You are eligible to receive Medicare Benefits once you turn 65 years old. You can first sign up for Original Medicare during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month 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.

Read more about eligibility here: medicareondemand.com/medicare-eligibility

Disability eligibility for Medicare depends on how long you have received Social Security Disability Insurance (SSDI) payments. If you receive SSDI payments for two years you will be automatically enrolled in Medicare Part A and Part B. Individuals who have Amyotrophic Lateral Sclerosis (ALS) do not have to wait and are eligible for Medicare immediately after collecting SSDI, while people with end-stage renal disease (ESRD) are eligible for Medicare three months after beginning dialysis treatment or immediately after receiving a kidney transplant.

To see if you’re eligible go here: www.medicare.gov/eligibilitypremiumcalc/#eligibility

You don’t need to sign up for Medicare each year. However, you should review your Medicare health and prescription drug coverage and make changes if it no longer meets your needs or if you could lower your out-of-pocket expenses.

There are four basic parts of Medicare:

Part A – covers inpatient and hospital care.

Part B – covers outpatient, doctor services, and other non-hospital care.

Part C – The section of Medicare that allows private insurers to offer “Medicare Advantage” plans, which must cover everything Original Medicare (Part A + Part B) covers, usually with additional benefits, often including drug coverage.

Part D – Prescription drug coverage – private insurers offer additional prescription drug coverage for additional monthly premiums.

For a more in-depth look at the parts of Medicare, visit our “Medicare ABCs” by going here: medicareondemand.com/medicare-basics

Medicare isn’t free. Most receive Part A for free after paying into Medicare through income taxes over the course of time, but Part B still carries a monthly premium ($170.10 in 2022). Additionally, you may need to pay for out-of-pocket costs like the deductible, copayments and coinsurance, prescription drug coverage, and any late-enrollment penalties.

Read more by going here medicareondemand.com/medicare-basics

Medicare doesn’t cover everything. It does not cover things like long-term care, vision, dental, hearing, personal care services, non-medically necessary services, and more.

Find out more by going here: medicareondemand.com/medicare-basics

No, Medicare only covers beneficiaries who are 65 years old, and it only covers beneficiaries on an individual basis.

Most of the time, No. There may be specific rare circumstances, such as the loss of continuing coverage, that may result in Special Enrollment Periods where you will not be penalized for late enrollment. Otherwise, penalties must be paid to keep your Medicare coverage.

If you have to pay an extra amount and you disagree (for example, you have a life event that lowers your income), visit socialsecurity.gov or call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

If you get Social Security or Railroad Retirement Board (RRB) benefits, your Medicare Part B (Medical Insurance) premium will be deducted from your benefit payment.

If you’re a federal retiree with an annuity from OPM and not entitled to RRB or SSA benefits, you may request to have your Part B premiums deducted from your annuity. Call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) to make your request.

If you don’t get these benefit payments, you’ll get a bill. If you choose to buy Medicare Part A (Hospital Insurance), you’ll always get a bill for your premium. There are 4 ways to pay these bills:

  1. Pay by check or money order. Write your Medicare Number on your payment, and mail it with your payment coupon to: Medicare Premium Collection Center P.O. Box 790355 St. Louis, MO 63179-0355
  2. Pay by credit/debit card. To do this, complete the bottom portion of the payment coupon on your Medicare Premium Bill, and mail it to the address above. Payments submitted without the bottom portion of the payment coupon may not be processed.
  3. Sign up for Medicare Easy Pay. This is a free service that automatically deducts your premium payments from your savings or checking account each month. Visit Medicare.gov and search for “Easy Pay,” or call 1-800-MEDICARE to find out how to sign up.
  4. Use your financial institution’s Online Bill Payment service. Electronic online bill payments are a secure and fast way to make your payment from checking or savings account. Ask your financial institution if it allows customers to pay bills online. Not all financial institutions offer this service and may charge a fee. You’ll need to give your financial institution information:
    1. Account number: This is your Medicare Number. It’s important that you use the exact number on your red, white, and blue Medicare card, but without the dashes.
    2. Biller name: CMS Medicare Insurance
    3. Remittance address: Medicare Premium Collection Center P.O. Box 790355 St. Louis, MO 63179-0355

Note to RRB Annuitants: If you get a bill from the RRB, mail your premium payments to:  RRB Medicare Premium Payments P.O. Box 979024 St. Louis, MO 63197-900024

If you have questions about your premiums, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). If you need to change your address on your bill, call Social Security at 1-800-772-1213 (TTY -800-325-0778). If your bills are from the RRB, call 1-877-772-5772 (TTY 1-312-751-4701).

If you’d like more information about paying your Medicare premiums, visit Medicare.gov to view the brochure “Understanding the Medicare Premium Bill Form (CMS-500).”

If you need to replace your card because it’s damaged or lost, sign in to your MyMedicare.gov account to print an official copy of your Medicare card. If you don’t have an account, visit MyMedicare.gov to create one. If you need to replace your card because you think that someone else is using your number, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Most U.S. doctors accept Medicare. To find a list of doctors in your area who accept Medicare and it’s required pricing for procedures, go to Medicare’s Physician Compare tool (www.medicare.gov/physiciancompare) and look to see if your doctor “Accepts Medicare Assignment.” You can also call 1-800-MEDICARE (1-800-633-4227, TTY users call 1-877-486-2048), or call your doctor’s office and ask before you schedule an appointment.

First, try and find out why it was denied. Sometimes coding errors result in denials your doctor can correct, then resubmit. If you have supplemental insurance Medicare may cover an expense but did not correctly submit the claim to your insurer. Drug coverage claims can be denied if you don’t follow procedures for step therapy, prior authorization, and other formulary issues. You may be able to reverse that denial by resubmitting forms. If none of these steps work, there is an appeals process that you can initiate within 120 days of the claim denial (60 days for Medicare Advantage and Part D plans). Consult your Medicare Summary Notice and Explanation of Benefits for details, and visit www.medicare.gov for more info about the appeal process. Your State Health Insurance Assistance Program can also help appealing a claim denial (www.shiptacenter.org), as can the Medicare Rights Center (www.medicarerights.org; 800-333-4114). You should also consult the Center for Medicare Advocacy’s appeal self-help packet (www.medicareadvocacy.org).

During the first year of joining Medicare Part B beneficiaries are eligible for what’s known as a “Welcome to Medicare” visit. You should complete a Health Risk Assessment questionnaire about your health status to help inform the plan you develop with your doctor to keep you as healthy as can be. This visit also ensures you get the right medical care, preventive/screening services, medicines, and self-care support. After your first year, you can schedule what’s known as an “Annual Wellness Visit” where your doctor will check core health factors (blood pressure, weight, height, body-mass index, etc.) and review your medicines and treatments. You are not charged for these visits, they are completely covered by Medicare (meaning no deductible charges, copays, or coinsurance). The only costs you may be responsible for are any other services that may be combined with your visit (for instance, treatment for high blood pressure proscribed by your doctor after checking your blood pressure).

Long-term care (sometimes called “long-term services and supports”) includes non-medical care for people who have a chronic illness or disability. This includes non-skilled personal care assistance, like help with everyday activities, including dressing, bathing, using the bathroom, home-delivered meals, adult day healthcare, and other services. Medicare and most health insurance plans, including Medicare Supplement Insurance (Medigap) policies, don’t pay for this type of care, sometimes called “custodial care.” You may be eligible for this type of care through Medicaid, or you can choose to buy private long-term care insurance.

Use these resources to get more information about long-term care:

  • Visit longtermcare.acl.gov to learn more about planning for long-term care. Call your State Insurance Department to get information about long-term care insurance. Visit www.medicare.gov/contacts/#resources/sids, or call 1-800-MEDICARE (1-800-633-4227, TTY1-877-486-2048) to get the phone number.
  • Call your Medicaid office (State Medical Assistance Office) and ask for information about long-term care coverage. To get the phone number for your state, visit www.medicare.gov/contacts. You can also call 1-800-MEDICARE (1-800-633-4227, TTY1-877-486-2048).
  • Get a copy of “A Shopper’s Guide to Long-Term Care Insurance” from the National Association of Insurance Commissioners at naic.org/documents/prod_serv_consumer_ltc_lp.pdf.
  • Call your State Health Insurance Assistance Program (SHIP) by going here: www.shiptacenter.org and using the SHIP Locator to find your local SHIP’s telephone information.
  • Visit the Eldercare Locator, a public service of the U.S. Administration on Aging, at eldercare.acl.gov/Public/Index.aspx to find help in your community.

Medicare has very specific rules for what it will cover. There are several resources available to see if Medicare will cover your test, item, or service:

  • Medicare’s Online Coverage Search Tool: www.medicare.gov/coverage.
  • Find out what’s covered by using Medicare’s “What’s covered” mobile app. You can download it for free on both the App Store and Google Play. www.medicare.gov/blog/whats-covered-mobile-app.
  • The “Medicare & You” handbook published annually includes important information about Medicare coverage. You can request a paper copy by calling 1-800-MEDICARE (TTY 877-486-2048) or download a copy at www.medicare.gov/Pubs/pdf/10050-medicare-and-you.pdf.
  • If you have private Medicare Advantage health plan you should call your plan carrier directly with coverage questions. You can usually find their phone number on your MA insurance card.
  • If you have Original Medicare, you can also call Medicare at 1-800-MEDICARE (800-633-4227, TTY 877-486-2048) with any questions.

For Medicare Advantage plans, No. Each Medicare Advantage plan must charge the same premiums for all beneficiaries, and cannot vary premiums based on age, smoking history, gender, or pre-existing medical conditions.

For Part D Prescription Drug Plans, No. Part D plan premiums cannot vary depending on your health status, pre-existing conditions, or smoking. The monthly premium that any specific Part D plan charges is the same for all beneficiaries.

For Medigap plans, it varies. If you apply for a Medigap plan during your Medigap Open Enrollment Period, then, you are have the right to purchase any Medigap plan at the same premium the offered to other beneficiaries your age, regardless of your past or current health problems. Some plans have a waiting period (up to six months) before covering a pre-existing condition, and some can offer “discounts” for non-smokers. If you apply for a Medigap plan after your Medigap Open Enrollment Period, then usually private insurers can apply medical underwriting to your application and may reject your application based on a health condition, or charge a higher premium. In some cases, insurers cannot underwrite applications for Medigap plans if you miss the Medigap Open Enrollment Period, and some states limit or prohibit underwriting. Call your State Health Insurance Assistance Program (SHIP) about your Medigap rights and protections by going here: www.shiptacenter.org and using the SHIP Locator to find your local SHIP’s telephone information.

First, contact your doctor’s office and ask if they accept your specific plan. Second, you can contact your Medicare Advantage plan carrier, either on their website or by calling them on the phone, to find out which doctors accept the Medicare Advantage plan you’re enrolled in.

If the Medicare Advantage plan you are currently enrolled in won’t be offered next year you have two choices: choose another MA plan or be enrolled, by default, in Original Medicare.

If you lose your MA plan and stay with Original Medicare, you will not receive extra help with your Part D costs, and you will need a Part D prescription drug plan if you need drug coverage, (unless you have drug coverage from another source such as the VA or from your former employer/union).

If you want to stay enrolled in a Medicare Advantage plan, you can compare options and enroll in a new plan during the Annual Enrollment Period (AEP) (Oct 15th– Dec 7th). You will also usually qualify for a Special Enrollment Period (SEP) when your plan is discontinued. Finally, during the Medicare Advantage Open Enrollment (Jan 1st – Mar 31st) you may join a different MA plan.

No, Medicare Advantage Plans listed at $0 are not free. Rather, the $0 amount refers to no additional cost amount other than the standard Part B Premium ($170.10 in 2022). Even with a $0 MA Plan, you will still have to pay this premium amount ever month. Private insurance companies can offer this no additional cost premium because they enter contracts with networks of hospitals and physicians, as well as cover preventive and disease management care, to keep costs down. You still will have copayments and deductibles with a MA Plan.

Health Maintenance Organizations and Preferred Provider Organizations mainly differ in network size, costs, specialist referral processes, and coverage for out-of-network services. Generally, HMOs are less flexible but have overall lower costs, while PPOs are more flexible but carry higher premiums and deductibles.

See more about HMOs vs. PPOs here: medicareondemand.com/medicare-part-c

No. Drug coverage from the VA (Veterans Affairs) is considered creditable prescription drug coverage, meaning the coverage is at minimum equal to what Medicare drug plans provide, so you do not need to enroll in a Part D plan. Other sources of creditable drug coverage include:

  • The Federal Employee Health Benefits (FEHB) program
  • TRICARE (military health benefits)
  • Indian Health Services (IHS).

Beneficiaries with creditable coverage should receive a notice from their coverage provider confirming your coverages is creditable. Keep this notice in case you need proof that you had creditable coverage if you later decide you want Part D prescription drug coverage.

If you have employer or union coverage, call your benefits administrator before you make any changes or sign up for any other coverage. Signing up for other coverage could cause you to lose your employer or union health and drug coverage for you and your dependents. If you lose your employer or union coverage, you may not be able to get it back. If you want to know how Medicare prescription drug coverage works with other coverage you may have, read more here: www.medicare.gov/drug-coverage-part-d/how-part-d-works-with-other-insurance

If your current Part D drug plan will not be offered next year, you can enroll in a new plan. Whenever a plan is discontinued, beneficiaries enrolled in that plan will qualify for a Special Enrollment Period (SEP) that gives you time to enroll in a new plan. If your plan is not being renewed next year, you have from the first day (Oct 15th) of the Annual Enrollment Period (AEP) through the end of February of the following year to pick a new plan.

You are not alone, many individuals on Medicare cannot afford their prescription drug costs.

For more on help paying, including Medicare’s “Extra Help” program, go here: medicareondemand.com/get-help-paying

Well, sort of. The “Donut Hole,” the colloquialism that describes the coverage gap after reaching the end of your Initial Coverage Limit and before your Out-of-Pocket Limit, was substantially altered but beneficiaries must still pay a standard 25% copay on drugs in that coverage gap. Generic drug beneficiary cost-sharing has been decreasing since 2011 due to provisions in the Affordable Care Act (the ACA – also known as Obamacare) and was set to be 25% in 2020 beyond. In 2018, President Trump signed the Bipartisan Budget Act of 2019 that “closed” the Coverage Gap for brand-name drugs, with beneficiary cost-sharing decreasing to 25% in 2019 (one year earlier than planned).  So, the “Donut hole” still exists for beneficiaries that cross the 2022 $4,430 initial coverage period limit, they will enter a coverage gap where they must pay 25% of prescription drug costs, regardless of type or price of the drug. You remain in this Part D donut hole coverage gap until you have paid $7,050 in out-of-pocket costs for covered drugs in 2022. You then enter the catastrophic coverage phase. So, while the gap between cost-sharing discrepancies may have closed there is still a gap in coverage between your Initial Coverage Limit and your Out-of-Pocket Limit.

Medicare Supplements policies, also called ‘Medigap’ policies, help cover costs Original Medicare (Part A + Part B) don’t cover, including copayments, coinsurance, and deductibles. Supplement plans require an additional monthly premium in addition to Part A and/or Part B premiums, are generally more flexible for out-of-network coverage restrictions carried by MA Plans. Medigap plans do not cover prescription drugs.

Read more about Medigap plans here: medicareondemand.com/medigap

Prior to January 1st, 2020, Medigap plans C and F were options for covering your Part B deductible with a Medicare Supplement. After this date Medigap policies can no longer offer coverage for the Part B deductible. If you signed up for a Plan C or Plan F prior to 2020 can keep their Medigap plan. However, premiums may rise significantly over time as no new enrollees are permitted.

For a full breakdown of all available Medigap plans read more here: medicareondemand.com/medigap

Yes! Many folks who qualify for Medicare also qualify for Medicaid, known in the business as “dual-eligibles.” Medicaid can help pay for what Medicare doesn’t.

To learn more, visit this page: medicareondemand.com/medicare-vs-medicaid

It depends on what plan you have. If you have Original Medicare, as well as Original Medicare plus a Medigap policy, you will be covered in a new city if your healthcare providers accept Medicare and perform Medicare approved procedures for approved prices. If you have a Medicare Advantage plan, you may not be able to receive coverage, depending on whether your plan is a MA HMO, PPO, PFFS or HMO-POS. Generally, MA plans have networks that are specific to a particular location. Contact your plan administrator to see if your coverage travels with you outside your current service area. You may have to wait until the Annual Enrollment Period (AEP) or MA Open Enrollment Period (OEP) to change plans.

If you have Medicare, you should keep it. It is illegal for insurance companies to sell you Marketplace plans if they know you are covered by Medicare. If you drop Medicare and re-enroll later, you can only re-enroll during the Medicare General Enrollment Period (GEP) from Jan 1st – March 31st. As a result, your coverage would not begin until July of that year, meaning that there would be a significant a gap in coverage. You could additionally face a penalty for late enrollment in Medicare Part B and Part D.

Even if you have Marketplace coverage, you should enroll in Medicare when you’re first eligible to avoid the risk of a delay in Medicare coverage and the any late enrollment penalty. It’s important to end your Marketplace coverage in a timely manner to avoid an overlap in coverage. Once you’re eligible for, or enrolled in, Part A, you won’t qualify for help through the Marketplace. If you continue to get help paying your Marketplace plan premium after you have Medicare, you may have to pay it back when you file your taxes. Visit HealthCare.gov to connect to the Marketplace in your state and learn more. You can also find out how to end your Marketplace plan or Marketplace financial help when your Medicare enrollment begins. You can also call the Marketplace Call Center at 1-800-318-2596 (TTY 1-855-889-4325.)

When you have other insurance and Medicare, there are rules for whether Medicare or your other insurance pays first.

  • If you have retiree insurance (insurance from your or your spouse’s former employment), Medicare pays first.
  • If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has 20 or more employees, your group health plan pays first.
  • If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has fewer than 20 employees, Medicare pays first.
  • If you’re under 65 and have a disability, have group health plan coverage based on your or a family member’s current employment, and the employer has 100 or more employees, your group health plan pays first.
  • If you’re under 65 and have a disability, have group health plan coverage based on your or a family member’s current employment, and the employer has fewer than 100 employees, Medicare pays first.
  • If you have Medicare because of End-Stage Renal Disease (ESRD), your group health plan will pay first for the first 30 months after you become eligible to enroll in Medicare. Medicare will pay first after this 30-month period.
  • If you have Medicaid, Medicare pays first.

Here are some important facts to remember about how other insurance works with Medicare covered services:

  • The insurance that pays first (primary payer) pays up to the limits of its coverage.
  • The insurance that pays second (secondary payer) only pays if there are costs the primary insurer didn’t cover.
  • The secondary payer (which may be Medicare) might not pay all of the uncovered costs.
  • If your employer insurance is the secondary payer, you might need to enroll in Part B before your insurance will pay.
  • For more information, visit www.medicare.gov/pub/popular-medicare-publications to view the booklet “Medicare & Other Health Benefits: Your Guide to Who Pays First.” You can also call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).
  • If you have other insurance or changes to your insurance, you need to let Medicare know by calling Medicare’s Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY 1-855-797-2627).

COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, retiree health plans, VA coverage, and individual health coverage (like through the Health Insurance Marketplace) aren’t considered coverage based on current employment. You aren’t eligible for a Special Enrollment Period to sign up for Medicare when that coverage ends. To avoid paying a higher premium, make sure you sign up for Medicare when you’re first eligible.

If you have TRICARE (healthcare program for active-duty and retired service members and their families), you generally must enroll in Part A and Part B when you’re first eligible to keep your TRICARE coverage. However, if you’re an active-duty service member or an active-duty family member, you don’t have to enroll in Part B to keep your TRICARE coverage. For more information contact TRICARE for Life (TFL) (Call: 1-866-773-0404, TTY: 1-866-773-0405, Online: tricare.mil/tfl)  and the TRICARE Pharmacy Program (Call: 1-877-363-1303, TTY: 1-877-540-6261, Online: tricare.mil/pharmacy) If you have CHAMPVA coverage, you must enroll in Part A and Part B to keep it. Call 1-800-733-8387 for more information about CHAMPVA.

You can’t contribute to your HSA once your Medicare coverage begins. However, you may use money that’s already in your HSA after you enroll in Medicare to help pay for deductibles, premiums (if you’re billed directly), copayments, or coinsurance. If you or your employer contribute to your HSA after your Medicare coverage starts, you may have to pay a tax penalty. To avoid a tax penalty, you should stop contributing to your HSA at least 6 months before you apply for Medicare. If you’d like to continue contributing to your employer-sponsored HSA without penalty after you turn 65, you shouldn’t apply for Medicare, Social Security, or Railroad Retirement Board (RRB) benefits.

SHIPs are state programs that get money from the federal government to give local health insurance counseling to people with Medicare at no cost to you. SHIPs aren’t connected to any insurance company or health plan. SHIP staff and trained volunteers work hard to help you with these Medicare questions:

  • Your Medicare rights.
  • Billing problems.
  • Complaints about your medical care or treatment.
  • Plan comparison and enrollment.
  • How Medicare works with other insurance.
  • Finding help paying for healthcare costs.

You can call your State Health Insurance Assistance Program (SHIP) by going here: www.shiptacenter.org and using the SHIP Locator to find your local SHIP’s telephone information.