Clients count on their agents to answer Medicare insurance questions. Can they count on you? Although it’s reasonable to require a little time so you can research complex and unique situations and get back with an accurate response, when it comes to the most common questions, it’s good to have your answers ready to go.
Do you know the answers to the following questions? If not, study up!
Question: When do I need to enroll in Medicare?
Answer: You become eligible for Medicare when you turn 65, and the initial enrollment covers the seven months around your 65th birthday. That includes your birthday month, the three months before your birthday month, and the three months after. People who receive a qualifying health plan through an employer can delay Medicare but must enroll once the employment or coverage ends, even if COBRA is available. Be careful. Missing a deadline results in hefty lifetime penalties. Learn more about Medicare enrollment deadlines here.
Question: Can I enroll in a health plan from the ACA marketplace exchange instead of Medicare?
Answer: No. People who are eligible for Medicare are not supposed to buy insurance on the ACA marketplace, and those who enroll in an ACA plan instead of Medicare will be subject to the lifetime late enrollment penalty.
Many people did not realize this and signed for ACA coverage. Due to the confusion, CMS has offered to waive the late penalty for some individuals who enrolled in Medicare A and an ACA plan. The original deadline to apply for a waiver was September 30, 2017, but CMS has extended the deadline to September 30, 2018. Learn more about the equitable relief program here.
Question: What is the difference between different types of Medicare?
Answer: The term “Medicare” can refer to a number of different plan types.
- Medicare Part A: This covers hospital services, including hospital care, nursing facility care, nursing home care, hospice and home health services.
- Medicare Part B: This provides most of your medical care and doctor visits, including services needed to diagnose, treat and prevent medical conditions.
- Medicare Part D: This provides your prescription drug coverage.
- Medicare Part C: This is also called Medicare Advantage. It refers to Medicare plans offered by private insurance companies. It generally includes coverage otherwise offered through Medicare Parts A, B and D. It may also include other types of coverage.
- Original Medicare: This refers to Medicare Parts A and B.
- Medigap: This refers to supplemental Medicare policies offered by private companies. They are used in combination with Original Medicare and can help pay for copayments, deductibles and other costs.
Question: What is the Medicare prescription donut hole?
Answer: The so-called donut hole refers to a coverage gap experienced by some people enrolled in Medicare prescription drug plans. People are in the donut hole after they reach their spending limit and before they reach their out-of-pocket limit. During this time, they will have to pay a higher price for prescriptions.
Under the ACA, certain steps were taken to reduce the financial hardship that the donut hole can cause, including rebates, discounts and closing the coverage gap by 2020.
Question: How can I switch to a different Medicare plan?
Answer: You can switch your Medicare plan during the Annual Open Enrollment period, which starts on October 15 and ends on December 7. During this time, people enrolled in Original Medicare can pick a Medicare Advantage plan, and people enrolled in Medicare Advantage can pick a new plan or switch to Original Medicare. Medicare enrollees can also pick a new Medicare Part D plan. Learn more about Open Enrollment here.