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FAQs about Medicare

  1. What is Medicare?

    • Medicare is a federal health insurance program for people aged 65 and older, certain younger people with disabilities, and individuals with End-Stage Renal Disease (ESRD).

  2. What are the different parts of Medicare?

    • Medicare is divided into four parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).

  3. When can I enroll in Medicare?

    • You can enroll during your Initial Enrollment Period (IEP), which is the 7-month period that starts 3 months before you turn 65, includes your birth month, and ends 3 months after.

  4. What is Medicare Part A?

    • Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

  5. What is Medicare Part B?

    • Medicare Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

  6. What is Medicare Advantage (Part C)?

    • Medicare Advantage Plans are an alternative to Original Medicare offered by private insurance companies that provide all Part A and Part B benefits, often including additional services like vision, dental, and prescription drug coverage.

  7. What is Medicare Part D?

    • Medicare Part D is prescription drug coverage offered by private insurance companies to help cover the cost of medications.

  8. What is a Medicare Supplement Plan (Medigap)?

    • Medicare Supplement Plans, or Medigap, are insurance policies that help cover some of the healthcare costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.

  9. When is the Annual Enrollment Period (AEP) for Medicare?

    • The Annual Enrollment Period runs from October 15 to December 7 each year.

  10. What is the Medicare Advantage Open Enrollment Period (MA OEP)?

    • The MA OEP runs from January 1 to March 31 each year, allowing those already enrolled in a Medicare Advantage plan to switch to another MA plan or return to Original Medicare.

  11. What is a Special Enrollment Period (SEP)?

    • An SEP allows you to make changes to your Medicare plan outside of the usual enrollment periods due to specific life events, such as moving or losing other insurance coverage.

  12. What happens if I don’t sign up for Medicare Part B when I’m first eligible?

    • If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Part B.

  13. Can I have both a Medicare Advantage Plan and a Medicare Supplement Plan?

    • No, you cannot have both a Medicare Advantage Plan and a Medicare Supplement Plan at the same time.

  14. What does the Medicare Part D late enrollment penalty mean?

    • The Part D late enrollment penalty is an amount added to your Part D premium if you go without creditable prescription drug coverage for 63 or more days after your Initial Enrollment Period.

  15. How can I get help paying for Medicare Part D costs?

    • If you qualify for the Low Income Subsidy (LIS) or “Extra Help” program, you can get assistance with your Part D costs, including lower premiums and copayments.

  16. What is the Initial Coverage Election Period (ICEP)?

    • The ICEP is the period when individuals first become eligible for Medicare, allowing them to enroll in a Medicare Advantage plan. It begins 3 months before the month of your 65th birthday and ends either the last day of the month before your Part B becomes effective or 3 months after your 65th birthday month, whichever is later.

  17. What is a Dual Eligible Special Needs Plan (D-SNP)?

    • A D-SNP is a type of Medicare Advantage plan for individuals who are eligible for both Medicare and Medicaid.

  18. What is a Chronic Condition Special Needs Plan (C-SNP)?

    • A C-SNP is a type of Medicare Advantage plan for individuals with specific chronic conditions, providing specialized care and coverage for their needs.

  19. Can I switch from Original Medicare to a Medicare Advantage plan?

    • Yes, you can switch from Original Medicare to a Medicare Advantage plan during the Annual Enrollment Period (AEP) or if you qualify for a Special Enrollment Period (SEP).

  20. What is a Medicare Prescription Drug Plan (PDP)?

    • A PDP is a stand-alone plan that offers prescription drug coverage and can be added to Original Medicare or some Medicare Advantage plans that do not include drug coverage.

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Additional FAQs about Medicare

  1. What is the General Enrollment Period (GEP) for Medicare?

    • The General Enrollment Period runs from January 1 to March 31 each year for those who didn't sign up for Medicare Parts A and B when first eligible. Coverage starts next 1st of the month and you may have to pay a late enrollment fee for Part B.

  2. What is the difference between Medicare and Medicaid?

    • Medicare is a federal program primarily for people aged 65 and older and some younger people with disabilities, while Medicaid is a state and federal program providing health coverage for people with low income.

  3. Can I enroll in a Medicare Advantage plan if I have End-Stage Renal Disease (ESRD)?

    • Yes, as of January 1, 2021, individuals with ESRD are eligible to enroll in Medicare Advantage plans.

  4. What is the Late Enrollment Penalty for Medicare Part B?

    • The Late Enrollment Penalty for Part B is an additional 10% of the standard premium for each full 12-month period that you could have had Part B but didn’t sign up.

  5. What is a Special Needs Plan (SNP)?

    • An SNP is a type of Medicare Advantage plan tailored to meet specific needs of certain groups of people, such as those with chronic conditions, those institutionalized, or those eligible for both Medicare and Medicaid.

  6. Can I drop my Medicare Advantage plan and go back to Original Medicare?

    • Yes, you can drop your Medicare Advantage plan and return to Original Medicare during the Annual Enrollment Period or Medicare Advantage Open Enrollment Period.

  7. What services are covered by Medicare Part A?

    • Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

  8. What services are covered by Medicare Part B?

    • Medicare Part B covers outpatient services, doctor visits, preventive services, and some home health care.

  9. What is the Initial Enrollment Period for Medicare Advantage?

    • The Initial Enrollment Period for Medicare Advantage coincides with the Initial Enrollment Period for Original Medicare, starting 3 months before the month you turn 65, including your birth month, and ending 3 months after.

  10. What is the cost of Medicare Part B?

    • The standard premium for Medicare Part B varies annually. Higher income beneficiaries may pay more based on their income.

  11. Can I get help with Medicare costs if I have a low income?

    • Yes, programs like Medicaid, Extra Help, and Medicare Savings Programs can assist with Medicare costs for those with low income.

  12. What is a formulary in a Medicare Prescription Drug Plan (Part D)?

    • A formulary is a list of prescription drugs covered by a Medicare Part D plan. It categorizes drugs into tiers that determine cost-sharing amounts.

  13. What is a Medicare Medical Savings Account (MSA) Plan?

    • An MSA Plan is a type of Medicare Advantage plan combining a high-deductible health plan with a medical savings account that you can use to pay for healthcare costs.

  14. Do Medicare Advantage plans cover prescription drugs?

    • Many Medicare Advantage plans (MA-PD plans) include prescription drug coverage, but some do not. Always check the plan details.

  15. What happens if I don’t pay my Medicare premiums?

    • If you do not pay your Medicare premiums, your coverage could be terminated. There are specific guidelines and grace periods for late payments.

  16. Can I change my Medicare Advantage plan outside the Annual Enrollment Period?

    • You can change your Medicare Advantage plan during Special Enrollment Periods (SEPs) if you qualify due to specific circumstances, such as moving out of your plan’s service area.

  17. What is a Medicare Savings Program?

    • Medicare Savings Programs help pay Medicare premiums, deductibles, and coinsurance for low-income Medicare beneficiaries.

  18. What is the difference between Medicare Supplement Plans and Medicare Advantage Plans?

    • Medicare Supplement Plans (Medigap) help cover out-of-pocket costs not covered by Original Medicare, whereas Medicare Advantage Plans (Part C) provide an alternative way to receive Medicare benefits through private insurers.

  19. What should I do if I lose my Medicare card?

    • If you lose your Medicare card, you can request a replacement through your MyMedicare.gov account or by calling 1-800-MEDICARE.

  20. Can I get dental and vision coverage through Medicare?

    • Original Medicare does not cover routine dental and vision care, but some Medicare Advantage plans offer these benefits. Always check the specific plan details.

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