A blog about Medicare. What you and your employees need to know
Common Medicare Questions
Author: Lora Drummond
Medicare Transition Specialist
Q: “How much does Medicare Cost?”
A: Part A has no cost as long as you or your spouse (must be married at least 10 years) has worked at least 10 years in the US. Part B currently in 2020 has a monthly premium of $144.50 a month per person. As Original Medicare (Parts A and B) cover only about 80% of a medical expense, most folks add a Medigap and a Part D Prescription Drug Plan, or transfer their Original Medicare to an all-in-one Medicare Advantage Plan to offset what Medicare does not cover. These monthly premiums vary. (See Chapter Two for details)
Q: “All my friends say I have to enroll in Medicare at age 65 or I’ll get in trouble. Is this true?”
A: This is not necessarily true. If you are on a creditable employer plan (as good as Medicare) with 20+ employees on the plan, then you DO NOT need to sign up for any part of Medicare.
Q: “Can I switch from plan to plan after I’m on Medicare?”
A: Yes, No, Maybe!” It depends on several factors – contact one of our Certified Medicare Planners™ to review your particular situation.
Q: “Do I have to sign up for Medicare now that I’m turning 65?”
A: Not necessarily, if you elect to stay on our employer plan after age 65 and keep working (because it is creditable, as good as Medicare, with 20+ employees on the plan), you do not have to sign up for any part of Medicare and stay on our employee health coverage.
If there are fewer than 20 employees on the employer’s health plan or the employee health plan is “not creditable” the answer is “Yes, you have to sign up for Medicare Parts A and B or receive a penalty.
Q: “Does my health plan provide coverage when I travel?”
A: You will have emergency and urgent care anywhere in the U.S. with a Medicare Advantage Plan, or with a Medigap policy. However, Medicare DOES NOT work outside the U.S. (Some plans do offer limited coverage outside the country; we recommend that you get travel insurance).
Q: “Do my spouse and I have to pick the same Medicare medical plan?”
A: No, all Medicare plans are individual. You may each choose the plan that most appropriately meets your individual needs with either an Advantage Plan or a Medigap + Part D.
Q: “How much are co-pays”?
A: Co-pays vary by plan; you will want to shop for plans and compare them to select the plan that is most appropriate for you. (Review individual Summary of Benefits for each plan or contact a Certified Medicare Planner™ for details.)
Q: “With Advantage Plans, does my doctor have to be on the network?”
A: If you have an HMO, then Yes. These plans work very similarly to the employer plan where your network primary care doctor will also have to give you referrals to see a specialist in your network. PPOs are now becoming a more popular offering under Medicare and they also have a network like HMO plans.
Q: “Can I pick any Medicare plan I want?”
A: Yes, when you initially enroll in Medicare there are no medical questions”. (This holds true for your Initial Enrollment Period and any Special Election Periods that apply, but if you are under 65, a Medicare Supplement may not be available.)
Q: “Is Medicare effective on my 65th birthday?”
A: Medicare plans are effective the 1st of the month of your birth at age 65 regardless of the actual day you were born. Exception: If you were born on the first of the month, you’re Medicare will start the first of the month prior to your birth-month. (i.e. June 1st birthday is eligible to begin Medicare on May 1st)
Q: The employee stayed on the employer’s health plan and continued to work, and they are now age 68 and plan to retire soon. They ask, “When do I have to sign up for Medicare?”
A: You can start the process up to 60 days before you want your Medicare to be effective on the 1st of that month. It is important to coordinate the end of employee benefits with the beginning of Medicare.
Q: “Do I have to get a drug plan if I don’t take any drugs”?
A: Yes, when you initially enroll in Medicare there are no medical questions”. (This holds true for your Initial Enrollment Period and any Special Election Periods that apply, but if you are under 65, a Medicare Supplement may not be available).
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