• Wiser Medicare

Frequently Asked Questions (FAQ's)

How do I sign up for Medicare?

Most people get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) when first eligible (usually when turning 65). For more details, click the link below and answer a few questions to check when and how to sign up based on your personal situation. Learn about Part A and Part B sign up periods and when coverage starts.

[Read More at: https://www.medicare.gov/basics/get-started-with-medicare/sign-up]


What's the difference between Original Medicare and Medicare Advantage?

Original Medicare gives you great flexibility. You can choose any doctor in the U.S. that accepts “Medicare assignment” (and most do). And you can see specialists without asking permission. But your out-of-pocket costs are open-ended unless you buy a private policy to help cover the gap. You’ll also have to buy a standalone prescription drug plan if you want help paying for medications.


Medicare Advantage plans cover the same services as Original Medicare, but they bundle in other benefits. These can include dental, vision, fitness, hearing – and prescription drug plans. Out-of-pocket costs are limited to an annual maximum. But you’ll likely have to stay within a network of providers in your local area. (Medical expenses away from home are only covered in emergencies.) Also, you’ll need referrals from your primary care physician or insurer to see specialists.

[Read More at: https://www.wisermedicare.com/post/your-first-big-decision-original-medicare-or-medicare-advantage]


Should I have a Medicare Broker?

A health insurance broker is a go-between – between you and the insurance company whose policy you choose. If you know the insurance company you want to work with, you can call the company directly, and they will route you to an agent who will work with you.


But if you are buying this type of insurance for the first time or have run into claims or billing issues before, a broker who has access to multiple companies could be your best option.


This broker could be a traditional (offline) broker or an online go-between, which includes e-brokers and marketplaces. Here we’ll focus on traditional brokers.


Buying Medicare insurance is not “one and done.” With Original Medicare, your Parts A and B do not change. But you may want to change add-on prescription drug plans or supplement (Medigap) plans.


With Medicare Advantage, you will have to renew your plan each year. And changes to your plan’s approved doctors or prescription drug plan medications can lead to a policy change.


Having the right broker for Medicare can make or break your retirement, whether you choose Original Medicare or a Medicare Advantage plan. So how do you make sure you have the right person?


1. Are they licensed?

A broker needs to pass the state licensing exam and obtain a license to market Medicare plans. If licensing information isn’t on their website or forms, ask them for it in writing, maybe as an email.


Action: Most state Department of Insurance websites let you confirm if the person’s license is active and see if any disciplinary action has ever been taken against them.


2. What experience do they have selling Medicare plans in your state?

Regulations differ state-to-state on what plans can be offered and how prices can be increased. Therefore, you want someone who is an expert in your state.


Action: Ask for their professional history working in your state. Check the issue dates on licenses as confirmation.


3. Are there any broker costs involved?

The insurance company covers the cost of a broker helping you to buy a policy. But if the broker is going to manage your policy over time, that may not be free.


Action: Ask if there are any extra fees for services and get a fee schedule in writing. You will have to include any fees in your budget.


4. What can you expect as customer service?

You only discover how good a service provider is when you have a problem to solve. But you’ll want the reassurance of direct access to your broker. Whether that person is part of a small business or a larger brokerage, you want to know that one specific person will oversee your account – someone who knows you and your needs.


Action: Check for online ratings, reviews and testimonials. Some brokers may be accredited by the Better Business Bureau, so check there, too. If you didn’t find the broker through a reliable reference, ask for the name of an existing client you can call.


5. Do you like the person?

Facing health insurance issues can make you feel vulnerable, especially if you’re sick. You want someone who is fighting for you, not someone who is cold, disinterested or unreachable.


Action: What does your gut tell you? Can you share your real healthcare needs comfortably? And is the person listening? Do they even care? If you feel any discomfort, move on and find another broker before making your final decision.

[Read More at: https://www.wisermedicare.com/post/5-things-you-need-to-know-when-selecting-a-traditional-broker

https://www.wisermedicare.com/post/5-things-you-need-to-know-when-selecting-an-e-broker]


How much does Original Medicare Cost? What additional costs are associated with Original Medicare?

The Cost of Original Medicare Premiums

Most people don't have to pay a Medicare Part A (hospital) insurance premium when they come of Medicare-eligible age (typically age 65). However, if you paid Medicare taxes for less than 30 quarters (by working and paying taxes for 7.5 years) during your life or have a disability and have exhausted other entitlements, Medicare Part A could cost you roughly $499 a month ($5,652 a year).


Medicare Part B (medical) insurance will cost about $170 each month ($1,782 a year) in 2022 for most people, but you’ll pay more if your individual income is more than $91,000, and people who file jointly with their spouse will pay more if their joint income is more than $182,000.


If you're on original Medicare and opt to purchase Part D health insurance to cover the cost of your prescription medications, as most people do, the Centers for Medicare and Medicaid Services estimates that a stand-alone premium will cost you an average of $30 a month, and premiums vary from plan to plan. Similar to Part B, people with Medicare who have higher incomes will pay higher premiums for Part D plans.


When shopping for or comparing different Medicare plans available to you, there are 4 main pieces to pay close attention to. After you have found a plan that meets your preferences for a network of providers and pharmacies, it’s important to compare the different cost aspects of a plan.

  • Premium: This is the amount you will pay monthly for your plan. This typically does not count towards your deductible or out-of-pocket maximum.

  • Deductible: This is the amount you pay out of pocket for health care costs until your insurer picks up a greater share of the costs.

  • Copay: This is the amount you will pay out-of-pocket for medical visits, services, or prescription drugs.

  • Out-of-pocket maximum: This is the maximum out you will be required to pay out of pocket in a year before your insurer picks up 100% of the costs of your care.

[Read More at: https://www.wisermedicare.com/post/medicare-out-of-pocket-costs-you-should-know-and-expect

https://www.wisermedicare.com/post/understanding-your-plan-s-costs]


Does Original Medicare cover hearing, dental and vision coverage?

Original Medicare has only limited hearing, dental and vision coverage. Thus, many seniors opt to get additional hearing, dental, and vision coverage.

[Read More at: https://www.wisermedicare.com/post/access-to-affordable-hearing-aids-this-summer-or-later]


What does Medicare Part A cover? What does Medicare Part B cover?

Traditional Medicare is composed of Parts A and B. Part A, also called hospital insurance, covers care in hospitals, home health care, nursing facility care, and hospice care. Part B covers preventative care, services from health care providers, home health care, outpatient care, and durable medical equipment.


What is a Medicare Part C Plan? Do I need one?

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.


If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).


Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

[Read More at: https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html]



What is a Medicare Part D Plan? Do I need one?

Medicare Part D is Medicare’s outpatient prescription drug benefit. These drug plans are offered by private insurers to Medicare members in Traditional Medicare. If you are in a Medicare Advantage plan, your drug benefit is included in that plan.


It is recommended that Medicare beneficiaries enrolling in Parts A and B also pick a Part D plan. Even if you are not currently taking any prescriptions, if you are prescribed something later in the year and have to enroll, you will pay a penalty for enrolling late.


When am I eligible to sign up for Medicare?

Most people sign up for both Part A (Hospital Insurance) and Part B (Medical Insurance) when they’re first eligible (usually when they turn 65). Generally, there are risks to signing up later, like a gap in your coverage or having to pay a penalty. However, in some cases, it might make sense to sign up later. Visit https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-can-i-sign-up-for-medicare to find out when you should sign up.


If I'm over 65 and still working -- am I eligible for Medicare?

It depends on how you get your health insurance now and the number of employees that are in the company where you (or your spouse) work.

Generally, if you have job-based health insurance through your (or your spouse’s) current job, you don’t have to sign up for Medicare while you (or your spouse) are still working. You can wait to sign up until you (or your spouse) stop working or you lose your health insurance (whichever comes first).

  • If you’re self-employed or have health insurance that’s not available to everyone at the company: Ask your insurance provider if your coverage is employer group health plan coverage (as defined by the IRS.) If it’s not, sign up for Medicare when you turn 65 to avoid a monthly Part B late enrollment penalty.

  • If the employer has less than 20 employees: You might need to sign up for Medicare when you turn 65 so you don’t have gaps in your job-based health insurance. Check with the employer.

  • If you have COBRA coverage: Sign up for Medicare when you turn 65 to avoid gaps in coverage and a monthly Part B late enrollment penalty. If you have COBRA before signing up for Medicare, your COBRA will probably end once you sign up.

[Read More at: https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65]


How do I protect myself from Medicare fraud?

1. Treat Your Medicare Number Like it's Your Social Security Number.

Only give it to people you trust and know are your medical providers. Oftentimes, scammers will call and offer free medical equipment or devices. They say all you need to provide is your Medicare number. This allows them to abuse your number and could lead to you paying for fake services or equipment.


2. Keep Track of Your Appointments and Procedures on a Calendar or in a Notebook.

Writing down all of your appointments and procedures will not only help you remember your appointments, but will serve as a reference if you ever notice something incorrect on a medical bill. Sometimes providers will bill you for extra services they didn’t provide to try and get more money from Medicare.


3. Decline Services You Know Aren’t Covered

If someone tries to offer you a questionable service that doesn’t sound medically necessary, decline it. These could be offers for things like massages, dance classes, or electro- acupuncture to name a few services advertised in past scams. You can refer to the list of Medicare-Covered services to check what Medicare will and won’t cover.


4. Be Skeptical of Calls or Solicitors Who Come to Your Door

Anyone who is offering you a deal or a gift over the phone or at your doorstep is unlikely to be a real medical provider. In the past they have tried to sell braces and COVID-19 tests or offer to review your medical records to suggest treatments. Trust your judgement in these situations.


While you may never be targeted by a scammer, it's always best to know what to watch out for and to be prepared. Medicare keeps a page of recent scams you check to know what else scammers might be trying. For more information on avoiding scams you can read this article from AARP and a list of Do’s and Don’ts from Medicare.gov.


What is a Medicare supplement plan? What are the different types?

These plans do not replace Original Medicare. Instead, they work in tandem with Parts A and B. You will pay the plan’s premium to a private insurance company. The federal government defines ten standardized plans (Plans A-N). All “A” plans must offer the same coverage, regardless of what company sells them. The same holds true for B-N.


All plans cover all or part of your:

  • Part A coinsurance and hospital costs,

  • Part A hospice care coinsurance or copayment,

  • Part B coinsurance or copayment, and

  • The first three pints of blood.

Beyond that, some plans will cover:

  • Skilled nursing facility care coinsurance,

  • Part A deductible,

  • Part B deductible,

  • Part B excess charge, and

  • Some foreign travel costs.

[Read More at: https://www.wisermedicare.com/post/what-you-need-to-know-to-save-money-with-a-medicare-supplement]


What additional resources are there to help cover my healthcare costs?

Depending on your income and resources, you may be eligible for one or more of the following:


Medicaid. If you need help affording medical costs, Medicaid (a joint federal and state program) might help. The rules vary state-by-state, so contact your state’s Medicaid office to see what’s available.


Medicare Savings Programs. Your state can help you pay your Medicare premiums, plus some deductibles, coinsurance and copayments through one of the four programs known best by their alphabet-soup initials:

  • QMB – Qualified Medicare Beneficiary Program

  • SLMB – Specified Low-Income Medicare Beneficiary Program

  • QI – Qualifying Individual Program

  • QDWI – Qualified Disabled and Working Individuals Program

Again, contact your state’s Medicaid office about your eligibility.


Extra Help with Drug Costs. Do you need help paying the costs of your Medicare Part D prescription drug plan (such as premiums, deductibles and coinsurance)? If so, check out the Extra Help program. However, it only works for Part D of Original Medicare, not Medicare Advantage.


If you qualify, you could pay no more than $3.95 for a generic drug and $9.85 for a brand-name covered medicine in 2022. Social Security (who runs Extra Help) says it could save you about $5,000 per year.


You might qualify automatically for Extra Help if you have Medicare coverage plus Medicaid, a Medicare Savings Program or Supplemental Security Income (SSI) benefits. Otherwise, apply through the Social Security Office.


Program of All-inclusive Care for the Elderly (PACE). Do you have considerable health care needs but prefer to stay in your community instead of going to a care facility? PACE builds teams of health care professionals to coordinate your care and make that happen. Unfortunately, it is not available everywhere, so check with your state’s Medicaid office.


State Health Insurance Assistance Program (SHIP). SHIP is a free state-level counseling service that can answer any questions you have about Medicare, including the various financial assistance programs in your state. The program’s name might change in each state, but the services are similar.


Aunt Bertha

Aunt Bertha is an organization that uses social care technology to connect users with local resources for financial assistance, healthcare, food, and other social services. To use the website you will need to visit https://www.findhelp.org/ and follow the prompts. The website will lead you through a series of questions to determine what kind of services you are looking for and what’s available in your area. After completing your search the website will list the various organizations who provide that kind of support. You can also view a map to see your distance from each of the organizations.


National Council of Aging

The National Council of Aging’s mission is to help create a society in which we all age with dignity, purpose, and security. Along these lines it has a large library of educational resources and articles, including ones on helping to pay for Medicare. In addition to its educational content, the NCOA also offers a search option to find help near you. To use the search option you will need to visit this link and enter your zip code.


One of the best ways to get questions answered about your Medicare plan is to ask your plan directly. Your plan should have a website where you can create an account. Most plan websites allow you to see your plan’s benefits, your list of medications, your providers, and any claims you may have. It will also likely have a section where you can ask questions about your plan or will have a phone number listed for you to call for help.

[Read More at: https://www.wisermedicare.com/post/where-to-get-help-paying-for-medicare-costs &

https://www.wisermedicare.com/post/the-top-3-ways-to-get-local-help-with-your-medicare-plan]


When can I change Medigap plans?

One detail to note is that it is best to enroll in a Medigap plan during Medigap Open Enrollment which is the first six months from when you turn 65 and have chosen Medicare Part A and B plans. During this six month period you can purchase any Medigap plan, regardless of any existing health issues. If you wait to purchase a Medigap plan after this enrollment period you might have to pay more.

You can still shop Medigap plans this Medicare Open Enrollment period that starts on October 15th 2021 and runs through December 7,2021. Any changes you make to your existing coverage or if you choose a new plan, will take effect on January 1, 2022.

[Read More: https://www.wisermedicare.com/post/what-is-medigap]

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