, hearing, or mouth. It's OK that Medicare Part A & B doesn't cover hearing, vision, or dental. You can find a Medicare Advantage or Medicare Supplement that does cover those benefits.

DOES MEDICARE COVER DENTURES?

Medicare does not care if you can hear, see, or chew UNLESS you have a disease that has caused the problem with your vision, hearing, or mouth. It's OK that Medicare Part A & B doesn't cover hearing, vision, or dental. You can find a Medicare Advantage or Medicare Supplement that does cover those benefits.

DOES MEDICARE COVER GLASSES?

Medicare does not care if you can hear, see, or chew UNLESS you have a disease that has caused the problem with your vision, hearing, or mouth. It's OK that Medicare Part A & B doesn't cover hearing, vision, or dental. You can find a Medicare Advantage or Medicare Supplement that does cover those benefits.

WHAT IS MEDICARE PLAN F?

Medicare Plan F cover "excess charges" from the Doctor. The Doctors set charged are negotiated for standard services. But in some cases, the Doctor may see fit to charge you "excess charges". Sometimes they sneak up and hit you months after your Doctor's appointment. You should always ask if the service is fully covered by your plan but sometimes you'll get surprised. You can and should call the provider to get clarification on what this "excess charge" was in the first place. You can also check with the provider.

WHAT IS MEDICARE PLAN G?

Medicare Plan G covers excess charges which are sometimes incurred from a Doctor.  Medicare Plan G also does not cover your Part A deductible.

WHAT IS MEDICARE PLAN N?

Medicare Plan N provides you a set copay price for Doctors Office visits of $20. Medicare Plan N does NOT cover any excess charges that may be incurred by your Doctors. Medicare Plan N also covers your Part B deductible.

HOW CAN I COMPARE PLANS?

ALL health insurance providers HAVE to provide the same exact coverage. Look at the Carrier and Rates to see if your doctors, your hospitals, pharmacies, and medications are covered. They all offer the same coverage but with different twists (exclusions and limitations). Make sure you are comparing apples to apples. Ask all the questions you need to ask until you fully understand. If your broker is impatient or frustrated...time to get a new broker.

CAN I GET A MEDICARE PLAN THAT COVERS A HEALTH CLUB MEMBERSHIP?

Part A and Part B, does not cover any of the costs associated with gym memberships or fitness programs. However, there are other Medicare plan options that may cover the cost of a gym membership.

WILL MEDICARE PAY FOR AMBULANCE SERVICES?

Medicare pays for limited ambulance services. If you go to a hospital or skilled nursing facility (SNF), ambulance services are covered only if any other transportation could be a danger to your life or health. If the care you need is not available locally, Medicare helps pay for necessary ambulance transportation to the closest facility outside your local area that can provide the care you need.

DOES MEDICARE PLANS COVER TRANSPORTATION FOR MEDICAL REASONS?

Original Medicare (Part A and Part B) generally does not cover transportation to get routine health care. However, it may cover non-emergency ambulance transportation to and from a health-care provider. You need to have a health condition diagnosed or treated and other forms of transportation could endanger your health. Your doctor must provide a written order verifying that ambulance transportation is medically necessary because of your health condition.

Also, many local municipalities (county government) offer non-emergency medical transport for daily activities like going to the doctor, the store, or the pharmacy. Check with your local county government, non-profits, and organizations that support people that require additional assistance due to income, disabilities, limited mobility, or aging.  Some counties have some pretty cool perks like Lyft and Uber rides for a fixed fee of $4. Pinellas County Florida is one of many counties offering the community more support to maintain their dignity and indepedence.

DOES MEDICARE COVER MENTAL HEALTH CARE?

Medicare Part A covers hospital inpatient mental health care, including room, meals, nursing, and other related services and supplies. This care can be received in a general hospital or a psychiatric hospital. Medicare has a lifetime limit of 190 days of inpatient care in a psychiatric hospital.

DOES MEDICARE COVER DIABETIC SERVICES OR DIABETES?

Medicare Part B covers the following diabetic services, generally requiring your Medicare-participating doctor’s order:

  • Diabetes screening 
  • Diabetes self-management training

Starting January 1, 2021, if you take insulin, you may be able to get Medicare drug coverage that offers savings on your insulin. You could pay no more than $35 for a 30-day supply.

I’M HAVING A HARD TIME AFFORDING MY MEDICARE PART D DRUG COVERAGE. ARE THERE ANY OPTIONS FOR FINANCIAL ASSISTANCE ME?

You may want to find out if you qualify for extra assistance with your Part D plan premiums and cost sharing, if your income and assets are low enough. Through the Part D Low-Income Subsidy program, sometimes referred to as “Extra Help”, additional premium and cost-sharing assistance is available for Part D enrollees with low incomes.

Medicare Advantage FAQs

WHAT ARE THE 4 TYPES OF MEDICARE ADVANTAGE PLANS?

The four types of Medicare Advantage Plan are HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), PFFS (Private Fee-for-Service), and a SNP (Special Needs Plan).

WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF MEDICARE ADVANTAGE PLANS?

Medicare Advantage offers many benefits to original Medicare, including convenient coverage, multiple plan options, and long-term savings. There are some disadvantages as well, including provider limitations, additional costs, and lack of coverage while traveling. Whether you choose original Medicare or Medicare Advantage, it’s important to review healthcare needs and Medicare options before choosing your coverage.

CAN I RECEIVE EXTRA BENEFITS FROM A MEDICARE ADVANTAGE PLAN THAT I WOULDN’T BE ABLE TO GET IN TRADITIONAL MEDICARE?

Yes, it is true that Medicare Advantage plans are able to offer extra benefits that are not offered in traditional Medicare. For example, some Medicare Advantage plans offer dental coverage or a fitness benefit to those enrolled. Beginning in 2020, Medicare Advantage plans are also able to offer benefits that are not directly health-related, like meal delivery services.

CAN I BE CHARGED A HIGHER PREMIUM FOR MEDICARE ADVANTAGE PLANS IF I HAVE A PRE-EXISTING CONDITION OR IF I SMOKE?

No, Medicare Advantage plans charge the same premiums to all enrollees; they are not permitted to vary premiums based on age, smoking history, gender, or pre-existing medical conditions.

IF I SIGN UP FOR A MEDICARE ADVANTAGE PLAN DURING THE MEDICARE OPEN ENROLLMENT PERIOD, WHEN WILL THE COVERAGE TAKE EFFECT?

If you enroll in a plan during the Medicare Open Enrollment period that runs from October 15 to December 7 each year, your coverage takes effect on January 1 of the following year.

I WANT TO SWITCH FROM MEDICARE ADVANTAGE TO TRADITIONAL MEDICARE BUT I STILL WANT DRUG COVERAGE. WHAT DO I NEED TO DO?

If you switch from a Medicare Advantage plan to traditional Medicare and you want drug coverage, you can sign up during the Medicare Open Enrollment period for a stand-alone prescription drug plan in your area. Prescription Drug plans vary by state. Your new coverage will take effect on January 1.

You can also switch from Medicare Advantage to traditional Medicare during the Medicare Advantage Open Enrollment period between January 1 and March 31, when you can sign up for a stand-alone drug plan to add drug coverage. In this case, coverage begins the first day of the month after the plan gets your enrollment form.

Medicare Supplement FAQs

DO I NEED TO BUY A MEDICARE SUPPLEMENT PLAN AND A MEDICARE ADVANTAGE PLAN?

If you already have Medicare Advantage plan, you can generally enroll in a Medicare Supplement insurance plan under one condition – your Medicare Advantage plan must end before your Medicare Supplement insurance plan goes into effect. In fact, it’s illegal for an insurance company to sell you a Medicare Supplement insurance plan if they know you're enrolled in a Medicare Advantage plan unless you can demonstrate (usually in writing) that you are leaving your Medicare Advantage plan.

I HAVE A MEDIGAP POLICY NOW, BUT I WANT TO BUY A DIFFERENT ONE. CAN I SWITCH MEDIGAP POLICIES DURING THE MEDICARE OPEN ENROLLMENT PERIOD?

The Medicare Open Enrollment period is designed for enrolling in or switching Medicare Advantage and Part D prescription drug plans, not Medigap policies. In most states, insurance companies can deny you a different Medigap policy and you won’t have guaranteed issue rights, unless you are either eligible to switch under a specific circumstance or you purchased your Medigap policy less than 6 months ago.

CAN I GET INFORMATION ABOUT MEDIGAP POLICIES ON THE MEDICARE PLAN FINDER?

Yes, you can find some information about Medigap policies on the Medicare Plan Finder, by going to the link to view and compare Medigap plans under “Additional Tools.” This tool produces a list of companies in your area that offer each type of Medigap plan.

I HAVE MEDIGAP AND I’M FINDING IT DIFFICULT TO AFFORD. WHAT ARE MY OTHER OPTIONS FOR SUPPLEMENTAL COVERAGE?

You may want to find out if you qualify for Medicaid, if your income and assets are low enough. Medicaid helps many low-income people on Medicare with their Medicare premiums and cost-sharing requirements, and may also cover some benefits that are not covered by Medicare, such as dental services and long-term services and supports. If you do not qualify for Medicaid and you want to stay in traditional Medicare, you could try to switch to a less expensive Medigap policy.

WHY DO I NEED TO GO THROUGH UNDERWRITING TO GET A MEDICARE SUPPLEMENT INSURANCE PLAN?

If you apply for Medigap coverage after your open enrollment period has passed, you may have to go through medical underwriting. The insurer may review your medical history and refuse to sell you a policy, or sell you one at a higher cost, if you do not meet its underwriting requirements.

Medicare Costs FAQs

IS THERE A MEDICARE DEDUCTIBLE?

Medicare Part A and Part B have deductibles you may have to pay. Medicare Part C and Part D may or may not have deductibles, depending on the plan.

WHAT’S THE MEDICARE ADVANTAGE OUT-OF-POCKET MAXIMUM?

The out-of-pocket maximum for Medicare Advantage plans is different from a deductible. Out of pocket maximum is the highest yearly amount you will have to pay out of pocket for covered health-care services.

ARE THERE $0 MONTHLY PREMIUM MEDICARE ADVANTAGE PLANS?

Not typically. However, you can find low cost plans that start around $13 per month with some providers. It is better to have a plan that is a low cost and to keep that consistently over the years, then to have a lapse in coverage. If you can afford to have a low cost plan, then you are seen as less of a risk than someone that has had a lapse in coverage. When you have a lapse in coverage, you may have to go through an underwriting process to get new coverage and that could increase your plan costs. If you need help paying for your Medicare plan, there may be extra help available for you based on your income. To see if you qualify, please visit Medicare.gov.