It’s natural to have numerous inquiries about Medicare swirling in your thoughts regularly. Yet, unraveling the solutions to these Medicare-related queries can often be more intricate than anticipated. Within this article, we’ve compiled a list of the 10 primary Medicare questions that consistently arise from our clients.

Our goal is that you discover this compilation to be a valuable resource for addressing your frequently encountered Medicare uncertainties, and perhaps even shedding light on queries you hadn’t yet considered.

1. Who Qualifies for Medicare?

To meet the eligibility criteria for Original Medicare, you need to either hold permanent legal residency (green card) status or be a U.S. citizen who has resided in the United States for a minimum of five years AND fall into one of the following categories:

1. Aged 65 or above
2. Below 65 years old and receiving Social Security Disability Income for a period of 24 months
3. Diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis.

2. Will I be automatically signed up for Medicare when I reach 65 years old?

Automatic enrollment in Medicare takes place when you turn 65 and are already receiving Social Security benefits or railroad retirement board benefits, provided this enrollment occurs at least four months prior to your Medicare enrollment.

However, if you are not receiving Social Security benefits or railroad retirement board benefits, you will need to get in touch with your local Social Security office to initiate your Medicare enrollment. This can be done up to three months before you reach your 65th birthday.

If reaching out to your local Social Security office is necessary, you can complete the enrollment for both Part A and Part B simultaneously. After submitting the application and the required documents, your benefits will commence starting from the first day of your 65th birth month.

If you wish to enroll in Original Medicare, you might need to get in touch with your local Social Security office under specific circumstances.

3. Is enrolling in Medicare necessary when working beyond 65 years old?

While not obligatory, we recommend enrolling in Medicare Part A Coverage as soon as you become eligible, especially if you qualify for premium-free Part A coverage. However, should you decide to delay your Medicare Part A enrollment, you will still have the option to enroll later during the General Enrollment Period or a Special Enrollment Period, if eligible. It’s important to note that delaying enrollment until the General Enrollment Period might result in late enrollment penalties.

In cases where your employer provides health coverage that is deemed creditable, enrolling in Medicare Part B isn’t mandatory if you’re working past the age of 65. Creditable coverage refers to healthcare coverage that offers benefits at least equivalent to those of Original Medicare. Should you lack creditable coverage and choose not to enroll in Medicare Part B during your initial eligibility, there’s a possibility of incurring the Medicare Part B late enrollment penalty as long as you hold Medicare Part B.

It’s crucial to remember that even with creditable coverage, it’s recommended to compare your current plan with Original Medicare, along with considering a Medigap plan and Part D. Oftentimes, combining these Medicare plans can provide the most comprehensive coverage available.

4. I postponed enrolling in Medicare when I turned 65. How can I enroll now?

In the event that you deferred your Medicare coverage beyond the age of 65 while maintaining creditable coverage, the next step would involve reaching out to Social Security to initiate your enrollment in Original Medicare.

Given your possession of creditable coverage, you will be granted a Special Enrollment Period for enrolling in both Medicare Part A and Part B. Following this, you have the option to enroll in a Medicare Part D prescription drug plan and either Medicare Part C or a Medicare Supplement plan.

However, if you chose to delay your Medicare coverage without having creditable coverage, the process would entail enrolling in Original Medicare during the General Enrollment Period. This annual period takes place from January 1 to March 31 each year. Importantly, it’s essential to note that coverage won’t commence until July 1 if you enroll during the General Enrollment Period.

5. How much does Medicare cost?

For the majority of individuals, the monthly premium for Medicare Part A is $0. However, if you don’t meet the criteria for a zero-premium Part A, the premium could go up to $506. To qualify for the premium-free option, a prerequisite is having worked for at least 40 quarters or a total of ten years while paying Medicare taxes. If you don’t fulfill this requirement, you’ll need to pay the Medicare Part A premium.

As for Medicare Part B, the standard premium for 2023 stands at $164.90 per month. This amount has the potential to increase based on your income level. This variance in premium is tied to what’s known as the Income Related Monthly Adjustment Amount (IRMAA).

For instance, if you and your spouse have a combined income of $230,000, both of you will be responsible for a monthly Medicare Part B premium of $230.80 each. If the IRMAA applies to you, an official letter will be sent to you, detailing your revised monthly premium amount.

6. Is it possible for me to sign up for both Medicare Advantage and Medigap?

Enrolling in both a Medicare Supplement plan and a Medicare Advantage plan simultaneously is against the law. Opting for both plans would result in neither plan functioning as your primary coverage, thereby resulting in denied services. This scenario might necessitate you covering all your healthcare expenses out of pocket, even though you possess both types of coverage.

To prevent this situation, agents are prohibited from enrolling you in one plan if you are already enrolled in the other and lack a valid means to opt out of either plan.

7. Is prescription medication covered by Medicare? 

Original Medicare does not include coverage for prescription drugs. If you desire prescription medication coverage, enrolling in Medicare Part D becomes necessary. Medicare Part D assists in offsetting the expenses associated with prescription medications. Furthermore, select Medicare Advantage plans also offer prescription drug coverage.

Failure to enroll in Medicare Part D might result in the imposition of the Medicare Part D late enrollment penalty. This penalty targets individuals who defer Part D benefits without having creditable coverage. You will be obligated to bear this supplementary cost for as long as you hold Medicare Part D.

8. Do I need Medicare when I already receive VA benefits?

Enrolling in Medicare isn’t compulsory if you’re already receiving VA benefits. Nevertheless, should you ever require coverage beyond the scope of the VA system, additional medical coverage would be necessary to address those costs.

It’s important to keep in mind that if you possess VA coverage and choose to delay enrolling in Medicare Part B, there’s a likelihood of incurring the Medicare Part B penalty should you decide to enroll in Medicare at a later stage. Upon enrolling in Medicare, it takes precedence as the primary payer, with the VA assuming the role of secondary payer.

9. Will Medicare take care of all my medical expenses?

Upon enrollment, Original Medicare does not provide full coverage for all your medical expenditures. Medicare Part A entails a deductible and copayments for each incident, while Medicare Part B involves an annual deductible and a 20% coinsurance.

If you desire comprehensive coverage, enrolling in a Medicare Supplement plan becomes essential to address the coverage gaps left by Original Medicare. Through this approach, you can decrease your out-of-pocket expenses when dealing with Medicare-related costs.

10. Do Medicare benefits change each year?