get the facts on medicare
We know Medicare can be confusing and intimidating. If you’re nearing 65, you’ve probably been flooded with mailings and flyers from numerous insurance companies. With all these options, how do you know which option is best for you? That’s where we come in. We will sit down and explain the ins-and-outs of ALL of your Medicare options in simple terms so you can make a fully informed decision.
Have a question about medicare? call us. (561) 845-6100
frequently asked questions
When Can I Enroll In Medicare?
Initial Enrollment Period
You can first sign up for Part A and/or Part B during your 7-month Initial Enrollment Period. The IEP begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after you turn 65. If you sign up for Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage starts the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month.
If you enroll in Part A and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Medicare coverage will be delayed.
General Enrollment Period
If you weren’t automatically enrolled in Medicare, and you missed your IEP, you can still apply for Medicare Part A and/or Medicare Part B during the General Enrollment Period. The General Enrollment Period runs from January 1 to March 31 each year. However, if you enroll in Medicare during the General Enrollment Period, your coverage begins in July.
Special Enrollment Period
If you (or your spouse) are still working, you may have a chance to sign up for Medicare during a Special Enrollment Period. If you didn’t sign up for Part B (or Part A if you have to buy it) when you were first eligible because you’re covered under a group health plan based on current employment (your own, a spouse’s, or if you’re disabled, a family member’s), you can sign up for Part A and/or Part B:
• Anytime you’re still covered by the group health plan
• During the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first.
Usually, you don’t pay a late enrollment penalty if you sign up during a Special Enrollment Period. This Special Enrollment Period doesn’t apply to people with End-Stage Renal Disease (ESRD).
How Much Does Medicare Cost?
Most people eligible for Medicare are entitled to Part A for free. This is because you or your spouse paid Medicare taxes while working.
If you buy Part A, you’ll pay either $274 or $499 each month (in 2022) for Part A, depending on how long you or your spouse worked and paid Medicare taxes.
You pay a premium each month for Part B. Most people will pay the standard premium amount.
The standard Part B premium amount in 2022 is $170.10 (or higher depending on your income).
If you enroll in a stand alone Prescription Drug Plan, you will have to pay a monthly premium. Since Part D plans are offered by private insurers, there is not set price. Each plan has it’s own formulary and premium amount.
What Is IRMAA?
What Does Medicare Cover?
Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.
In general, Part A covers:
- Hospital care
- Skilled nursing facility care
- Nursing home care
- Home health services
Part B covers two types of services:
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
What Part D prescription drug plans cover:
Each Medicare drug plan has its own list of covered drugs (called a formulary). Many Medicare prescription drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.
What If I Have Coverage Through My Employer?
Special Enrollment Period
If you didn’t sign up for Part B (or Part A if you have to buy it) when you were first eligible because you’re covered under a group health plan based on current employment (your own, a spouse’s, or if you’re disabled, a family member’s), you can sign up for Part A and/or Part B:
- Anytime you’re still covered by the group health plan
- During the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first
What If I Delay Enrolling In Medicare?
If you do not sign up for Part A and/or Part B when you’re first eligible, you may have to pay a late enrollment penalty.
Part A Penalty
Your monthly premium may go up 10%. You’ll have to pay the penalty for twice the number of years you could have had Part A, but didn’t sign up.
Example: If you were eligible for Part A for 2 years but didn’t sign up, you’ll have to pay a 10% higher premium for 4 years.
Part B Penalty
Your monthly premium may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. You will have to pay this penalty for as long as you have Part B.
Example: Mr. Smith’s Initial Enrollment Period ended September 30, 2015. He waited to sign up for Part B until March 2018 during the General Enrollment Period. His Part B premium penalty is 20%, and he’ll have to pay this penalty for as long as he has Part B. (Even though Mr. Smith waited a total of 30 months to sign up, this included only 2 full 12-month periods.)
Do I Need A Part D Plan If I Don't Take Any Prescriptions?
Even if you take no prescriptions, it is a good idea to enroll in a low cost Part D plan. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over; there is a period of 63 or more days when you don’t have Part D or other creditable prescription drug coverage. Generally, you will have to pay the penalty for as long as you have Part D coverage
How much more will I pay?
Currently, the late enrollment penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($33.37 in 2022) by the number of full months you were eligible but did not have a Medicare drug plan or other credible coverage. The final amount is rounded to the nearest $.10 and added to your monthly premium.
Example: Mrs. Smith didn’t join when she was first eligible—by June 2019. She doesn’t have prescription drug coverage from any other source. She joined a Medicare drug plan during the 2021 Open Enrollment Period, and her coverage began on January 1, 2022.
Since Mrs. Smith was without creditable prescription drug coverage from July 2019–December 2021, her penalty in 2022 is 30% (1% for each of the 30 months) of $33.37 (the national base beneficiary premium for 2022), which is $10.01. She’ll be charged $10.01 each month in addition to her plan’s monthly premium in 2022. She’ll continue to pay a penalty for as long as she has Part D coverage, and the amount may go up each year.
Here’s the math:
.30 (30% penalty) × $33.37 (2022 base beneficiary premium) = $10.01
$10.01 = Mrs. Martin’s monthly late enrollment penalty for 2022
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