Frequently Asked Medicare Questions and Answers
Medicare can be confusing and completely overwhelming! We are here to help!
What is Original Medicare?
The term “Original Medicare” refers to Medicare Part A and Part B. Part A helps cover the cost of hospital-related care, including inpatient services, lab tests and surgery. Part B is the medical insurance component of Medicare, which helps cover doctor visits, outpatient care and certain preventive services. Both Part A and Part B are administered by the federal government.
Will I pay a premium for Part A or Part B?
Most people do not have to pay a premium for Part A as long as they or their spouse paid Medicare taxes for at least 10 years while they were working.
There is also no premium for Part A if:
You're receiving Social Security or Railroad Retirement Board (RRB), opens new window benefits at the time you enroll. You’ve received disability benefits for at least 24 months.
There is a monthly premium for Part B, which is deducted from your Social Security or, for those who receive them, from their RRB benefits. For 2022, the standard premium for Part B coverage is $170.10 or higher, depending on your income.
When do I enroll in Medicare?
Initial Enrollment Period, which begins 3 months before your 65th birthday and ends 3 months after your 65th birthday.
What is supplemental Medicare coverage?
Medicare Supplement insurance, often called Medigap coverage, helps pay some of the healthcare costs that Original Medicare does not cover. That may include: Copayments, Coinsurance, Deductibles, Medical care when you travel outside the U.S.
You will pay a monthly premium for a Medicare Supplement plan in addition to your Part B premiums. Medicare Supplement plans are not available with Medicare Advantage plans.
Are there any other costs for Original Medicare?
In addition to premiums, plan members are also responsible for paying a deductible and coinsurance with Original Medicare. The 2022 deductible for inpatient hospital stays is $1,556 per benefit period. The annual deductible for Part B is $233. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services.
When do I become eligible for Medicare?
Most people become eligible for Medicare when they turn 65. If you are 65 or older, then you are eligible.
Some younger people are eligible, including those with disabilities, permanent kidney failure, or Lou Gehrig’s disease.
Do I need to sign up for Medicare when I turn 65?
Not necessarily. If you are still working and job-based health insurance through your (or your spouse’s) current job and it is affordable or your company is paying for it then no you do not.
If your employer has less than 20 employees: You do have to sign up for Medicare when you become first eligible
If you have COBRA coverage: You need to sign up for Medicare when you become first eligible to avoid and gaps in coverage and to avoid a Part B late enrollment penalty
Can I get Medicare with a pre-existing condition?
Yes, even with a preexisting condition, you can enroll in Original Medicare or a Medicare Advantage plan as long as you sign up for coverage during your initial enrollment period. This is the 7-month window that starts 3 months before your birth month and continues through the 3 months after your birth month in the year you turn 65.
What is a Medicare Advantage plan?
Medicare Advantage plans are offered by private insurance companies—like Humana—contracted by the federal government. Medicare Advantage, also referred to as Medicare Part C, covers the same healthcare services as Original Medicare, with the exception of hospice care. Many Medicare Advantage plans also include prescription drug coverage.
Are prescription drugs covered by Medicare?
There are 2 ways to get Medicare prescription drug coverage:
You can choose a Medicare Advantage plan that includes prescription drug coverage (these are called Medicare Advantage prescription drug plans)
You can purchase a stand-alone prescription drug plan—called Part D—to add to your Original Medicare
Your out-of-pocket costs for prescription drug deductibles, copays and coinsurance vary from plan to plan. Be sure to check each plan’s Drug List (list of covered drugs) to see what drugs are covered.
With Original Medicare, a primary care doctor is not required. You can visit any doctor who accepts Medicare.
With a Medicare Advantage plan, your choice of doctor depends on whether you select a health maintenance organization (HMO) or preferred provider organization (PPO) plan.
With an HMO plan, you can choose your primary care physician from any doctor in the plan's network. If you opt for a PPO plan, generally, choosing a primary care physician is optional. With both types of plans, you will usually save money by visiting a network provider.
It’s important to note that Medicare Advantage plans must offer emergency coverage outside of the plan's service area, anywhere in the U.S.
How much does Medicare Advantage cost?
With Medicare Advantage plans, instead of paying your healthcare bills directly, the federal government pays private insurance companies to administer your coverage.
While there is a monthly premium for Medicare Advantage plans, many private insurance companies choose to offer affordable or $0 plan premiums to compete for your business. They also set the guidelines for your deductible, coinsurance, and copays. This information is readily available on private insurers’ websites, or you can make an appointment with a licensed Humana sales agent to learn the details.
As with Original Medicare members, Medicare Advantage members must continue to pay their Part B premium.
Does Medicare cover dental, vision, or hearing care?
Original Medicare (Parts A & B) does not cover dental, vision, or hearing care. These types of coverage can be purchased in addition to your Original Medicare plan, or you may bundle these coverages in a Medicare Advantage plan.
How much do we charge for our service?
There is never a charge for our service. We are compensated by the carrier of the policy that you enroll in to. We will assist you in finding the right Medicare plan that works best for you.
Can you help me enroll in a plan?
Absolutely, we help you find the Medicare plan that best suits your needs and budget. We will do all the enrolling online with you.
We are now your Medicare advisor and will make sure you get everything you need to feel comfortable and confident in your Medicare decisions.
You will pay a monthly premium for a Medicare Supplement plan in addition to your Part B premiums. Medicare Supplement plans are not available with Medicare Advantage plans.