Medicare FAQs & Quick Links

Original Medicare is the federal health insurance program designed specifically for seniors who are U.S. citizens or legal residents age 65+, persons younger than 65 that have been disabled for 24 months, or those with End-Stage Renal Disease. 

Original Medicare consists of:

Part A* (Hospital Insurance) which covers:

• Hospital stays
• Emergency room visits
• Care in a skilled nursing facility
• Hospice
• Some at-home health care

Part B* (Medical Insurance) which covers:

• Primary & Specialist doctor visits
• Outpatient care
• Medical supplies
• Preventive services

*Monthly premiums, deductibles and co-insurance may apply

• Part A Premiums:  For the majority of working Americans, you will be eligible for premium-free Part A benefits if you or your spouse paid Medicare taxes for at least 10 years(40 quarters) and are eligible to receive Social Security benefits now or in the future.  In some instances, a senior may have to pay a monthly premium. Go here to get more info on Part A premiums.

• Part A Deductibles/Coinsurance:  This is the amount your must pay first before Medicare pays for eligible services.  For 2020 this amount was $1408, and for 2021 it is $1484.  Go here for the most recent info on Part A deductible and coinsurance costs.

• Part B Premiums:  Every person who is eligible to receive Medicare will face a Part B premium which is based on the beneficiary's yearly income.  For instance, in 2021 your Part B premiums were based on your 2019 income and in 2022 your premiums will be based on your 2020 income, and so on.  Those who are above the income threshold will face IRMAA (Income Related Monthly Adjustment Amount). Find out more about the current and upcoming  Part B premiums and income limits by going here.

• Part B Deductible:  This is the amount you must pay out-of-pocket before Medicare will cover qualifying services.  For 2021, the deductible is $203.  Go here (click on the Medicare Part B tab) for a complete list is Part B costs.

Yes, you are required to have a qualifying drug plan in place once you become eligible for Medicare. Failure to do so means that you will likely face a penalty if you are without coverage for more than 63 days in a row after turning 65.  

Part D prescription drug coverage is not included in Original Medicare, which means you will need a pay a separate premium to have a plan that covers the cost of your prescription drugs. 

You become eligible to enroll in Medicare when you turn 65 or have been fully disabled for two years.  Some people will be automatically enrolled in Parts A & B, while others must enroll themselves.  Once you become eligible, the initial enrollment period is a 7-month timeframe that includes the three months prior to your birthday, the month of your birthday, and the three months after your birthday.

Set up your free account at ssa.gov to get an estimate of your Social Security benefits and to register for your A & B  benefits.  Remember, you must also buy either a standalone Part D drug plan or a Medicare Advantage plan with drug coverage, otherwise you may incur a penalty.

It depends. There may be help available to you if you meet certain income requirements. You may qualify for:

• Low Income Subsidies, also called Extra Help, which can help cover some of your out-of-pocket prescription drug costs.  Click here to learn more about how Low Income Subsidies work.

• Medicaid, which is state-sponsored coverage that may pick up the costs of your Part B monthly premium, as well as other services like hearing, eyeglasses, prescription drugs, and some long-term care. Go here to learn more about Medicaid income eligibility requirements.  If you do not qualify for Medicaid, Low Income Subsidies may still be a good option to apply for.

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Medicare Advantage is a  "bundle of services" offered by private insurance companies which include your Part A & B coverage, sometimes Part D coverage, and often times many added benefits that are not included in Original Medicare, such as hearing, dental, vision, complimentary gym memberships, and more!  

The other advantage to having a Medicare Advantage plan is that your out-of-pocket expenses for covered services are capped (varies by plan and company), whereas Original Medicare has no such cap and out-of-pocket expenses are unlimited.

Many Medicare Advantage Plans have a $0 monthly premium.  If you choose a plan that does have a monthly premium, it is generally still very low. 

* Remember:  Any monthly costs are in addition to your monthly Part B premium.

• An HMO, or Health Maintenance Organization, is coverage that restricts the beneficiary to a plan-approved network of doctors.  HMO's will also require that you obtain a referral by your Primary Physician in order to see any specialists.  The main benefit of this type of coverage is that out-of-pocket expenses are typically lower.

• A PPO, or Preferred Provider Organization, is a type of coverage that allows more flexibility to the beneficiary because they are less restricted to a network and referrals are not required.  The main downside to a PPO is that out-of-pocket expenses tend to be higher.

The Medicare Annual Enrollment Period runs from October 15th - December 7th every year.  Beneficiaries have the option to auto-enroll to stay in their current Medicare Advantage plan, enroll in a new plan or go back to Original Medicare Parts A & B only.  

Go here why we suggest not auto-enrolling before speaking to a licensed broker.   

If you are a current Medicare Advantage plan member, you may make a one-time change to your plan by either:

• Disenrolling in your current Medicare Advantage plan and switching to a different one, or
• Go back to having Original Medicare only

The Medicare Advantage Open Enrollment Period runs from January 1 -  March 31.

Special Enrollment Periods depend upon certain circumstances, and may be available outside the usual enrollment periods year-round.  Some ways you may qualify for a Special Enrollment Period include:

• Retire and lose your employer coverage
• Move to a new plan service area, even if it's within the same state
• Newly qualify for extra financial assistance
• Have been diagnosed with certain qualifying chronic health conditions
• Live in a federally declared disaster area

If any of the above scenarios apply to you, please reach out to us and we'd be happy to help you understand your options!

It depends. There may be help available to you if you meet certain income requirements. You may qualify for:

• Low Income Subsidies, also called Extra Help, which can help cover some of your out-of-pocket prescription drug costs.  Click here to learn more about how Low Income Subsidies work.

• Medicaid, which is state-sponsored coverage that may pick up the costs of your Part B monthly premium, as well as other services like hearing, eyeglasses, prescription drugs, and some long-term care. Go here to learn more about Medicaid income eligibility requirements.  If you do not qualify for Medicaid, Low Income Subsidies may still be a good option to apply for.

Yes! Although many people think they will lose their TFL benefits, that isn't the case at all!  In fact, many insurance carriers have created Medicare Advantage plans designed specifically for retired military veterans.  

These plans are unique because they have been designed to work in tandem with your Original Medicare and TFL benefits, while offering many other additional benefits that only Medicare Advantage has to offer.

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