New To Medicare ( Turning 65 )
Medicare Advantage vs Medicare Supplement
Whether you’re approaching 65 and new to Medicare, have been enrolled for years and are considering a plan change, or have delayed your Medicare and now need coverage as your retirement benefits end, Prime Choice Agency is here to assist you. Our agents will work with you to understand your unique circumstances and help you explore the best options that fit your budget and healthcare requirements.
Frequently Asked Questions
Find answers to commonly asked questions about Medicare.
How Do I Qualify For Medicare?
To qualify for Medicare, you generally need to meet the following criteria:
– Age: You must be at least 65 years old. You can apply for Medicare three months before your 65th birthday.
– Citizenship or Residency: You must be a U.S. citizen or a legal resident who has lived in the U.S. for at least five continuous years.
– Work History: You or your spouse must have worked and paid Medicare taxes for at least 10 years (40 quarters). If you don’t meet this requirement, you may still qualify by paying a premium for Part A.
– Eligibility for Other Programs: If you are under 65, you may qualify if you have certain disabilities or medical conditions, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
How To Apply For Medicare?
Applying for Medicare is a straightforward process. Here’s how you can do it:
– Online: Through the Social Security website
– By Phone: 1-800-772-1213 (TTY 1-800-325-0778)
– In Person: At your local Social Security office
What Is A Medicare Supplement Plan?
A Medicare Supplement Plan, also known as Medigap, is a private insurance policy designed to help cover some of the out-of-pocket costs that Original Medicare (Part A and Part B) doesn’t pay. This includes expenses like copayments, coinsurance, and deductibles.
Here are some key features of Medicare Supplement Plans:
– Standardized Plans: Medigap policies are standardized and labeled with letters (e.g., Plan A, Plan B, etc.) across most states, making it easier to compare options. Each plan offers a different set of benefits.
– Coverage for Out-of-Pocket Costs: Medigap plans can help pay for costs such as:
Part A coinsurance and hospital costs
Part B coinsurance or copayment
First three pints of blood each year
Part A hospice care coinsurance or copayment
Skilled nursing facility coinsurance
– No Network Restrictions: Most Medigap plans allow you to see any doctor or specialist that accepts Medicare, giving you flexibility in choosing healthcare providers.
– Guaranteed Renewability: As long as you pay your premium, your Medigap policy cannot be canceled, even if you have health issues.
– Enrollment Period: The best time to enroll in a Medicare Supplement Plan is during your Medigap Open Enrollment Period, which lasts for six months starting the month you turn 65 and are enrolled in Part B. During this period, you have guaranteed acceptance regardless of your health status.
– Monthly Premiums: In addition to your Medicare premiums, you’ll pay a monthly premium for your Medigap policy. Prices can vary based on factors like the plan you choose and where you live.
What Is A Medicare Advantage Plan?
Medicare Advantage Plans, often referred to as “Part C” or “MA Plans,” serve as a comprehensive alternative to Original Medicare. These plans are provided by private companies that are approved by Medicare. When you enroll in a Medicare Advantage Plan, you still retain your Medicare coverage. These bundled plans typically include Medicare Part A (Hospital Insurance) and Part B (Medical Insurance), and often encompass Medicare drug coverage (Part D).
Many Medicare Advantage Plans provide additional benefits that Original Medicare does not cover, such as vision, hearing, dental care, and fitness programs (like gym memberships or discounts). Some plans may also offer even more services, including transportation to medical appointments, coverage for over-the-counter medications, and other wellness-promoting services.
The costs associated with a Medicare Advantage Plan can vary based on several factors. Generally, you’ll need to use healthcare providers within the plan’s network and service area to keep your expenses low. Some plans may not cover services from out-of-network providers.
Who Can Buy A Medigap Policy?
– Formulary Status: Check if your medications are included in your plan’s list of covered drugs (formulary).
– Drug Tier: The tier your medication falls under can affect the cost; higher tiers typically have higher copays.
– Coverage Phases: Your out-of-pocket expenses depend on which phase of your drug benefit you’re in, such as whether you’ve met your deductible or if you’ve reached the catastrophic coverage stage.
– Pharmacy Choice: The pharmacy you use matters. Preferred pharmacies may offer lower out-of-pocket costs because they have agreements with your plan, while out-of-network pharmacies might result in higher costs.
– Extra Help: If you qualify for Extra Help, it can significantly reduce your drug coverage expenses.
What If I Don’t Apply for Medicare? What Are My Options?
Your employer’s size affects whether you can postpone enrolling in Part A and Part B without incurring a penalty for late enrollment.
If the employer has fewer than 20 employees:
You should enroll in Part A and Part B when you first become eligible. In this situation, Medicare will be the primary payer, meaning it pays first before any other coverage you might have.
If the employer has 20 or more employees:
Consult your benefits manager to confirm whether you have group health plan coverage as defined by the IRS. If you have group health coverage linked to current employment, you may delay enrolling in Part A and Part B without facing a lifetime late enrollment penalty. If you choose to postpone both parts, there’s no action needed when you turn 65.
Will I Be Penalized For Not Having Medicare?
If you did not enroll in Part B when you were first eligible, your monthly premium may increase by 10% for each 12-month period you could have signed up but didn’t. This penalty will apply every time you pay your premiums for as long as you remain enrolled in Part B, and it increases the longer you delay coverage.
However, you typically won’t incur a late enrollment penalty if you qualify for a Special Enrollment Period based on certain conditions.
If you have limited income and resources, your state may assist you with costs for Part A and/or Part B. You may also be eligible for Extra Help with your Medicare prescription drug coverage.
For Part D, the late enrollment penalty is an additional amount added to your premium. You may face this penalty if there’s a gap of 63 days or more after your Initial Enrollment Period during which you don’t have Medicare drug coverage or other credible prescription coverage. This penalty will generally apply for as long as you have Medicare drug coverage.
If you qualify for Extra Help, you will not be subject to the late enrollment penalty.
I am New To Medicare-How Do I Get Started?
Call Us
At Prime Choice Agency, we’ll help you explore a wide range of insurance carriers to compare rates and find the best option for you. We handle all the details, and if we determine that you’re already enrolled in the best plan, we’ll let you know and won’t make any changes.
Delayed Your Medicare?
Step 1: Apply for Part A and B through the Social Security Administration’s website or by calling your local Social Security office.
Step 2: Fill out the following forms: CMS-40B and CMS-L564, with your previous employer to confirm you had credible medical coverage that caused the delay in your Medicare enrollment.
You can fax the completed CMS-40B and CMS-L564 forms to 1-833-914-2016, or mail them to your local Social Security office. If you have any questions, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
If your employer cannot complete Section B, you may fill it out as best as you can without their signature.
Additionally, submit one of the following types of secondary evidence by uploading a saved document from your computer:
Income tax returns showing health insurance premiums paid
W-2s reflecting pre-tax medical contributions
Pay stubs indicating health insurance premium deductions
Health insurance cards with the policy effective date
Step 3: Reach out to Prime Choice Agency for assistance in selecting the Medicare plan that best suits your needs!
Our services are FREE. We get paid directly by the insurance carriers.
CALL US AT: 703-705-2443