Medicare FAQs

We strongly recommend you apply as early as possible. You can apply for Medicare Part B three months prior to your birth month. For example, if your birth month is July, count back three months, June, May, April. You can apply for Medicare starting on April 1.

The quickest way is applying online. See our apply for Medicare checklist for the step by step.

Insurance companies need your Medicare number on a Medicare supplement or Advantage application, so we cannot submit one until you have it. Your card normally arrives about three to four weeks after you apply. You do not have to wait for the plastic, though: as soon as your enrollment is processed you can see and print your Medicare number from your account at Medicare.gov. Once you have the number, make an appointment to enroll in a Medicare insurance plan. If you like to plan ahead to make things easy, applying for Part B is a good first step.

If you sign up during the three months before your birthday month, coverage begins on the first day of your birthday month. Born July 20 and signed up in April, May or June: Medicare begins July 1.

Sign up in July or later and coverage starts the first of the following month instead, which is one reason we say apply early. If your birthday falls on the first of the month, your coverage starts a month earlier than you would expect.

Coming off a group plan opens a Special Enrollment Period. Three different clocks start at once, and they run for different lengths:

Part B: 8 months from the end of the coverage or the end of the employment, whichever comes first.

Part D: 2 months from the end of the month your drug coverage ends.

A Medicare Supplement: 63 days from the day the coverage ends. That is the shortest window and the easiest one to miss.

One important trap: COBRA does not count as active group health plan coverage for the Part B window. The 8 months runs from when your active employment coverage ended, not from when COBRA runs out. Call us the week you know your last day.

You will need a letter from your employer or insurance company verifying that you have had continuous coverage since turning 65. We can provide the forms.

Medicare Part A pays for inpatient hospital stays and skilled nursing facility care after a qualifying hospital stay. It also covers hospice and some home health care.

Medicare Part B pays for doctor visits, labs, x-rays, the surgeon, the assistant surgeon and the anesthesiologist, plus outpatient care, durable medical equipment and preventive services.

Remember the 80/20 formula for Part B expenses. After you meet the annual Part B deductible, Medicare pays 80 percent of the Medicare approved amount and the remaining 20 percent is your out of pocket cost. If you get supplemental coverage, that supplement pays the 20 percent for you. Most preventive services and most lab work are covered in full, outside that split.

For most people there is no cost for Medicare Part A. If you paid Medicare taxes long enough while working, generally at least 10 years or 40 quarters, you get what is sometimes called premium free Part A.

It depends on your income. There is a standard monthly premium that most people pay, and it can be billed quarterly, every three months.

If you have a higher individual or family yearly income you may pay more. That surcharge is called the Income Related Monthly Adjustment Amount, or IRMAA, and Medicare bases it on the modified adjusted gross income reported on your IRS tax return from two years ago. Social Security will tell you if you have to pay a higher premium because of your income.

The standard premium amount is set by Medicare and changes from year to year, so rather than publish a figure here that may be out of date we confirm the current amount with you. If you receive Social Security, the Part B cost can be automatically deducted from your check, which saves you the worry of missing a payment.

Medicare has separate deductibles for hospital and medical services that you are required to pay. In addition, after you meet the deductible for medical services such as doctor visits, labs, x-rays, MRIs, the surgeon and the anesthesiologist, you pay 20 percent of the costs.

A Medicare Supplement plan pays those 20 percent costs for you. On an ordinary year that is a convenience. On a year with a serious illness it is the difference between a manageable bill and a very large one. See the plan descriptions for how each plan handles it.

The cost of a prescription drug plan varies based on the medications an individual uses. There is no single price, which is exactly why the Medicare enrollment system asks you to enter your own medication list. See our Part D page.

If you go 63 days or more in a row without Medicare drug coverage or other creditable drug coverage, you build up a penalty of 1 percent for each full month you went uncovered. Creditable coverage from an employer, a union, the VA or TRICARE counts, and while you have it no penalty accrues. Your plan has to tell you in writing each year whether its drug coverage is creditable, so keep that notice.

For example, five years without creditable coverage is 60 uncovered months, so the penalty is 60 percent of the national base beneficiary premium. That is a figure Medicare sets each year, not the cost of the plan you pick. It is rounded to the nearest ten cents and added to your monthly premium.

The penalty stays with you for as long as you have Medicare drug coverage, even if you switch plans. The one way out is qualifying for Extra Help, which removes it.

In about an hour you can meet with a professional insurance agent at Hopper Insurance Services. In that hour the agent will:

• Educate you on Medicare.

• Educate you on your options for Medicare insurance plans.

• Help you find the plan that offers the best value for your needs and budget.

• Assist in completing the enrollment.

All in all, a professional insurance agent is your best resource.

Nothing. Agents are compensated by the insurance company, so there is no cost to the client. You pay the same premium whether you buy directly from the insurance company or through a local, licensed agent.

With a Medicare Supplement, you can see any doctor who accepts Medicare. There are three kinds of provider, and the difference matters.

Most doctors accept assignment. They take the Medicare approved amount as payment in full, and you owe only your deductible and coinsurance, which your supplement then pays.

Some are non-participating. Medicare still pays its share, but they can bill you up to 15 percent above the approved amount. That extra is the excess charge, which Plan G and Plan F cover and Plan N does not.

A small number have opted out of Medicare entirely. Medicare pays nothing except in an emergency, and you pay the whole bill under a private contract. Only this last group leaves you with the full cost, so it is worth asking which one your doctor is.

With a Medicare Advantage PPO, you can see any doctor in the insurance company network, and you pay a higher copay for a doctor outside the network.

With a Medicare Advantage HMO, you can see only doctors in the insurance company network. There is no out of network coverage except for emergency care, urgently needed care, and out of area dialysis.

Most doctors do accept Medicare and accept assignment, since people over 65 often have greater medical needs and that group is growing quickly. You can look up a specific provider on Medicare.gov, and we are happy to check for you before you choose a plan.

Medicare has its own cost effective system for annual exams, and it comes in two parts.

Welcome to Medicare Preventive Visit. During the first 12 months you have Part B you can schedule a one time exam that gives your doctor your baseline information. You pay nothing if your provider accepts assignment. Details at Medicare.gov.

Yearly Wellness Visit. Once you have had Part B for more than 12 months you get a yearly wellness visit, where your physician reviews your medical history and orders the specific tests you need for that year. Details at Medicare.gov.

We recommend that everyone sign up for automatic monthly premium payments from a checking account.

Why? Because you never have to worry about being canceled or dropped for nonpayment. Your agent completes the paperwork for you right at the time of application, so it is set up before you leave.