Frequently Asked Questions

Medicare covers, or will eventually cover, virtually all American workers, but this massive healthcare program isn’t well understood by millions of people. Many don’t know when they will become eligible for Medicare, what it covers (and doesn’t), and what it costs. With that in mind, here are seven frequently asked questions about Medicare and the answers to each.

When can I get Medicare benefits?

Unless you’re disabled, the answer is 65 years old. A common misconception among Americans is that you can get Medicare as soon as you claim Social Security Benefits, which can be as early as age 62. Unfortunately, even if you retire early and claim your Social Security benefit early, you’ll have to wait until 65 before you’ll be covered for Medicare.

How do I apply for Medicare?

You may not have to. If you’re already receiving Social Security retirement benefits when you turn 65, you’ll be enrolled in Medicare automatically. If this is the case, you’ll be automatically enrolled in Parts A and B of Medicare (more on the parts in a bit), and you can expect to receive your Medicare benefits card about three months before you turn 65.

If you aren’t receiving your Social Security retirement benefit when you turn 65, you’ll have to apply to Medicare, which you can do quite easily on the Social Security Administration’s website. Your initial enrollment period begins three months before the month of your 65th birthday and extends for three months after.

What are the “parts” of Medicare?

There are four “parts” of Medicare. Here’s a quick rundown, along with links to learn more about each part:

  • Part A is Hospital Insurance, or HI. This primarily covers hospital stays and some stays in skilled nursing facilities.
  • Part B is Medical Insurance. This covers doctors’ visits, lab tests, and outpatient procedures, just to name a few.
  • Part C is Medicare Advantage. These are plans offered by private companies to provide Medicare benefits.
  • Part D is Prescription Drug Coverage. This is optional for beneficiaries.

Parts A and B are collectively referred to as “Original Medicare,” and are generally what’s being referred to when I use the term Medicare.

How much does Medicare cost?

Medicare Part A is free for the vast majority of American seniors, but has a deductible of $1,340 per benefit period, as well as coinsurance requirements if your hospital stay lasts more than 60 days or if your skilled nursing stay extends beyond 20 days.

Medicare Part B has a monthly premium. For 2018, the standard monthly premium is $134, but high-income seniors pay significantly more than this. At the high end, seniors with incomes over $320,000 (joint tax return) or $160,000 (individual) have to pay $428.60 per month. In addition, Medicare Part B has an annual deductible of $183 for 2018.

Part D, prescription drug coverage plans, come with an average monthly premium of $35.

What does Medicare not cover?

One of the most important things for seniors to know is what Medicare does not cover. While this isn’t an exhaustive list, Medicare doesn’t cover long-term care, dental care, eye exams or glasses, dentures, acupuncture, hearing aids, and routine foot care.

This list is what Original Medicare (Parts A and B) doesn’t cover. Certain Medicare health plans may cover some of these services.

What is Medigap?

Since there are many copays and deductibles, private insurers sell Medicare Supplemental Insurance Plans, or Medigap. There are 10 different varieties of Medigap plans, with Medigap Plan G (the most comprehensive) the most commonly chosen option. While Medigap plans are standardized in terms of the coverage they provide, costs can vary significantly.

I have health insurance already through an employer. Do I have to enroll in (and pay for) Medicare at age 65?

It depends what kind of health insurance you have. If you have insurance through your employer or your spouse’s employer and the primary insured still working, you may not be required to enroll in Medicare as long as the company sponsoring your coverage has at least 20 employees. In this case, you’ll have a special enrollment period after you (or your spouse) retire or leave that employer.

On the other hand, if your insurance is through an employer you’ve already retired from, you still have to sign up at 65. If you are required to sign up for Medicare Part B, and don’t, you’ll face a permanent penalty of 10% of the Medicare Part B premium for every year you were supposed to enroll but didn’t.

It’s also worth noting that since Medicare Part A is free, it generally doesn’t make sense to delay signing up for it, even if you’re not required to. Your employer’s insurance will be your primary coverage, and Medicare will be secondary. However, since Part B comes with a premium, it does make sense to wait if you’re still covered by your employer’s plan.

Is there a monthly premium?

Yes. You pay your Medicare Supplement premium in addition to your Part B premium. There are 10 Medicare supplement plans and they are standardized. The benefits are the same regardless of which company you get coverage from, but the premiums can vary. The most popular plans are F & G.
Plan F pays 100% of the Medicare Part A & B deductibles, copays and the 20%. Plan G pays all but the Medicare Part B deductible.

When can you enroll in a Medicare supplement plan?

You will have the opportunity to enroll without any health questions within 6 months of your Part B effective date. This is a time when you can get any of the plans without answering any health questions. After the six-month open enrollment period, you must answer some health questions and you could be turned down if you have some serious health conditions.

There is also a “guaranteed issue period” for those who lose qualifying coverage such as a group plan or if you have a Medicare Advantage Plan that was canceled. The guaranteed issue period starts the day you lose your coverage and runs for 63 days.

10 Benefits of Medicare Supplement plans
  1. Freedom to choose your doctors and hospitals as long as they accept Medicare.
  2. The same basic standardized plan benefits, but costs vary by company and policy.
  3. Medicare Supplement plans are portable. You can use the plans in any state.
  4. Foreign travel emergency benefit of up to $50,000
  5. Automatic claims filing.
  6. Plan F pays 100% of your Medicare Part A & B deductibles and the 20%.
  7. Plan G pays everything Plan F pays except the Part B deductible. Premiums are around 25% lower than Plan F.
  8. Plan N pays the Part A deductible and copays and the 20% coinsurance for Part B. It does not pay the Part B deductible. There is also an office visit and ER copay on Plan N. The office visit copay cannot exceed $20, even for a specialist. The ER copay cannot exceed $50 and it is waived if you are admitted as an inpatient. Premiums are 30% lower than Plan F.
  9. Plan L pays 75% of the Part A deductible and skilled nursing coinsurance. It pays the Part A copays and provides an additional year in the hospital. Plan L pays 75% of the 20%, leaving you 5%. The premiums are about 40% lower than F.
  10. The option to add dental vision & hearing coverage, cancer coverage and your choice of Part D prescription coverage.
What’s not covered by my Medigap Policy?
  • Dental, vision or hearing care, except in very limited situations
  • Care received outside the United States, except in very limited situations
  • Custodial care such as help with eating, bathing or dressing
  • Prescriptions
  • Routine Dental Vision & Hearing benefits
  • Some new cancer treatments. Additional cancer coverage is a available from our company to supplement this benefit
Which Medicare Supplement Do We Like The Best?
Plan G – The Best Medicare Supplement

When learning about and shopping for Medicare Supplement plans, many often ask; Which is the best plan?  This question often subjective because “best” of anything often depends on your individual situation and preferences.  In the case of Medicare Supplements, this can be a good question because it helps cut through the clutter of information and available option.  With that said, If I were to list one plan as the best, it would definitely be Medicare Supplement Plan G.

So, what does G stand for? Guapo, good looking, gorgeous? Due to it’s popularity, you might think so.  Actually, G doesn’t really stand for anything. One important thing to understand is that all Medicare Supplement policies are represented by a letter.  Because they are standardized and regulated by Medicare, that letter means you get a certain set of benefits. I like to refer to Plan G as the “Gold” standard.  It’s not Platinum or Silver, but right in the middle of the top plans offering a great value.

Plan G Coverage

As a Medicare Supplement, Plan G is a secondary insurance policy that helps you cover out of pocket costs under Medicare A & B.  If you only have Medicare A & B, you can be liable for deductibles & co-insurance (20%) up to an unlimited amount. These are your out of pocket costs known as “cost shares” when you receive medical care.  What having Plan G does is simple. It pays for these costs for you, all except one; The Medicare Part B deductible. In 2019 the Part B deductible is $185 for the year. So, If you have Plan G, your out of pocket medical costs are limited to $185 per year in 2019.  Pretty good right? You’re starting to see why Plan G is so popular.

To reiterate, when you are covered by Plan G, you are only liable for the annual Part B deductible.  This deductible is set by Medicare and can change each year.  To see the most current deductibles and other costs, click here to visit Medicare’s Part A & Costs page.

Like all Medicare Supplements, Plan G will only pay its share of services covered by Medicare.  So, in order to be covered, the medical care you receive has to be covered by Medicare A & B.

As you can see, Medicare Supplement Plan G provides great coverage and makes things simple for you.  By only having to worry about a small deductible each year, being covered by Plan G can give you great peace of mind.

Plan G Premium Costs

The second reason Medicare Supplement Plan G is so popular is that many find it to be a great value.  In terms of the top 3 Medicare Supplements that are most often chosen, Plan G is in the middle for coverage and premium costs.  Traditionally, Medicare Supplement Plan F has been the most popular planbut not in recent years.  Plan F differs from Plan G very  slightly as far as coverage goes.  As I mentioned earlier, Plan G covers all of your costs under Medicare A & B except the annual Part B deductible.  Very simply, Plan F also covers this deductible.  So the only difference between Medicare Supplement Plan G and Plan F coverage, is the annual Part B deductible.  Which, as I said, is $185 in 2019.

So why isn’t Plan F more popular?  It covers more.  As I said earlier, Medicare Supplement Plan F has traditionally been the most popular because it offers the most coverage available.  But coverage is only one factor. The second is what you pay to have the plan, a.k.a your premium cost.  Both plans are great coverage, keeping your out of pocket medical costs to a very low amount.  What makes Plan G so popular is it’s combination of great coverage and value premiums.

The difference in premiums for Plan G vs. Plan F is between $366 and $476 annually.  With the difference in coverage only being $185 and the premium being $366 or higher; this is why many Medicare Supplement buyers are choosing Plan G over Plan F.  Another thing to notice as well is that the cost difference gets larger as you get older.  One thing that I have observed over the years and that many in the industry are aware of is that Plan F has higher premium increases than Plan G over time.  This makes Medicare Supplement Plan G more stable in terms of costs, another benefit in comparison of the two.

Premiums vary based on your exact age, sex, tobacco status, and zip code.  We can provide you with more information on your eligibility for coverage and a personalized price comparison.  (GET YOUR FREE QUOTE Link)

Many folks who are on Medicare are seeking financial security, value, & peace of mind.  Either you are on a fixed income now or you know you will be in the future.  It’s for these reasons that many choose to have more coverage through a Medicare Supplement Policy.  It can often be a challenge to find out which plan will give you the right combination of cost and benefits, so you have good coverage without over paying.  For many Medicare Supplement Plan G is the answer.  In an era of high deductibles and even higher premiums, it is a breath of fresh air.  By keeping your out of pocket costs to a small deductible,  while offering affordable premiums; Plan G has become the gold standard the best of all Medicare Supplements.

What should I know about Medicare Supplements?
8 things to know about medicare supplements
  1. You must have Medicare Part A and Part B.
  2. A Medigap policy is different from a Medicare Advantage Plan.  Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
  3. You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
  4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
  5. You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
  6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
  7. Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
  8. It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you’re switching back to Original Medicare.
Who is eligible for medicare?

Everyone age 65 or older, people under 65 with certain disabilities, and anyone with ESRD (end-stage renal disease, permanent kidney failure treated with dialysis or a transplant) or ALS (Lou Gehrig’s disease), regardless of their age.

What does IEP stand for?

Initial Enrollment Period

When and how long is your (IEP) Initial Enrollment Period?

7 months long, the three months before your 65th birthday, the month of your birthday, and the three months following your birthday. For example, if your birthday is in March, you may enroll in Medicare for the first time anytime from December through June.

When should I expect to receive my Enrollment and Medicare Card?

You should automatically get your Medicare card in the mail three months prior to your eligibility. You will automatically be enrolled into Medicare Part A when you turn 65. Then you can choose to enroll in Medicare Part B if you need medical coverage.

A Medicare card should be sent to you three months before your 65th birthday or during the 25th month of receiving disability benefits.

What does Part A cover?
  • Hospital stays
  • Critical access hospitals
  • Inpatient rehabilitation facilities
  • Inpatient care in a religious, non-medical health care institution
  • Skilled nursing facility care
  • Nursing home care (as long as custodial care isn’t the only care needed)
  • Hospice care
  • Home health services
  • Lab tests, X-rays and radiation treatment received as an inpatient
  • Surgeries
How do I find out if Medicare will cover what I need?
Medicare coverage is based on 3 main factors
  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
What are the Medicare Premiums for 2019?
  • Medicare Part A has no premium if you paid payroll taxes.
  • The premium for Medicare Part B is $135.50 per month, although some who qualify for Medicaid may not have to pay it. High income individuals will have to pay more.
When should you sign up?

You should sign up when you’re first eligible, unless you have other coverage to pay the 80% such as an employer group plan. If you don’t, your monthly premium may be higher when you do sign up, and you will have to wait until the yearly general enrollment period.

Is there a monthly premium for Part B?

Yes, you need to pay the Part B premium each month. The amount you pay can change each year and may be different depending on your income. Your Part B premium may come out of your Social Security benefits, or you may get a monthly bill. The standard monthly premium in 2018 is $134, but can be as high as $428 per month for high income individuals.

What does Part B Cover?
  • Doctor services
  • Outpatient care
  • Home health services
  • Durable medical equipment
  • Clinical research
  • Ambulance services
  • Mental health services
  • Second opinions before surgery
  • Home health services
  • Preventive services such as physical exams, screenings and flu shots
  • Some physical and occupational therapy to prevent or lessen complications from an existing medical problem
  • Medicare approved chemotherapy and radiation for cancer
How do I find out if Medicare will cover what I need?
  1. Talk to your doctor or other health care provider and ask if Medicare will cover the service or supplies.
  2. Find out if Medicare covers your item, service, or supply on Medicare.gov by clicking this link.
Medicare coverage is based on 3 main factors
  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
What are the Medicare Premiums for 2019?
  • Medicare Part A has no premium if you paid payroll taxes.
  • The premium for Medicare Part B is $135.50 per month, although some who qualify for Medicaid may not have to pay it. High income individuals will have to pay more.
When should you sign up for Part D?

You are eligible for Part D when you first become eligible for Part A. You can avoid late enrollment penalties by joining a Part D plan when you first become eligible. If you have had other credible coverage you are not subject to a penalty. Group insurance or Veterans benefits are examples of credible coverage. If you lose your credible coverage, you have 60 days to enroll in a plan.

Is there a monthly premium for prescription drug coverage?

Yes. Premiums vary depending upon the plan option you choose. Generally, they are under $30 per month and in some cases under $20 per month. The plan you chose depends on your prescriptions.

What are my options for prescription drug coverage?
  • Prescription drug coverage as part of a Medicare Advantage plan.You get Part A, Part B and Part D coverage in one plan.
  • Stand-alone Medicare prescription drug plan (PDP).These plans only offer prescription drug coverage. You can buy a PDP plan in addition to your existing Original Medicare (Part A and/or Part B) coverage, Medicare Supplement (Medigap) plan, Private Fee-for-Service (PFFS) plan without prescription drug coverage, some Medicare Cost Plans, or Medicare Medical Savings Account (MSA) Plans.
When should you sign up for Medicare Advantage?

If you choose to enroll in Medicare Advantage, you can enroll when you first become eligible for Medicare, or during the annual enrollment period (October 15th – December 7th). There are special enrollment periods for people who lose credible coverage.

Is there a premium for Medicare Advantage?

There is usually a premium, but in some cases there is no premium. FortifyCare offers Medicare Advantage plans as part of our product portfolio.

6 things you should know about Medicare Advantage Plans
  • Offers the same or greater benefits than Original Medicare
  • May include extras like wellness, vision, hearing and dental care, plus fitness club membership
  • May include prescription drug coverage
  • Requires payment of copays and/or coinsurance for covered services
  • Protects you with an annual out-of-pocket maximum (generally $6,700 to $10,000  yearly)
  • Requires you to see doctors in their network to receive the lowest cost
What are the different Types of Medicare Advantage Plans?
  1. Health Maintenance Organizations (HMOs) use a network of doctors and hospitals to lower your costs. You cannot use providers outside of the network except in case of emergency.
  2. HMO Point-of-Service (HMOPOS) plans—These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.
  3. Preferred-Provider Organizations (PPOs) allow you to use doctors outside the network but you generally pay more for services.
  4. Private Fee-for-Service Plans (PFFS) require no special networks or providers. You can visit any doctor or hospital that is eligible to receive payment from Medicare, agrees to treat you and accepts the plan’s terms and conditions. PFFS plans are being phased out in most areas.
  5. Special Needs Plans (SNPs) are designed to meet the specific needs of Medicare beneficiaries who meet one of the following criteria:
    1. Are eligible for state Medicaid health insurance
    2. Have needed or are expected to need the services provided by a long term care or skilled nursing facility for 90 days or longer
    3. Have a specific severe or disabling chronic condition

*Medicare Advantage is not a Medicare supplement insurance policy, and those with Medicare Advantage plans do not qualify for a “Medigap” or Medicare Supplement insurance policy.

*Part D prescription coverage may be included as part of a Medicare Advantage plan, or it can combined with Original Medicare and a Medigap policy.  

Important Links

Provider Lookup

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File a complaint (Grievance)
How to file an appeal
Check the status of a claim

Coverage

What does part a cover?
What does PART B cover?
What do drug plans cover?

Other information

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