Penn Medicare Solutions
A division of Penn Health Insurance Solutions, Inc.
Serving PA, NJ, DE & MD
2960 Ash Mill Road – P.O. Box 309
Holicong, PA 18928
Medicare Enrollment & Resources
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 on the first of the month, you may begin Medicare coverage one month before you turn 65.
As early as three months before 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 leave the Group Health plan.
For clarification on enrollment rules and timing, please feel free to call us toll-free at 888-959-1335.
Q: What is meant by Medicare “Part A” and “Part B?”
A: Medicare Part A is generally hospital insurance coverage. Medicare does not charge a monthly premium to most people for Part A.
During 2019, Part A hospital deductible will be $1,364, but Medigap Plans F, G, and N will pay this for you.
Medicare Part B is referred to as “outpatient insurance.” Medicare Part B in 2019 costs most people $135.50 per month, payable to Social Security. Part B sometimes can cost more than $135.50 per month if household income is greater than $170,000 annually for married couples or greater than $85,000 annually for singles.
Medicare Part B covers physician services; outpatient hospital; emergency room; diagnostic tests; physical therapy; durable medical equipment and much more.
For 2019, Medicare Part B asks that you pay the first $185 per calendar year in a deductible and then asks you to pay 20% of the Medicare allowed charges for services.
Have no fear here — Medigap Plan F will pay these charges for you! Plan G will also pay these charges but will ask you to pay the annual Part B $185 deductible.
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 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 Medigap Plans (Medicare Supplemental).
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.
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: What are Medigap Plans (Medicare Supplemental)?
A: Medigap Plans… also known as 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 Medigap plan, you will show the health care providers your Medicare Card and your Medigap card.
In our professional opinion, Medigap coverage has huge benefits over Medicare Advantage plans in several ways: you may seek care at any doctor or hospital in the USA that accepts Medicare; you do not need a referral to see a specialist; and nearly all Medicare medical co-pays are eliminated.
Q: Do Medigap Plans include prescription drug coverage?
A: No. The strategy here is simply to choose a separate stand-alone prescription plan to complement the Medigap plan. Easy to do.
See also: Understanding Enrollment Periods
Below are some Internet links and PDFs with important Medicare information.
“My wife and I worked with John for our Medicare and he continues to be available for help.”
– Bill W., Hamilton, NJ