Faq

You are eligible if you are 65 or older, under 65 with certain disabilities, or have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

You can enroll online at the Social Security website, by phone, or in person at your local Social Security office.

You can enroll during your Initial Enrollment Period (IEP), which starts three months before you turn 65 and ends three months after your 65th birthday month.

Medicare has four parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).

Part A is usually premium-free if you or your spouse paid Medicare taxes while working. Part B, Part C, and Part D typically have monthly premiums.

Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Part B covers outpatient care, preventive services, ambulance services, and durable medical equipment.

Part C, or Medicare Advantage, is an alternative to Original Medicare offered by private companies that includes Parts A and B and often Part D.

Part D covers prescription drugs.

If you have employer coverage, you may delay Part B without penalty. However, you should check with your benefits administrator.

You can enroll during the General Enrollment Period (January 1 to March 31), but you may face late enrollment penalties.

Yes, you can have both Medicare and VA benefits, but they do not coordinate coverage.

You can sign up during the General Enrollment Period or a Special Enrollment Period if you qualify.

SEPs are times outside the usual enrollment periods when you can sign up for Medicare due to specific life events, like losing employer coverage.

Yes, you can change plans during the Annual Enrollment Period (October 15 to December 7).

AEP is the time each year when you can make changes to your Medicare coverage.

From January 1 to March 31, you can switch Medicare Advantage plans or return to Original Medicare.

You can update your address online through the Social Security website or by calling Social Security.

You can request a replacement card online through the Social Security website or by calling Social Security.

The standard Part B premium is adjusted annually and may be higher based on your income.

The Part B deductible is an annual amount you must pay out-of-pocket before Medicare starts to pay its share.

Prescription drugs are covered under Medicare Part C if you enroll in a MAPD or is covered in part D.

The donut hole is a coverage gap in Part D where you pay higher out-of-pocket costs for prescriptions until you reach catastrophic coverage

Yes, by 2025, the donut hole will be eliminated, and there will be a $2,000 cap on out-of-pocket prescription drug costs.

Medicare Advantage plans are an alternative to Original Medicare, while Medigap (Medicare Supplement) plans help cover out-of-pocket costs not covered by Original Medicare.

No, you cannot have both. You must choose one or the other.

The Part A deductible is the amount you pay for inpatient hospital stays before Medicare starts to pay.

Original Medicare does not cover routine dental, vision, or hearing care, but some Medicare Advantage plans do.

The Medicare Savings Program helps pay Medicare premiums, deductibles, and coinsurance for eligible individuals with limited income and resources.

Yes, Medicare covers many preventive services, such as screenings, vaccines, and annual wellness visits.
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Medicare covers many healthcare services, but you may still have out-of-pocket costs like deductibles, copayments, and coinsurance.

Medicare does not cover long-term care, such as custodial care in a nursing home.

Hospice care is for terminally ill patients and includes medical and support services to manage symptoms and provide comfort

Medicare covers home health care if you meet certain conditions, such as being homebound and needing skilled nursing care.

DME includes items like wheelchairs, walkers, and oxygen equipment that Medicare Part B covers if medically necessary.

Yes, Medicare covers outpatient and inpatient mental health services.

Original Medicare does not cover hearing aids, but some Medicare Advantage plans may offer this benefit.

Original Medicare does not cover dental implants, but some Medicare Advantage plans may offer dental coverage.

Extra Help is a program that helps pay for Part D prescription drug costs for people with limited income and resources.

Most claims are filed by your healthcare provider, but if you need to file a claim yourself, you can do so using the form available on the Medicare website.

You can appeal the decision by following the instructions on your Medicare Summary Notice or Explanation of Benefits.

You can appeal by submitting a written request to the address provided on your Medicare Summary Notice or Explanation of Benefits.

An MSN is a statement you receive every three months that lists the services billed to Medicare and what Medicare paid.

An EOB is a statement from your Medicare Advantage or Part D plan that shows what was billed, what the plan paid, and what you owe.

You can check the status of your claim online through your MyMedicare account or by calling Medicare.

MACs are private companies that process Medicare claims and handle appeals.

You can report suspected fraud to the Medicare Fraud Hotline at 1-800-MEDICARE or online through the Medicare website.

The Ombudsman helps beneficiaries with complaints, grievances, and information about Medicare rights and protections.

No, Medicare cannot drop you because of your health condition.

A Medigap policy is a Medicare Supplement Insurance that helps pay some of the healthcare costs not covered by Original Medicare.

Compare plans based on coverage, costs, and the insurance companies’ reputations. You can use the Medicare Plan Finder tool for assistance. For no cost assistance you can reach out to your local Insurance agent that specializes in Medicare plans

Yes, but you may have to go through medical underwriting unless you have guaranteed issue rights.

These are rights you have in certain situations when insurance companies must offer you a Medigap policy without medical underwriting.

Medicare Advantage plans are an alternative to Original Medicare, offered by private companies, that include Parts A and B and often Part D.