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Medicare Q & A

Frequently Asked Questions

You’ve got questions, we’ve got answers.

Many people struggle with Medicare set up. For your convenience we’ve created a list of the most frequently asked Medicare questions that we hear. Click on the questions you are most interested in for the answer.

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What is Medicare?
MEDICARE IS THE FEDERAL HEALTH INSURANCE PROGRAM FOR:

  • Most people age 65 and over.
  • People under the age 65 with certain disablities
  • People with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.
  • People of all ages with End-Stage Renal Disease (ESRD), also known as permanent kidney failure that requires dialysis or a transplant.

What is the difference between Medicare and Medicaid (Title 19)?
What Is the Difference Between Medicaid and Medicare (Title 19)?

While Medicare and Medicaid sound similar, they are in fact very different programs. Each program has a different set of eligibility requirements and provide different coverage options. In some circumstances, it is possible to qualify for both Medicare and Medicaid. However, eligibility for each program is determined by different governing bodies. One of the biggest differences between the two programs is that Medicare is a federally governed program, whereas Medicaid is a program that is governed on a state level.

MEDICARE VS MEDICAID

MEDICARE

Medicare is a federal health insurance program designed for people age 65 and older or people with certain disability. The main focus of this program is to provide support for to individuals who have paid into the system and reached a specific point of eligibility. This program is attached to Social Security and it is not free. Fees are paid through deductibles and monthly premiums.

Medicare was designed to help pay high medical costs of the elderly. It is geared toward recipients that pay into Medicare through taxes or payroll and is available regardless of income.

COVERAGE OPTIONS

Medicare is a four-part program. Each program covers different aspects of health care.

  1. Part A covers hospitalization expenses.
  2. Part B provides medical insurance.
  3. Part C is a privately purchased additional coverage that provides additional services. This is a health maintenance organization PPO/HMO.
  4. Part D covers prescription drug costs. This is an option out-of-pocket add on to the regular Medicare benefits. Part D was added to help address concerns about the high costs of prescription drugs.

Those who are under the age of 65 are eligible for Medicare in certain circumstances. As covered in Question #3.

MEDICAID

Medicaid, unlike Medicare, is a program of health coverage for certain individuals with low incomes, in which eligibility and enrollment is administered on the state level of government. Because the Medicaid program is administered on a state lever, there are actually 50 different Medicaid programs. Eligibility requirements for Medicaid are much more strict that the requirements for Medicare. Specific requirements vary by state. Most states however require recipients to have less that $2,000 in liquid assets to qualify. Medicaid is also used to provide coverage for: children, pregnant women, and people with disabilities.

Medicaid is often used to provide funding for long-term care that is not covered by Medicare. However, Medicaid is geared to be a “last resort” to those with no other mean of paying necessary bills. In most cases patients do not have to pay any fees, however co-pays are sometimes required.

COVERAGE PROVIDED

Coverage for specific services vary from state to state. However, the federal government mandates the the following services be covered by Medicaid when necessary.

  • Nursing services
  • Family planning
  • X-rays
  • Laboratory services
  • Pediatric services
  • Hospitalization
  • Doctor services
  • Screening, diagnosis and treatment for those 21 and under
  • Clinic treatment

Eligibility for Medicare depends on age or disability only.

When are you eligible for Medicare? Can I receive benefits prior to the age of 65?

When am I Eligible for Medicare? Can I Receive Benefits Prior to Age 65?

Generally individuals must be 65 or older in order to be eligible for Medicare. However, in some circumstances individuals can receive benefits prior to the age of 65. If you have End-Stage Renal Disease (ESRD), Lou Gehrig’s Disease, or any other permanent disability, we advise you to call Social Security at 1-800-772-1213 or online at www.ssa.gov to check your eligibility.

What is Medicare Part A?

What is Medicare Part A?

Medicare Part A covers:

  • In-Patient Hospital Services, such as:
    • In-Patient Hospital stays
    • In-Patient skilled Nursing Facility stays
    • Home Health Care
    • Hospice Care

What is Medicare Part B and should I enroll in it?
What is Medicare Part B and Should I Enroll?

Medicare Part B covers:

  • Out-Patient Medical Services, such as:
    • Doctor Visits
    • Diagnostic Lab Tests
    • Preventative Care

Should you enroll in Part B?

  • It really depends on a number of different factors. (Are you working full time?) For thorough guidance, call FHK today and speak to a senior insurance advisor. If you are not automatically enrolled in Medicare, you can enroll by calling Social Security at the number above.

What is Medicare Part C? (Medicare Advantage, Medicare Choice)

What Is Medicare Part C and Should I Enroll? (Medicare Advantage, Medicare Choice)

Medicare Part C

Medicare Part C, also known as Medicare Advantage, is administered by private insurance companies that are contracted and approved by Medicare to cover both Part A and Part B benefits.

In most cases, Medicare Advantage is a lower-cost alternative to the Original Medicare Plan. These plans generally offer extra benefits, such as:

  • Preventative Care
  • Gym Memberships
  • Dental, Vision and Hearing
  • Most include Prescription Drug Coverage (Medicare Part D)

What is Medicare Part D? (Medicare Prescription Drug Programs)

What Is Medicare Part D? (Medicare Prescription Drug Programs)

  • Medicare Part D is Prescription Drug Coverage Insurance that is provided by private companies approved by Medicare.
  • Medicare Part D was designed to help people with Medicare to lower their Prescription Drug costs.
  • You may need to enroll in a Part D plan when you first become eligible for Medicare to avoid a late enrollment penalty (LEP).

What are my insurance options?

What Are My Insurance Options?

Insurance Options

Listed below are the insurance options offered.

What are the important Medicare dates I should know?
MEDICARE PART A

  • You will be enrolled into Medicare Part A automatically on the first day of the month you turn age 65.

MEDICARE PART B

  • Medicare Part B will generally start the same date as Part A. Note: If you are currently working you may not need Part B. Be sure to talk to your employer or an FHK professional before making any decision to voluntarily enroll in Part B.
  • When enrolling in Medicare Part B, your initial enrollment period creates a 7 month window which begins 3 months before your birthday, the month of, and 3 months after you first become eligible for Medicare Part B.
  • If you are eligible and do not enroll in Part B during this 7 month window (Initial Enrollment Period), your next opportunity will be during Medicare’s General Enrollment Period (January 1st – March 31st). Your Part B coverage will then start July 1st.
  • Delaying your enrollment in Medicare Part B could result in a Part B premium increase of 10% for each 12 month period following your Initial Enrollment Period. Note: If you are currently working you may not need Part B. Be sure to talk to your employer or an FHK professional before making any decision to voluntarily enroll in Part B of Medicare.

MEDICARE PART C & D

  • Enrollment in Medicare Part C and Part D is voluntary and must be done during specific Medicare enrollment dates.
  • Medicare Advantage generally includes Medicare Part D. These programs often follow the same enrollment guidelines which are as follows:
    • Initial Enrollment Period (IEP)
      This is a 7 month window to enroll in a Medicare Advantage Plan. This begins 3 months before, the month of, and 3 months after turning 65 or enrolling in Part B of Medicare.
    • Annual Enrollment Period (AEP)
      Medicare Enrollment Period for 2015 is October 15 – December 7th, 2014.
    • During Medicare’s AEP, consumers may choose to enroll in or change their existing Medicare Advantage and Prescription Drug Plan or return to original Medicare. Note: Coverage will begin January 1st, 2015.

MEDICARE ADVANTAGE DESENROLLMENT PERIOD (MADP)

  • January 1st – February 14th, 2015
  • During this time, you may elect to disenroll from your existing Medicare Advantage Plan and return to Original Medicare. This will also provide you with an opportunity to enroll in a stand-alone prescription drug plan.
  • Note: Coverage will begin the first day of the next month after you sign up. You may not change to another Medicare Advantage Plan; you can only go back to Original Medicare during this time period.
  • February 15th – October 14th, 2015
  • During this time period you will generally not be able to add, change, or drop Medicare Advantage or Prescription drug coverage. Your next opportunity is during Medicare’s AEP (October 15th – December 7th) unless you qualify for a Special Election which is determined by certain circumstances.
  • Examples of Special Election Periods (SEP’s) include but are not limited to:
    • Voluntary or involuntary loss of employer health benefits.
    • Loss of existing Medicare Advantage or Prescription Drug coverage due to moving outside plans service area.
    • Individuals with Medicare and Medicaid (Title 19).
    • Involuntary loss of creditable prescription drug coverage.
    • Upon entering a nursing home

Please note: Turning 65 or enrolling in Medicare Part B also provides you with an opportunity to enroll in Medicare Advantage and Prescription Drug plans outside Medicare’s Annual Enrollment Period (AEP).

Enrollment periods are determined by the Centers for Medicare and Medicaid Services (CMS). These periods are subject to change. If you have any other questions or thoughts,

How do I enroll in Medicare?
Part B of Medicare: Should I Enroll? If So How?

How do I know if I need to apply??

  • Some people may need to enroll online for Part B or Part A if:
    • You qualify because of End-Stage Renal Disease
    • You live to Puerto Rico and what to apply for Part B
    • You are not receiving Social Security or Railroad Retirement Board benefits

 

How to sign up:

In order to sign up and learn how to apply for Medicare in the Milwaukee area you will need to either call Social Security at 1-800-772-1213, visit your local office, or go online at www.ssa.gov to verify your eligibility.

What are the Medicare Premiums?
What Are the Medicare Premiums?

  • There are no Part A Medicare premiums.
  • For Medicare Part B, monthly Medicare premiums for most beneficiaries is $104.90 in 2015. In addition to the standard Part B premium, some beneficiaries will pay an income-related monthly adjustment amount

You can review these helpful Medicare Premium Charts, or give us a call at (414) 228-7555 or toll free (800) 262-3440. We’ll be happy to answer your questions and provide you with a free, no obligation quote.

Do I qualify for a Low Income Subsidy (LIS)?
Do I Qualify For a Low Income Subsidy (LIS)

In order to qualify for the Low Income Subsidy (LIS), beneficiaries must be enrolled in a Part D plan and their assets and income must be less than the limits that have been established.

Beneficiaries who qualify for a Low Income Subsidy (LIS) pay lower co-pays for their prescriptions and are exempt from falling into the coverage gap or what is also known as the “Doughnut Hole”.

Part D is administered by the Centers for Medicare and Medicaid Services (CMS), and it is the Social Security Administration (SSA) that determines whether or not an applicant seeking to qualify for an LIS is eligible.

Is Aurora in my Network? Is Froedtert accepted by my insurance plan? Does my insurance accept Columbia St Mary’s or Wheaton Franciscan?
We would have to look what you have now to make sure who is in what network. However, we have plans that include all of these Providers as in-network in the most cost efficient way.
What do all the dates and numbers mean on my Medicare card?
What Do All the Dates and Numbers Mean on My Medicare Card?

1)  Medicare’s 1-800 number on your card is the number you want to use to contact Medicare regarding any claims, expenses or medical records. Their customer service department is available to answer your call 24 hours a day, seven days a week.

 

2) The claim number on your medicare card includes a code. You may also find this code on any correspondence you receive from the Social Security office.

3) Here is where you will see what part(s) of Medicare you receive.

4) The effective date tells when your coverage begins for each plan.

If you have any further questions, please feel free to contact us or the Social Security Administration.

FHK Insurance offers a variety of Medicare Advantage Plans tailored to meet the needs of our greater Milwaukee area clients. FHK Insurance Services has been working with Part D since its inception in 2006. This gives us the understanding and resources to find the best fit for your individual needs.

Contact one of our experienced local agents for more Medicare Part D details at (414) 228-7555 or