Top 5 Medicare FAQs

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Trying to make sense of Medicare. Here are answers to 5 of the most commonly asked questions to get you started.

Number 1

Who is eligible for Medicare?

To be eligible for Original Medicare, you must be a permanent legal resident (green card holder) or an American citizen who has lived in the United States for at least five years AND one of the following:

  • Age 65 or older
  • Under age 65 and receiving Social Security Disability Income for 24 months
  • Diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis

To enroll in Original Medicare, you may be required to reach out to your local Social Security office in some circumstances.

Number 2Will I automatically be enrolled when I turn 65?

You will automatically be enrolled in Medicare at age 65 if you are receiving Social Security benefits or railroad retirement board benefits at least four months before you enroll in Medicare.

However, suppose you are not receiving Social Security benefits or railroad retirement board benefits. In that case, you will need to contact your local Social Security office to enroll in Medicare up to three months before your 65th birth month.

If you must contact your local Social Security office, you can sign up for Part A and Part B at the same time. Once you complete the application and provide the required documentation, you will begin receiving benefits on the first day of your 65th birth month.

Number 3 Do I need to enroll in Medicare if I work past 65?

While it is not mandatory, we recommend you enroll in Medicare Part A coverage as soon as you become eligible if you qualify for premium-free Part A coverage. However, if you delay Medicare Part A, you will be able to enroll later during the General Enrollment Period or a Special Enrollment Period if you qualify. But, if you delay enrollment to the General Enrollment period, you will be required to pay late enrollment penalties.

If your employer offers creditable health coverage, you do not need to enroll in Medicare Part B if you are working past age 65. Creditable coverage is health care coverage that provides at least equal benefits to Original Medicare. Suppose you do not have creditable coverage and do not enroll in Medicare Part B when you first become eligible. In that case, you may have to pay the Medicare Part B late enrollment penalty as long as you have Medicare Part B.

Remember that even if you have creditable coverage, it is essential to compare your current plan to Original Medicare with a Medigap plan and Part D. Often, combining these Medicare plans will provide you with the most comprehensive coverage possible.

Number 4Are Medicare Supplement and Medicare Advantage the same thing?

Medicare Supplement plans and Medicare Advantage plans are not the same things. While both Medicare Supplement and Medicare Advantage plans bring additional benefits to Original Medicare, they work very differently. Medicare Supplement plans, also known as Medigap plans, work as a secondary to Original Medicare (Medicare Part A and Part B). The plan will only pay after Original Medicare has paid its portion. These plans have no networks, no restrictions, and no referrals to see specialists.

Medicare Advantage plans, also known as Medicare Part C, on the other hand, become your primary coverage over Original Medicare. They often require you to follow a strict network of doctors and have higher out-of-pocket costs. However, they often provide additional benefits.

These additional benefits provided by Medicare Advantage plans often include dental, vision, hearing, and prescription drug coverage, as well as transportation assistance and gym memberships. However, not every plan or every carrier is required to offer these additional benefits.

Number 5How much does Medicare cost?

For most, the Medicare Part A premium is $0 per month. However, if you do not qualify for zero-premium Part A, the premium can be as high as $506. To qualify for zero premium, you must have worked at least 40 quarters or ten years paying Medicare taxes. If you did not meet this qualification, you would be required to pay the Medicare part A premium.

The standard Medicare Part B premium in 2023 is $164.90. This can increase based on income. This difference in premium reflects your Income Related Monthly Adjustment Amount (IRMAA).

For example, if you and your spouse make $230,000 combined, you will each pay $230.80 monthly for Medicare Part B. If you are subject to IRMAA, you will receive a determination letter with your new monthly premium.

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Simplify Medicare is a full service agency in Rotterdam, N.Y., with 30 Licensed Insurance Agents serving the entire United States. We take pride in helping seniors remove the confusion from the Medicare process. We are Licensed Insurance Agents and Advocates who help to streamline a somewhat complicated system. We align ourselves with top rated insurance companies that ensure access to affordable high quality health care. We offer Medicare Supplements, Medicare Advantage Plans and Prescription Drug Plans and will assist you in finding the best plan that fits your health & financial needs.

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