1. Understanding Medicare

• What is Medicare?
  Medicare is a federal health insurance program primarily for people aged 65 and older, as well as for some younger individuals with disabilities or specific medical conditions like End-Stage Renal Disease (ESRD) and ALS.

• Who funds Medicare?
  Medicare is funded through payroll taxes, premiums paid by beneficiaries, and general revenue from the federal government.

• Who is eligible for Medicare?
  Individuals aged 65 and older, people with certain disabilities, and those with ESRD or ALS qualify for Medicare.

• What is the difference between Medicare and Medicaid?
  Medicare is a federal program providing health coverage primarily for seniors and some disabled individuals, while Medicaid is a state and federal program offering health coverage to low-income individuals and families.

• What is Original Medicare?
  Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance), allowing beneficiaries to visit any doctor or hospital that accepts Medicare.

• How does Medicare work?
  Medicare covers various medical services and supplies. Beneficiaries can choose between Original Medicare and Medicare Advantage (Part C), and they can also add Part D for prescription drug coverage.

• What services are not covered by Medicare?
  Medicare does not cover routine dental care, vision care, hearing aids, cosmetic surgery, long-term care, or alternative therapies like acupuncture (except in limited cases).

2. Medicare Parts Overview

• What is Medicare Part A?
  Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.

• What is Medicare Part B?
  Part B covers outpatient services, doctor visits, preventive care, durable medical equipment, and some home health care.

• What is Medicare Part C (Medicare Advantage)?
  Medicare Advantage plans are private insurance plans that combine Part A, Part B, and often Part D coverage. These plans may offer additional benefits like dental, vision, and hearing coverage.

• What is Medicare Part D?
  Part D provides prescription drug coverage through private insurance plans approved by Medicare.

• What is the difference between Medicare Advantage and Medicare Supplement plans?
  Medicare Advantage (Part C) replaces Original Medicare and may offer extra benefits. Medicare Supplement (Medigap) plans help pay for out-of-pocket costs associated with Original Medicare but do not include drug coverage.

• What are Medigap plans and how do they work?
  Medigap plans are supplemental insurance policies that help cover deductibles, copayments, and coinsurance costs not covered by Original Medicare.

3. Enrolling in Medicare

• When should I sign up for Medicare?
  Most people should sign up for Medicare during their Initial Enrollment Period (IEP), which begins three months before they turn 65 and lasts for seven months.

• What happens if I miss my Initial Enrollment Period?
  If you miss your IEP, you may have to wait until the General Enrollment Period (January 1 – March 31) and may face late enrollment penalties.

• Do I need to sign up for Medicare at 65 if I’m still working?
  If you have employer coverage, you may be able to delay Part B without penalty. Check with your employer to confirm how Medicare interacts with your current insurance.

• How do I enroll in Medicare?
  You can enroll in Medicare through the Social Security Administration (SSA) online, by phone, or at a local SSA office.

• What is a Medicare Special Enrollment Period (SEP)?
  An SEP allows you to enroll in or change Medicare plans outside regular enrollment periods due to qualifying life events, such as losing employer coverage or moving to a new service area.

• Who can help me enroll in a Medicare plan?
  You can get assistance from the Social Security Administration, Medicare.gov, independent brokers, or State Health Insurance Assistance Programs (SHIPs).

• How soon after I enroll will my Medicare benefits begin?
  If you enroll during your Initial Enrollment Period, your benefits typically start the first day of your 65th birth month.

4. Medicare and Other Insurance

• Can I defer Medicare Part B?
  Yes, if you have creditable employer coverage, you can defer Part B without penalty and enroll later through a Special Enrollment Period.

• How does Medicare work with employer or union health plans?
  If you have employer or union coverage, Medicare may be secondary or primary, depending on the employer size and policy.

• Can I be enrolled in Medicare and Medicaid at the same time?
  Yes, this is called “dual eligibility,” and those who qualify can receive extra help with Medicare costs through Medicaid.

• What if I lose my Medicaid coverage?
  If you lose Medicaid, you may qualify for a Special Enrollment Period to switch Medicare plans and seek financial assistance options.

5. Medicare Costs & Financial Assistance

• How much does Medicare cost?
  Costs vary depending on the plan. Part A is usually free if you or your spouse paid Medicare taxes for at least 10 years. Part B has a standard monthly premium, and Part D costs depend on the plan and income.

• What are Medicare premiums, deductibles, and copays?

  • Premiums: Monthly payments for Medicare coverage.

  • Deductibles: The amount you pay before Medicare starts covering expenses.

  • Copays/Coinsurance: A portion of the cost you pay for services after meeting the deductible.

• Is there help if I can’t afford Medicare’s premiums?
  Yes, programs like Medicaid, Medicare Savings Programs, and Extra Help for Part D can assist with costs.