FAQ

If you are receiving Social Security, you will receive a consumer guide in the mail from your state’s Department of Insurance.

Medicare is a federal health insurance for people age 65 or older, under 65 with certain disabilities and any age with End Stage Renal Disease (permanent kidney failure) requiring dialysis or a kidney transplant. Medicaid is a medical assistance program for low-income people and jointly funded by the federal government and the states.

To qualify for Medicare you must have contributed to it through U.S. payroll taxes for at least 10 years (40 quarters) before turning 65. For this fact alone, it’s not free. However, many people do not pay a premium for Part A. Part B is not free. Today’s monthly premium is $135.50 or higher (for 2019)! Advantage plans and supplemental insurance add to the cost.

Medicare Advantage plans (Part C) are part of the Medicare Program but run by private insurance companies. With Medicare Advantage plans you generally get all your Medicare-covered health care through that plan. Coverage can include prescription drug coverage or extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs. You may have to use the plan’s network doctors and hospitals to get services. You don’t need to buy a Medi-gap policy when you have an Advantage Plan. These plans may require a monthly premium in addition to your Part B premium.

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you are not yet 65, you might also qualify for coverage if you have a disability or have End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

Some people on Medicare pay a premium for Part A. However, you can get Part A at age 65 without having to pay premiums if:

• You already get retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible to get Social Security or Railroad benefits but you haven’t yet filed for them.
• You or your spouse had Medicare-covered government employment.
• If you are under 65, you can get Part A without having to pay premiums if you have:
  • Received Social Security or Railroad Retirement Board disability benefits for 24 months.
  • End-Stage Renal Disease and meet certain requirements.

While you do not have to pay a premium for Part A if you meet one of these conditions, you must pay for Part B if you want it.

If you began receiving Social Security income prior to age 65 or you receive Social Security disability income, your enrollment is automatic. Those who are already receiving benefits from the RRB are enrolled automatically. Everyone else must apply for Medicare through the Social Security office.

If are just now turning 65, you have a total of seven months to enroll beginning three months before the month of your 65th birthday and ending three months after the month of your 65th birthday. If you apply before your birth month, your Medicare coverage should start on the first day of your birth month.

If you don’t enroll in Medicare during your initial seven-month enrollment period, you must wait to apply during the next general enrollment period (January through March each year and the effective date will be July 1). You may also owe a 10 percent penalty on your Part B premium for each year you delay Part B. A beneficiary’s Part B premium may go up 10% for each full 12-month period in which s/he could have had Part B but didn’t.

We can! Whatever you do, we recommend that you talk to someone who can ask the right questions, come to understand your circumstances, needs and budget, and recommend a plan that is right for you.

Original Medicare does not pay all medical expenses. A Medicare supplement policy fills most of Medicare’s coverage gaps. You have options.

Medicare does not cover long-term care in a nursing home. However, you may be covered for short stays in a skilled-care facility. You must meet certain pre-entrance requirements in order to qualify for benefits. If you’re eligible, Medicare will cover skilled care for the first 20 days and a certain amount each day for days 21-100. After 100 days per benefit period, Medicare pays nothing.

Yes, but only if your doctor orders part-time skilled care and you are homebound. If you meet Medicare’s requirements for home health care, it is paid at 100 percent.

No. Coverage is available through stand-alone insurance plans or through some Medicare Advantage plans.

Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers.