Frequent questions on Medicare enrollment & plan choices
Q: When does my Medicare Coverage Begin?
A: Medicare coverage begins on the first day of the month that you turn age 65. If your birthday is on the first of the month, you may begin Medicare coverage one month before you turn 65.
As early as three months before the month you turn age 65, Medicare will automatically pre-enroll you in Medicare Part A and will pre-enroll you in Medicare Part B if you are already collecting Social Security benefits before age 65 or choose to begin collecting Social Security benefits at age 65.
Sometimes, there is confusion on enrollment in Part B, particularly for persons who are not yet collecting Social Security benefits, so if you do not have a Medicare card two months prior to turning age 65, it is a good idea to call Social Security Administration at 1-800-772-1213. Social Security Administration handles enrollment for Medicare.
If you are working for an organization with 20 or more employees and you are covered by an Employer Group Health Plan, you will still be enrolled in Medicare Part A, but you (and your spouse) may not need to enroll in Medicare Part B unless you are covered by a Group Medicare Plan. The strategy here might be to avoid enrolling in Part B until you retire and actually leave the Group Health plan.
Q: I am approaching age 65. Do I need to inform Social Security Administration (SSA) to begin my Medicare, Parts A& B?
A: Most persons will automatically receive Medicare Part A on the first day of their age 65 birth month, with no charge from SSA. However, if we wish to activate Medicare Part B, which is needed for outpatient coverage and for enrolling in Medicare Supplemental or Medicare Advantage medical insurance, we usually need to inform SSA.
Q: What do I need to do to activate Medicare Part B:
A1: If you will soon turn age 65, are already receiving Social Security income and wish Medicare Parts A &B to begin on the first day of your age 65 birth month — You are all set! SSA will automatically enroll you for Medicare Part A and Medicare Part B. You will receive your Medicare card as early as three months before your 65th birthday month.
A2: If you will soon turn age 65, are not yet receiving Social Security income, but wish to begin Medicare coverage on the first day of age 65 birth month — You will automatically receive Medicare Part A but must inform SSA that you wish to receive Medicare Part B. Beginning three months before your age 65 birth month, you may enroll for Medicare Part B by: visiting a local Social Security office (post-Covid); phoning Social Security at 1-800-772-1213 and scheduling an appointment; or by applying online at: www.ssa.gov/benefits/medicare
Applying online is the easiest method. Here you will need to establish a User ID and a password at the Social Security website and then use this User ID and password to log into the Medicare Part B application. Part B coverage then starts on the first day of your age 65 birth month, unless you were born on the first of a month, in which case coverage begins on the first day of the month before your age 65 birth month.
A3: If you will work past age 65, will continue health insurance coverage on an employer group health plan and the employer has more than 20 employees – No action necessary now — You will receive Medicare Part A but do not yet need to enroll for Medicare Part B. This is also true for your spouse, as long as he/she is also covered by your employer group health plan. In this case, you will be able to schedule the start of Medicare Part B at a later date, usually as you prepare to retire. You may continue with the group health coverage. If, for some reason, you will still work, but you are not happy with the group health coverage (too expensive, too high a deductible, etc.), you will be able to leave the group plan and come to Medicare when you wish.
To enroll for Medicare Part B past age 65, we will assist you with the use of two forms:
- CMS40B Form– Application for Enrollment in Medicare Part B;
- CMSL564 Form– Request for Employment Information
For clarification on enrollment rules and timing, please feel free to call us toll-free at 888-959-1335.
Q: Does SSA charge for Medicare?
A: Yes. The standard charge, for 2023, is $164.90/month, for Part B. Most people do not need to pay for Part A. For some persons, considered high-income households, SSA will apply a surcharge beyond the $164.90/month. The surcharge system, called IRMAA, has five brackets. Generally speaking, these IRMAA charges begin when a single tax filer earned more than $91,000 in Year 2020 adjusted gross income. For tax filers married/jointly, the IRMAA charges begin at Year 2020 AGI of $182,000.
Please follow these links for additional info on SSA charges:
Q: If I get hit by SSA with an IRMAA high-income surcharge, based on my AGI from 2020, am I stuck with his surcharge the rest of my life?
A: If your income remains high for the rest of your life, you will experience some kind of IRMAA surcharge. SSA and IRS will examine your federal income tax returns from two years prior, to see Adjusted Gross Income (AGI) and from there the decision is made on IRMAA for the current year.
However, if your current year AGI is expected to be less than two years prior AGI, then we will fille form SSA44 to reduce or eliminate IRMAA for you. We will help here —no charge at all!.
About Medicare Medical Coverage
Q: What is meant by Medicare “Part A?”
A: Medicare Part A is generally hospital insurance coverage. Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and limited home healthcare services
Medicare does not charge a monthly premium to most people for Part A, as long as you have worked “40 quarters” in your life, or have been married, for ten years, to someone who has worked “40 quarters.” If you don’t meet this test, you usually will be able to activate Medicare Part A, but there is a monthly charge for it.
During 2022, Part A hospital deductible will be $1,556 per stay, but Medicare Supplemental Plans F, G, and N will pay this for you.
Q: What is meant by Medicare Part B?
A: Medicare Part B is often called outpatient insurance. It covers physician services; outpatient hospital; emergency room; diagnostic tests; physical therapy; durable medical equipment; outpatient cancer treatments; ambulance; mental health counselling and much more.
For 2022, Medicare Part B asks that you pay the first $226 per calendar year in a deductible and then asks you to pay 20% of the Medicare allowed charges for services.
Have no fear of the 20% open-ended financial risk here — Medicare Supplemental Plan G will pay these charges for you. Medicare Supplemental Plan N will also pay these charges, but will ask you to shoulder two copays types–$20 at the outpatient doctor and $50 at the Emergency Room.
Q: Must I opt for Medicare Part B?
A: Part B coverage is not mandatory, but it would be foolish to opt out of coverage unless you have Group Health coverage at your workplace (with more than 20 employees) and this coverage offers comparable benefits. Also, you must pay the Part B premium in order to access additional private Medicare medical coverage.
Q: Okay, so I have enrolled in Medicare Parts A & B…. now what happens?
A: Most persons, when seeking an individual Medicare plan, will now choose between what are called Medicare Advantage Plans and Medicare Supplemental plan.
Q: What are Medicare Advantage plans?
A: Medicare Advantage plans are private health insurance plans that act as primary payer for Medicare. In exchange for a monthly premium paid to a health insurance company, you agree to a series of medical co-pays and you agree to use a network of doctors and hospitals. These plans are HMOs and PPOs, similar to what you may have now with health insurance. For the most part, the concept of Medicare paying the 80% of medical charges and the insurer paying the 20%…is not valid here. You put away the Medicare card and you use the insurer’s Medicare advantage card for your medical and prescription needs.
The good news on Medicare Advantage is that many of these plans have no monthly cost for the insurance premiums – meaning that you often do not have to pay a premium to the insurance company to receive this coverage. Further, many of the plans include valuable ancillary benefits beyond what Medicare covers. These add-on benefits can include: no-cost, quarterly allowance for over-the-counter medicines/supplies; dental insurance; vision/eyeglass insurance; hearing aid benefit; and Silver Sneakers gym/YMCA benefits.
Q: Do Medicare Advantage plans include prescription coverage?
A: Medicare Advantage Plans will often bundle prescription coverage as part of the plan package, but plans are also offered without prescription coverage. Prescription co-pays vary based on the whether the prescription is a generic or a name-brand.
Q: Why do some people opt for Medicare Advantage coverage?
A: Some people opt for Medicare advantage because of insurance premium savings and because of the add-on benefits. With Medicare Advantage plans, by not paying any insurance premiums, you should expect to save significant money versus paying insurance premiums for Medicare Supplemental coverage and stand-alone Part D drug coverage. The insurance premiums savings can often exceed $2,000 per year. Further, Medicare advantage may offer add-on benefits: no-cost, quarterly allowance for over-the-counter medicines/supplies; dental insurance; vision/eyeglass insurance; hearing aid benefit; and Silver Sneakers gym/YMCA benefits. In return for these insurance premiums savings and valuable dd-on benefits, , you must be willing to accept copays and seek care in a specific health network.
Q: What are Medicare Supplemental Plans (Medigap)?
A: Medicare Supplemental Plans are “secondary” insurers to Medicare because they pay the “gap” – the payment due to doctors/hospitals that Medicare doesn’t pay. When you seek medical care with a Medicare Supplemental plan, you will show the health care providers your Medicare Card and your Medicare Supplemental card.
Q: What is a Medicare Supplemental Plan G?
A: Plan G means…
• Medicare is primary payer and the plan is the secondary payer.
• Good at any doctor/hospital in the entire USA as long as they accept Medicare –No referrals required. No claims forms. No paperwork.
• Annual $226 Part B deductible. After this deductible is met, no other charges for Medicare covered services.
• Standardized plans …so the same benefits/access to doctors with each insurer. All Plan G coverage is exactly the same with insurer – by law.
Q: What is a Medicare Supplemental Plan N?
A: Medicare Supplemental Plan N is a Medicare Supplemental Plan with some co-pays. In return for lower monthly premiums than Plan G:
• $226 calendar year Part Deductible
• $20 co-pays per outpatient doctor visit
• $50 co-pay per emergency room visit
• Possible 15% Excess charge if use non-Medicare doctor who agrees to accept Medicare for your needs. This is not allowed in PA.
Q: With Medicare Supplemental, why might a person sometimes choose Plan N versus Plan G?
A: Plan N can often be $30-$40 per month lower cost that Plan G. Let’s say we save $35/month with Plan N, by foregoing Plan G. Annualized, we save $420 in insurance premiums. In return for this saving, we then must pay a $20 copay at the outpatient Medicare doctor and $50 copay at the Emergency Room. If we visit the outpatient Medicare doctor 21 times in a calendar year—the Plan N ends up costing the same as Plan G. But what if we don’t visit the doctor 21 times in one year? What if we visit 6 times? With six visits, we pay a total of $120 for copays, but we have saved $420 for insurance premiums. We are ahead $300 here – and this type of savings is the basis for considering Plan N.
Q: Do Medicare Supplemental Plans include prescription drug coverage?
A: No. The strategy here is simply to choose a separate stand-alone prescription plan to complement the Medicare Supplemental plan. Easy to do.
Q: Why do some people opt for Medicare Supplemental coverage, coupled with a Part D plan, and forego using Medicare Advantage coverage?
A: Medicare Supplemental persons generally want to avoid medical copays associated with Medicare Advantage coverage. They also want the freedom to seek care in every hospital in the USA and to see any Medicare -accepting doctor in any state. In return for these benefits, Medicare Supplemental people must pay insurance premiums.
See also: Understanding Enrollment Periods
“My wife and I worked with John for our Medicare and he continues to be available for help.”
– Bill W., Hamilton, NJ