#ask free medical questions
Answers to your most common Medicare questions
QUESTION: How much will Medicare cost me this year?
ANSWER: That depends and some of those costs are still unknown, especially if you get Original Medicare provided directly by the federal government.
However, most people don’t pay a monthly premium for Medicare Part A. which is hospital insurance, because they or their spouse has paid Medicare taxes while working. In fact, this is sometimes called “premium-free Part A.” However, if you or your spouse worked and paid Medicare taxes for fewer than 7 1/2 years, there is a premium. That hasn’t been set yet for 2016, but in 2015, Part A cost those beneficiaries $407 each month.
Those younger than 65 are eligible for premium-free Part A if they have gotten Social Security or Railroad Retirement Board disability benefits for 24 months, or have End-Stage Renal Disease (ESRD).
Most people pay the Part B premium. That cost $104.90 each month in 2015 for most people, but the cost was higher for an individual who made more than $85,000 or a couple that made more than $170,000. That cost most likely will increase in 2016, though it’s not clear by how much. Additionally, there was a $147 per year deductible for Part B in 2015. After the deductible, consumers typically pay 20% of the Medicare-approved amount for most doctor services. outpatient therapy, and durable medical equipment.
You can also pay for a Medigap policy, provided through a private insurer, that will help cover costs not covered in Parts A and B. Costs vary depending on your plan and possibly your age.
Another option is to purchase an Advantage plan. Like Medigap, it is provided through a private insurer. Unlike Medigap, it’s a managed care that includes the same benefits as Parts A and B and offers extras, such as gym memberships and, very often, drug plans.
Finally, if you have an Advantage plan without drug coverage or you need a drug plan to add to your Original Medicare, there is a Part D plan you can purchase. Like Medigap and Advantage, the plans are provided through private insurers and costs vary depending on the drugs you use, whether you go to a pharmacy in your plan’s network, whether the drugs you use are on your plan’s covered drug lists, and whether you get Extra Help, a program for low-income beneficiaries, paying your Medicare Part D costs.
Q: What’s this about penalties?
A: If you aren’t eligible for premium-free Part A, a nd you don’t buy it when you’re first eligible, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up. If you’re still working and plan to keep your employer’s group health coverage, talk to your benefits administrator to determine when and how to enroll in Parts A and B.
There’s a penalty for drug coverage, too, if you don’t sign up when you’re eligible.
A late enrollment penalty is added to your monthly premium for Medicare Part D, or a stand-alone drug plan, if you go without Part D or what is called “creditable prescription drug coverage” for any continuous period of 63 days or more after your’re first eligible. That’s prescription drug coverage from an employer or union, for example, that pays on average at least as much as Medicare’s standard prescription drug coverage.
You don’t have to pay the penalty if you’re eligible for Extra Help, a program for low-income beneficiaries.
Q: I still work. Do I have to have Medicare?
A: If you or your spouse is still working after you turn 65 for a company with 20 full-time workers and you get health insurance through work, you may not need all of Medicare when you turn 65. You can delay Part B or Part D and get them later when you retire or if you lose your job-related insurance.
But most people should enroll in Medicare Part A when they turn 65, even if they have employer health insurance. Chances are it’s free because you’ve paid into Medicare through payroll deductions while you work. If you have insurance through a job, Medicare Part A may not pay much toward your healthcare costs because Part A generally kicks in after your job’s insurance.
If you get insurance from your job or your spouse’s, talk with the enrollment benefits coordinator to determine how your job’s insurance may change when you get Medicare.
Q: Should I delay Part B?
Most people should enroll in Part B when they first become eligible for Medicare both to have coverage and to avoid having to pay a late enrollment penalty.
The exception? You might want to delay Part B if you or your spouse is working for a company with 20 or more workers when you turn 65 and you get health insurance through your job or your spouse’s job .In that case, the employer coverage will be primary to Medicare coverage.
When your situation changes, you qualify to enroll in a Special Enrollment Period, which is the eight-month period that begins the month after the work-related plan coverage ends. As long as you enroll then, you won’t pay a penalty.
It’s important to note that you won’t get any enrollment information from Medicare if you’re not getting Social Security. If that’s the case, call Social Security at 800-772-1213 at least 3 months before you turn 65 to avoid any penalties.
Q: Can I have Medicare and retiree coverage?
A: Yes. When you become eligible for Medicare, you’ll probably need to enroll in both Part A and Part B to get full benefits from your retiree plan. Your retiree plan usually offers benefits that fill in Medicare’s gaps in coverage and sometimes include extra benefits, such as prescription drugs. Unsure how your plan works with Medicare? Ask for a copy of your plan’s benefits booklet or call your benefits administrator. Questions about Medicare? call 800-633-4227.
Q: I don’t take medications. Why should I get a drug plan?
A: First, you can’t predict your needs next year. Additionally, there’s a late-enrollment penalty for Medicare Part D, a stand-alone drug plan, if you don’t have drug coverage from somewhere else. That’s called creditable prescription drug coverage. That’s prescription drug coverage from an employer or union, for example, that pays on average at least as much as Medicare’s standard prescription drug coverage.
Q: I have Original Medicare rather than Medicare through a private insurer. Who do I call with questions about my bill or coverage?
A: Call Social Security at 800-772-1213.
Q: I travel. Am I covered?
A: It depends. Original Medicare covers the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. But in general, health care while you travel outside the U.S. isn’t covered under Original Medicare. There are rare exceptions.
Medicare plans offered through private insurers often have out-of-country coverage.
Q: I’m still confused. Help?
A: Nearly 700 paid and volunteer staff through the Michigan Medicare/Medicaid Assistance Program are experts in the complexities of Medicare and how your unique situation fits. The website www.mmapinc.org offers fact sheets, brochures and videos explaining Medicare and Medicaid. Counselors are available at 800-803-7174.