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Medicare Q & A

You’ve got questions, and we have answers.

We understand that many people struggle with Medicare setup, and for your convenience, we’ve created a list of the most frequently asked Medicare questions we get from our clients.

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Medicare is the federal health insurance program for:

  • Most people age 65 and over.
  • People under the age of 65 with certain disabilities.
  • 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.

Medicare is a federal health insurance program designed for people age 65 and older or people with certain disabilities. The main focus of this program is to provide support for 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 for the elderly. It is geared toward recipients that pay into Medicare through taxes or payroll and is available regardless of income.

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.

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 optional out-of-pocket add-on to 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.

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

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 at 414-228-7555 and speak to a senior insurance adviser.
  • If you are not automatically enrolled in Medicare, you can enroll by calling Social Security at 1-800-772-1213.

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)
  • 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).

Some people may need to enroll online for Part B or Part A if:

  • You qualify because of End-Stage Renal Disease
  • You live in Puerto Rico and want 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.

  • There is no Part A Medicare premium.
  • For Medicare Part B, monthly Medicare premiums vary by year. 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.

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 on 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) – This is October 15th through December 7th each year. During this period, consumers may choose to enroll in or change their existing Medicare Advantage and Prescription Drug Plan or return to original Medicare.

Medicare Advantage Dis-enrollment Period (MADP)

  • MADP is January 1st through February 14th each year. 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.
  • After February 14th, you will generally not be able to add, change, or drop Medicare Advantage or Prescription drug coverage until Medicare’s Annual Enrollment Period (AEP) unless you qualify for a Special Election which is determined by certain circumstances.
  • Examples of Special Election Periods (SEPs) 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.

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.

While Medicare and Medicaid sound similar, they are in fact very different programs. Each program has a different set of eligibility requirements and provides 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.

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Medicaid, unlike Medicare, is a program of health coverage for certain individuals with low incomes, in which eligibility and enrollment is administered at the state level of government. Because the Medicaid program is administered on a state level, there are actually 50 different Medicaid programs. Eligibility requirements for Medicaid are much more strict than the requirements for Medicare. Specific requirements vary by state. Most states, however, require recipients to have less than $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 means of paying necessary bills. In most cases patients do not have to pay any fees, however, co-pays are sometimes required.

Coverage for specific services varies from state to state. However, the federal government mandates 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.

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 a LIS is eligible.

We would have to look at 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.

If you don’t see your question, simply click here and ask us directly!

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 click on the button below.