Did You Know?
Frequently Asked Questions
1. What is Medicare and who is eligible?
Medicare is a federal health insurance program primarily for people aged 65 and older. It also covers certain younger individuals with disabilities and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). To be eligible, you must be a U.S. citizen or a legal resident for at least 5 continuous years.
Did you know?
Typically, with some exceptions that may be earlier, after collecting disability for 24 months, a consumer may be eligible for Medicare.
Often times clients are unaware s/he has Medicare.
2. What are the different parts of Medicare?
Medicare Part A:
Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B:
Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Did you know?
There are options whether to enroll in Part B. This can be confusing. Do not risk penalties or being unable to qualify for appropriate coverage. I am here to guide.
Medicare Part C (Medicare Advantage):
A type of Medicare health plan offered by private companies that contract with Medicare to provide Part A and Part B benefits.
Did you Know?
You have options. What is the difference between Medicare Advantage (Part C) and Supplement (Medigap) coverage?
Contact me to discuss your options based on your needs.
Medicare Part D:
Provides prescription drug coverage and is also offered by private insurance companies.
Did you know?
If you do not secure prescription drug coverage (Part D) within a specific timeframe, you may be subject to a penalty.
Veterans prescription drug benefits are considered "credible drug coverage" and so the no Part D penalty does not apply.
The same is not the case for Part B. Veterans must enroll in Part B or may be subject to a penalty.
Let's discuss your options if you have union or retiree prescription drug benefits.
Please see IRMAA note for higher incomes under Medicare Part B which also pertains to addition cost for Part D premiums.
3. How do I enroll in Medicare?
You can enroll in Medicare during the Initial Enrollment Period (IEP), which starts three months before you turn 65, includes the month you turn 65, and ends three months after you turn 65. If you miss your IEP, you can sign up during the General Enrollment Period from January 1 to March 31 each year, with coverage starting on July 1. Special Enrollment Periods are available under certain conditions, such as losing other health coverage.
Did you know?
I recommend contacting me 4-5 months prior to the first of the month you turn 65. This way I can explain and guide you with enrolling into Medicare based on your current situation (working, retiring) and with considerations such as the fact that you are not responsible for Medicare deductibles if enroll in a Medicare Advantage (then why wait to enroll after your Medicare effective date), whether you decide to enroll in Medicare and Social Security benefits at this time or SS at a future date...
My services are at no cost. Let's get this done right for you.
4. What is the cost of Medicare?
Medicare Part A:
Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while working. If you buy Part A, you’ll pay up to $506 per month in 2024.
Medicare Part B:
The standard Part B premium is $174.70 (*IRMAA) per month in 2024. The deductible is $240.
Did you know?
* For those who make a yearly income above the annual thresholds (2024 for 2022 income over $103,000 Individual and over $206,000 married joint), the income-related monthly adjustment amount (IRMAA) is a fee you pay on top of your Medicare Part B and Part D premiums. Each year there are brackets/charts available. If your income is determined that IRMAA fees apply, Social Security will mail you a notice.
Medicare Part C and Part D:
Costs vary by plan and provider. Medicare Advantage and Part D plans may have additional premiums, deductibles, and copayments.
5. What is Medigap and how does it work?
Medigap, also known as Medicare Supplement Insurance, is sold by private companies to cover gaps in Original Medicare (Parts A and B) such as copayments, coinsurance, and deductibles. To be eligible for Medigap, you must have Medicare Part A and Part B. Medigap plans do not cover prescription drugs, so if you need drug coverage, you can join a Medicare Prescription Drug Plan (Part D). Medigap plans are standardized and labeled A through N, with different benefits for each plan.
Did you know?
The most popular Supplement plans are Pans N, G, F. Plan F is not available any longer for those eligible for Medicare effective as of 1/1/2020. Those who already are enrolled may keep Plan F and those eligible for Medicare prior to 1/1/2020, may elect to enroll in Plan F.
6. What is the difference between Medicare and Medicaid?
Medicare is a federal health insurance program primarily for people aged 65 and older, and for certain younger individuals with disabilities. Medicaid, on the other hand, is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid offers benefits that Medicare doesn’t typically cover, like nursing home care and personal care services.
Did you know?
The Medicaid income limits for those that are Medicare eligible have increased in 2023 and again in 2024. If you have been told you are over income for Medicaid or Medicaid subsidies, it may be time to reconsider.
7. Can I have both Medicare and Medicaid?
Yes, if you qualify for both Medicare and Medicaid, you are considered "dual eligible." In this case, Medicare pays first for covered services and Medicaid may cover costs that Medicare doesn’t, like Medicare premiums, deductibles, and coinsurance. You may also be eligible for additional benefits like prescription drug coverage through Medicare Part D with the Extra Help program (medicareresources.org) (Centers for Medicare & Medicaid Services).
Did you know?
I am always prepared to provide the Medicare Savings Program application and the Medicaid Application (which actually requires two forms for those eligible for Medicare) to clients determined to be eligible. I guide the consumer on how to submit these applications and what to expect.
Recent Medicare News
Changes to Medicare in 2024
- The Medicare Part A deductible will increase to $1,632 in 2024, up from $1,600 in 2023. This deductible covers inpatient hospital stays for the first 60 days. Daily coinsurance for hospital stays beyond 60 days will also see an increase (medicareresources.org) (Centers for Medicare & Medicaid Services).
- Medicare Part B premiums will rise to $174.70 per month in 2024, up from $164.90 in 2023. The annual deductible for Part B will also increase to $240 (Centers for Medicare & Medicaid Services).
Medicare Advantage and Prescription Drug Programs
- Enrollment in Medicare Advantage plans is projected to grow from 31.6 million in 2023 to 33.8 million in 2024, making up about 50% of all Medicare enrollees. The average monthly premium for Medicare Part D is expected to decrease slightly to $55.50 in 2024 (Centers for Medicare & Medicaid Services).
- The CMS Innovation Center’s Medicare Advantage Value-Based Insurance Design (VBID) Model will expand in 2024, providing person-centered benefits aimed at improving health equity. This includes additional supplemental benefits such as food and nutrition assistance (Centers for Medicare & Medicaid Services).
Financial Assistance Programs
- The Low-Income Subsidy Program, also known as Extra Help, will see enhancements in 2024, allowing eligible enrollees to benefit from no deductibles, no premiums, and lower copayments for certain medications. This expansion aims to assist up to 3 million seniors and people with disabilities (Centers for Medicare & Medicaid Services).
Recent Medicare Advocacy Updates
- Recent articles from the Center for Medicare Advocacy highlight issues such as gaps in Medicare coverage, which can prevent beneficiaries from receiving necessary care, and lawsuits challenging improper Medicare marketing tactics (Center for Medicare Advocacy).
CMS disclosure:
We may not offer every plan available in your area. Currently we represent 8 organizations which offer over 200 products in the NY and CT area. Please contact Medicare.gov,1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options. Not affiliated with any government agency including Medicare.
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