Frequently asked medicare questions
Your questions, answered.
Medicare can be a complicated topic. We’ve got the answers to the most common questions we are asked.
You qualify for premium-free Medicare Part A when you reach the age of 65, are a US Citizen ( or legal permanent resident who has been in the US for at least the last 5 years), and if you or your spouse (deceased or alive) paid Medicare taxes for at least 10 years.
If you are already receiving Social Security, you will be enrolled automatically in the Medicare Parts A and B. You will receive your Medicare card in the mail about 3 months before your 65th birthday.
If you are not receiving Social Security, you will be enrolled automatically in Medicare Part A. But you will need to sign up for Medicare Part B. You can do this online at Social Security: SSA.gov; visit a local Social Security office or by calling 1-800-772-1213. You should do this about 3 months before 65th birthday.
If you are currently covered by a group plan, contact your plan administrator to find out whether you will need to sign up for Medicare Part B.
Medicare Part A is free for most people. If you paid into the system for 10 years (or your spouse), you would to have a premium for Part A.
For Medicare Part B, the premium for 2021 is $148.50/month. Most people will pay the standard premium. People with higher or lower income brackets may pay a different amount.
Medicare Supplement Plans or Medigap help pay some eligible expenses not paid by Medicare Part A & B. You are not restricted to use a network of healthcare providers. You can go directly to the physician and specialist you chose, meaning you do not need referrals. The plans are all Standardized and represented by letters A through N. A Plan G offered by one company has exactly the same benefits as a Plan G offered by another company.
Medicare Advantage Plans provide Part A, Part B, and typically Part D coverage. To enroll in a Medicare Advantage, you must be enrolled in original Medicare Part A and Part B.
Medicare Advantage Plans are part of the federal Medicare program and offered through private insurers. The type of plans is offered in our area are mainly HMO’s and PPO’s.
With a Medicare Advantage Plan, you may pay a deductible, but typically have fixed copays for routine doctor’s office visits. These plans have yearly limits on out of pocket costs, after which you pay nothing for the remainder of the year.
No. Each Medicare Advantage plan is different. Although all Medicare Advantage plans must cover at least the Medicare “Medically-Necessary Services,” Medicare Advantage Plans can charge different deductibles, offer co-payments (for instance $30 per office visit) or various co-insurance terms (such as 20 percent of procedure cost). Some Medicare Advantage plans have a limit on how much you can spend in a year. Medicare Advantage plans may also offer additional services such as eye care, dental care, and fitness programs.
What is the difference between out of area costs for HMO plans vs. PPO plans?
If HMO plan members go outside of the network, you will pay for the full cost for the care received. The plan will not pay for the service unless it is urgent/emergency care. For PPO plan members you will pay the out of network cost share. Refer to your evidence of coverage.
Medicare Supplement or Medigap plan do not have networks. Medicare Advantage Plans have a network (HMO’s or PPO’s).
Medigap Plans typically have higher premiums, but fewer out of pocket costs than Advantage plans. Medigap plans are “guaranteed renewable”. Medigap plans can never be cancelled. Medicare Advantage plans are renewable on a annual basis. Benefits, networks and copays can change with this plan. Some Medicare Advantage plans offer extra benefits such as dental, vision, hearing and gym memberships.
You may owe a late enrollment penalty if you go without a Medicare Prescription Drug plan (Part D), or without a Medicare Advantage plan (Part C, like an HMO or PPO) or other Medicare Health plan that offers Medicare Prescription Drug coverage, or without credible prescription drug coverage for any continuous period 63 days or more after your Initial Enrollment Period is over.
The Annual Enrollment Period (AEP) for Medicare starts October 15th and continues through December 7th. During this time, you can make changes to your current health coverage. Changes will go into effect January 1st.
In addition, you can:
- You can enroll in a Medicare Advantage Plan for the first time.
- You can switch from one Medicare Advantage plan to another.
- You can change from Medicare Advantage plan to Original Medicare.
- You can enroll in a Prescription Drug plan for the first time.
- You can change Prescription Drug plans.
- You can do nothing and keep your existing plans.
Outside of AEP, there are a few other opportunities to enroll or disenroll in a Medicare plan.
- Initial Enrollment Period (IEP): This is a window of time that starts three months before your 65th birthday and continues for 3 months after your birthday.
- Special Enrollment Period (SEP): Available when life changes or special circumstances occur outside AEP that results in needing to change your current health plan.
- Open Enrollment Period (OEP): Medicare eligible persons can make “like plan” changes from January 1 – March 31. During this 3-month window, you can add or drop Part D coverage, or disenroll from a plan.
Yes, we have several plans that cover Dental, Vision, and Hearing. They not only cover preventive services, but also fillings, extractions, bridges, crowns, full or partial dentures, root canals and much more!
No, there is no fee. You pay exactly the same rate for your Medicare plan if you use us to help you find a plan. You pay ABSOLUTELY NOTHING for our help.
Eagan Advisor Group is an independent Medicare insurance broker. This means that we work with many different companies, so that we can provide you with the best Medicare plan that fits your needs. We work for you instead of offering just one companies insures products.
Yes! Jeff and his team are independent agents representing over 30 top rated companies. Let us shop around to find you the best coverage at the lowest price.
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