Medicare is a federal health insurance program with several different parts and seemingly endless rules and regulations that dictate how it is administered. Many people struggle to understand every aspect of Medicare and Medicare Supplement Insurance (also called Medigap).
To make things easier, we’ve compiled a list of 95 frequently asked questions about all things Medicare with links for where to find more information on each topic.
What is cost-sharing?
Cost sharing means you and your insurance provider share some of the total cost of care in the form of out-of-pocket costs. Cost sharing can include coinsurance, copayments and deductibles. Cost sharing does not include monthly premiums or the cost of non-covered services.
What is coinsurance?
For example, Medicare Part B typically requires a 20 percent coinsurance for many outpatient medical services. If the Medicare-approved cost of a medical service is $100, in this instance, your Part B coinsurance would be $20 (after you’ve paid your Medicare Part B deductible).
What is a copayment?
A copayment is a set amount you pay for a covered service that is predetermined in your health insurance plan provider.
For example, if you have $20 copayment for all primary care doctor’s visits, you will pay $20 out of pocket every time you go to the primary care doctor (after you’ve met your deductible).
What is a deductible?
A deductible is the amount you pay out of pocket for health care expenses before your insurance plan will begin paying for services.
For example, the Medicare Part B deductible is $203 per year in 2021. You would pay that $203 out of pocket before Medicare Part B starts paying its share of your medical costs.
What is a pre-existing condition?
A pre-existing condition is any health condition or medical history that existed (and was known to have existed) before writing and signing an insurance contract.
What is Medicare and how does it work?
Medicare is the U.S. federal health insurance program for people who are age 65 or older, younger than 65 with certain disabilities and those with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig’s disease).
There are four parts of Medicare: Part A, Part B, Part C and Part D. Part A (hospital insurance) and Part B (medical insurance) make up Original Medicare.
In most cases, your Original Medicare benefits allow you to go to any doctor, health care provider or hospital that accepts Medicare and is accepting new patients. You are not required to choose a primary care doctor and do not typically need a referral to see a specialist.
Who administers Medicare?
Original Medicare (Part A and Part B) is administered by the federal government. The Medicare program is managed by the Centers for Medicare and Medicaid Services (CMS), which is part of the Department of Health and Human Services.
Medicare Advantage (Part C) and Prescription Drug Plans (Part D) are administered by private insurance companies.
Do I need both Medicare Part A and Part B?
Whether or not you need both Medicare Part A and Part B may depend on whether Medicare will be your primary or secondary insurer. If you’re covered by a group health plan from either your or your spouse’s current employer when you turn 65, you may not need to enroll in Medicare coverage until you or your spouse retires or loses the group health coverage. If this is the case, you likely will qualify for a Medicare Special Enrollment Period, during which you can sign up for Medicare.
If Medicare is your primary insurer, you should enroll in both Part A and B, even though Part B is optional.
Keep in mind that retiree and COBRA insurance coverage are not considered current employment health care coverage and will NOT qualify you for a Special Enrollment Period. If you have retiree or COBRA health insurance coverage when you reach age 65, you should enroll in Medicare during your Initial Enrollment Period to avoid paying late enrollment penalties.
Who qualifies for Medicare?
There are certain requirements you must meet in order to be entitled to Medicare benefits. You automatically qualify for Medicare at age 65 if:
You may also qualify for Medicare under age 65 if:
Find out more about who qualifies for Medicare.
What are the steps I need to take to sign up for Medicare?
Once you are eligible for Medicare, you have five options for signing up (if you are not automatically enrolled):
You will be automatically enrolled in Medicare if you are 65 and are already receiving Social Security or Railroad Retirement benefits.
Do I have to sign up for Medicare myself or will I be automatically enrolled?
Some people are automatically enrolled in Medicare, but some people need to sign up themselves.
People who are already receive Social Security retirement benefits or Railroad Retirement benefits will be automatically enrolled in Medicare Part A and Part B when they turn 65.
If this is not the case for you, you will need to contact your local Social Security office or Railroad Retirement Board office in order to sign up for Medicare.
Can I sign up for Medicare Part B if I already have Part A?
You can sign up for Medicare Part B if you already have Part A. However, you may end up paying more for your Part B plan if you sign up outside of your initial enrollment period.
Your initial enrollment period begins three months before your 65th birthday, includes your birthday month and extends three months after your 65th birthday.
If you missed your initial enrollment period and wish to sign up for Medicare Part B — and don’t qualify for a special enrollment period — you may do so during the Medicare general enrollment period, which occurs from January 1 to March 31 each year. However, your coverage won’t begin until July 1 and you may be subject to a late enrollment penalty if you waited more than 12 months since your initial enrollment period to sign up.
This article provides more detailed information about Medicare Part B enrollment.
When can I enroll in Medicare if I have a disability?
People under age 65 with certain disabilities or end-stage renal disease can qualify for Medicare. You are automatically eligible for Medicare after receiving Social Security Disability Insurance (SSDI) benefits for 24 months.
If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease), your Medicare benefits will automatically begin the month you begin your disability benefits.
If you have end-stage renal disease and are receiving dialysis or have had a kidney transplant, you can sign up for Medicare by contacting Social Security.
Who qualifies for a Medicare special enrollment period?
Sometimes you can sign up for Medicare after your initial enrollment period if you are in one or more special circumstances. You qualify for a special enrollment period (SEP) to sign up for Part A and/or Part B without penalty if:
After your employment or health insurance coverage ends, you will have an 8-month SEP to sign up for Medicare Part A, Medicare Part B or both. This period will begin either the month your employment ends or the month after the group health insurance coverage from your employer ends (whichever comes first).
If you are covered by COBRA or retiree insurance, you are not eligible for an SEP because the coverage is not based on current employment. If your COBRA or retiree insurance ends after you missed your Medicare initial enrollment period and you did not sign up for Medicare Part B during your initial enrollment period, you may pay a late enrollment penalty.
You may also be eligible for an SEP if you are a volunteer serving in a foreign country or if you have a Health Savings Account (HSA) with a High Deductible Health Plan (HDHP) based on you or your spouse’s current employment.
Note: There are separate special enrollment periods with different circumstances for Medicare Supplement Insurance and Medicare Part C and Part D.
If I enroll in Medicare late, will I be charged a late penalty?
Yes. There are late-enrollment penalties for Medicare Part A, Part B and Part D.
If you aren’t eligible for premium-free Part A and don’t enroll during your initial enrollment period (IEP), you could end up paying a late-enrollment penalty. The penalty is a 10 percent increase on your monthly premium for twice the number of years you could have had Part A but didn’t.
For example, if you were eligible for Medicare Part A for 4 years but didn’t enroll, then you would have to pay the higher premium penalty for 8 years.
If you don’t sign up for Part B when you first become eligible for Medicare or during a special enrollment period (SEP), you will have to pay a late enrollment penalty on your Part B monthly premium for as long as you have the coverage. Your monthly premium will increase 10 percent for every 12 months that you could have had Part B but didn’t sign up.
You may also owe a late enrollment penalty if you go without Part D coverage (or any other health plan that offers creditable prescription drug coverage) for any continuous period of 63 days or more after your IEP is over. The cost of your penalty depends on how long you go without drug coverage and is calculated by Medicare when you finally do join a drug plan.
Can I dispute a late enrollment penalty?
If you do not think you deserve your late enrollment penalty, you can file an appeal asking Medicare to reconsider. For help filing an appeal, contact your local State Health Insurance Assistance Program (SHIP).
Will enrolling in Medicare late affect my coverage for pre-existing conditions?
If you are only signing up for coverage through Original Medicare (Part A and Part B), signing up late will not affect the coverage for your pre-existing conditions. However, you will likely have to pay a lifetime late penalty on your Part B or Part D premiums if you miss your Medicare initial enrollment period.
Keep in mind that if you want to sign up for Medicare Supplement Insurance (Medigap) to get help paying your out-of-pocket costs, enrolling after your Medigap open enrollment period allows companies to take your pre-existing conditions into account when deciding how much to charge you for your policy (or whether to deny your application altogether). If you are approved for a policy after your Medigap open enrollment period, your pre-existing conditions will still be covered, but you may have to pay more for your premiums.
If I have limited income, are there resources to help me pay for Medicare?
If you have limited income and resources, there are a several different options available to help you pay health care costs and save money. You may qualify for one or more financial assistance programs based on your age, financial resources and your disability status.
Every state has Medicare Savings Programs (MSP) that can help pay your Part B premium, along with some deductibles and copays. Medicaid is a joint federal and state program that helps pay for medical costs and some drugs. Medicaid also provides additional benefits such as nursing home and personal care services. You may also qualify for Extra Help, which helps pay for prescription drugs, deductibles, coinsurance and copays.
Contact your state Medicaid program to find out what resources are available in your state, which you qualify for and how to apply.
Can I be enrolled in both Medicare and Medicaid?
Yes, you can be enrolled in both Medicare and Medicaid. People who are eligible for Medicare who also have limited financial resources may additionally qualify for Medicaid, which covers services beyond what Medicare will generally pay for (such as nursing home care). People who receive benefits from both programs are called “dual eligible beneficiaries.”
Contact your state Medicaid program to find out if you meet your state’s eligibility requirements.
What is my Medicare effective date?
Your Medicare effective date is the day on which you can start using your Medicare benefits. The date your coverage starts depends on when you sign up. The easiest way to find out your Medicare effective date is to look at the bottom right corner of your Medicare card.
If you have questions about your Medicare effective date, contact Social Security at 1-800-772-1213. TTY: 1-800-325-0778.
Contact your insurance carrier directly if you have questions about your Medicare Advantage or Medicare Prescription Drug Plan.
How can I check the status of my Medicare application?
You can apply for Medicare benefits and check the status of your application online through your My Social Security account on the Social Security Administration’s website.
How long will it take for me to be insured after I sign up for Medicare?
If you enroll in Medicare during the first three months of your Initial Enrollment Period, your coverage will start on the first day of the month you turn 65.
If you sign up during the month you turn 65 or during the three following months, the start day for your Medicare coverage will work as follows:
What should I do if I need coverage before I receive my Medicare card?
If your Medicare coverage has started but you are still waiting on a replacement Medicare card to come in the mail, you can contact Social Security for temporary proof of insurance to use until you get your new card.
Can Medicare Part B pay retroactively?
No, Medicare Part B will not cover any costs that were incurred before your coverage begins. If you receive a test or service that is covered by Medicare Part B but your coverage has not yet begun, you will be responsible for the full price of that service.
Will my younger spouse receive Medicare benefits when I am 65?
Unlike with traditional health insurance plans, Medicare works on an individual basis; you cannot cover more than one person under a Medicare policy.
If your spouse will lose his or her health insurance when you leave an employer-sponsored plan and enroll in Medicare, they have some options for getting coverage, such as purchasing a private plan. In most cases, your spouse will have to wait until he or she reaches age 65 to sign up for Medicare.
Do spouses need to sign up for Medicare separately?
Yes. You and your spouse will both need to sign up for Medicare individually during your own separate initial enrollment periods. Medicare does not work like traditional employer group coverage, which can generally cover more than one person at a time.
If you are eligible for Medicare and your spouse is not, he or she will have to stay on an employer plan or purchase a private policy in order to maintain coverage until he or she becomes eligible for Medicare.
The same rule applies for Medicare Advantage plans, Medicare Supplement Insurance (Medigap) and Medicare Prescription Drug Plans (Medicare Part D). For these types of plans, both spouses must have their own policies to receive coverage.
Can I keep my employer insurance after I become eligible for Medicare?
In most cases, yes. If you plan on working past age 65 and are happy with your employer group health insurance, you can typically delay signing up for Medicare until you leave your job and lose your employer-provided coverage.
Most people do not pay a premium for Medicare Part A (hospital insurance), so there is likely no reason to opt out of Medicare Part A. You do not have to sign up for Medicare Part B until you are off of your employer-provided health plan (Medicare Part B does have a monthly premium). Once you leave your job, you should be eligible for a special enrollment period to sign up for Medicare, and you will not have to pay a lifetime penalty for late enrollment.
Check with your employer about how your group coverage will work with Medicare after you turn 65. Companies with less than 20 people are not required to continue offering you health insurance once you are eligible for Medicare.
How does COBRA insurance affect Medicare?
If you have COBRA insurance when you become eligible for Medicare, you should sign up for Medicare during your initial enrollment period. You will not be eligible for a special enrollment period to sign up for Medicare if you miss your initial enrollment deadline because you have COBRA insurance. This could leave you paying more for your Medicare Part B premiums (in the form of a late penalty) for as long as you have Medicare.
If you already have Medicare when you become eligible for COBRA, you are allowed to enroll in COBRA coverage. You may want to do this if your COBRA plan offers extra benefits (such as prescription drug coverage) or if you have high medical expenses. Unless you have end-stage renal disease, Medicare will become the primary insurer (it pays what it covers first), and COBRA pays second.
How does Medicare work with other insurance? What is “primary” insurance?
If you have another type of insurance in addition to Original Medicare (such as COBRA insurance or employer group coverage), one of your policies will be billed first when you receive medical care. This policy is considered your “primary” insurance because it pays first for whatever it will cover. Your “secondary” insurance is billed for any costs that may be left over.
Can I contribute to my health savings plan after I enroll in Medicare?
Once you enroll in Medicare Part A and/or Part B, you will no longer be able to contribute pre-tax dollars to a health savings account (HSA). However, you are still able to withdraw funds from the account to help cover medical expenses.
What costs do I have under Original Medicare?
The different parts of Medicare cover different services. With Original Medicare (Parts A and B) only, you’ll still be responsible for paying for most prescription drugs, vision care and dental services costs out of pocket. Even if Medicare covers a service you require, you’re still responsible for paying any Medicare deductibles, coinsurance and copayments the service may require.
What is a benefit period?
A benefit period is Medicare’s way of measuring how long you receive inpatient care at a hospital or skilled nursing facility. A benefit period is not related to the calendar year.
A benefit period begins the day that you enter the hospital or skilled nursing facility, and it ends once you have been out of the facility and have not received inpatient care for 60 consecutive days.
When one benefit period ends (after you have not received inpatient care for 60 days), a new benefit period will begin the next time you receive inpatient care. There is no limit to the number of benefit periods you can have.
Under Medicare Part A, you generally pay $0 during the first 60 days of a benefit period (once you have met your Part A deductible). After that, you will pay a $352 per day coinsurance (in 2020) until you reach 90 days. If the benefit period continues beyond 90 days, you have 60 lifetime reserve days where you will pay $704 in coinsurance per day (in 2020) until you have used all 60 of your lifetime reserve days. Once you have depleted you lifetime reserve days, you pay the full cost of in patient care that lasts longer than 90 days.
How do “lifetime reserve days” work?
Original Medicare (Part A and Part B) cover will cover up to 90 days in the hospital for each benefit period. A benefit period begins the day you are admitted to the hospital or skilled nursing facility for inpatient care and ends when you stop receiving inpatient care for 60 days in a row. A benefit period is not the same as a calendar year, and there is no limit to the amount of benefit periods you can have.
If you receive inpatient hospital care for more than 90 days in one benefit period, Medicare also covers the costs of 60 lifetime reserve days that you can use at any point while you are on Medicare. Once you exhaust your lifetime reserve days, they are gone and do not reset.
What are employment quarters?
Employment quarters (also called “Social Security credits,” or simply “credits”) are a period of time used to calculate your eligibility for Social Security and Railroad Retirement Board benefits in retirement. They also dictate how much you will pay for Medicare Part A (if you have to pay at all) once you become eligible for Medicare.
Employment credits are based on the amount if income you earn annually, which goes up slightly each year. In 2020, you earn one credit for every $1,410 of earnings and max out at four credits per year (one per each quarter).
In order to be eligible for premium-free Medicare Part A, you have to earn a total of 40 credits, which is equal to 10 years of work.
How much will I pay for Medicare Part B?
Everyone has to pay a monthly premium for Medicare Part B. The standard Part B premium amount is $148.50 per month in 2021, but it can be higher depending on your income.
If you get Social Security or Railroad Retirement Board benefits, your Part B premium will be automatically deducted from your benefits check.
In addition to your monthly premium, Medicare Part B also comes with an annual deductible ($203 per year in 2021). After you meet your deductible, you typically pay 20 percent of the Medicare-approved amount for services covered by Part B.
Keep in mind that Medicare Supplement Insurance plans have different premiums in addition to the Medicare Part B monthly premium.
Why do some people pay less for Medicare Part B than others?
Medicare Part B premiums for people who collect Social Security can sometimes be lower if they deduct their Part B premiums from their Social Security benefits payment. If you collect Social Security benefits, the Social Security Administration will mail you a letter that states your exact Part B premium cost each year.
What is an IRMAA?
If you make over a certain amount of money each year, you will likely have to pay more for your Medicare premiums than people who have lower incomes. An IRMAA, or Income Related Monthly Adjustment Amount, is the amount you pay for Medicare Part B or Part D premiums if you meet the high income standards as determined by your tax returns.
How can I set up payments for my Medicare premiums?
If you receive benefits from Social Security or the Railroad Retirement Board (RRB), your Medicare Part B premium will be deducted from your monthly benefit payment. If you are not entitled to social security but are a Civil Service retiree, your Medicare premiums will be deducted from your Civil Service annuity.
If you do not receive any of these benefits, you will need to pay your Medicare Premium Bill on your own. You will receive a monthly bill for what you owe for Medicare Part A, Part B and/or Part D. You have a few different options for paying this bill:
Medicare Premium Collection Center
P.O. Box 790355
St. Louis, MO 63179-0355
What does a Medicare recipient pay out of pocket for medical care?
Medicare covers a lot, but it doesn’t cover everything. If you have Original Medicare alone (Part A and Part B), you will still have deductibles, copayments and coinsurance to pay when you receive medical care, in addition to your monthly premiums.
Under Original Medicare, your 2021 costs under Medicare Part A include*:
Under Original Medicare, your 2021 costs under Medicare Part B include*:
*All costs are for 2021. Amount may change each year.
Can I change my Medicare primary care physician?
If you have Original Medicare (Medicare Part A and Part B), you can go to any doctor that accepts Medicare. The vast majority of providers in the US do.
You can find a doctor that accepts Medicare assignment — meaning the doctor has agreed to only charge the Medicare-approved amount for services —using the online Physician Compare tool from Medicare.gov. If see a doctor who accepts Medicare but doesn’t accept Medicare assignment, you could end up paying more for services.
Once you find a doctor that you would like to see, call them and make sure they are accepting new Medicare patients before you make an appointment. If you are also on Medicaid, make sure your doctor is accepting new Medicare and Medicaid patients.
What if my doctor does not accept Medicare assignment?
If you have Original Medicare (Part A and Part B), check to make sure your doctor accepts Medicare assignment. This means your doctor has agreed to only charge the Medicare-approved amount for services.
If your doctor does not accept assignment, you may want to consider finding a new physician to avoid paying more in excess charges.
What are Medicare Part B “excess charges”?
Medicare Part B excess charges occur when a doctor or provider charges more for a service than Medicare has approved to pay for that service. You can avoid these charges by choosing a provider that accepts Medicare assignment, meaning the provider has agreed to accept the Medicare-approved amount as full payment for all Medicare-approved services.
For more information, read this guide to Medicare Part B excess charges.
How often can I change Medicare plans?
You can review your Medicare benefits and make changes to your plan every year during the Medicare open enrollment period (Oct. 15 through Dec. 7).
During the annual Medicare open enrollment period, you can:
If you have Medicare Supplement Insurance (Medigap), you may be able to make changes to your Medigap plan throughout the year, but the best time to enroll in Medigap or switch Medigap plans is during your Medigap open enrollment period (different from the Medicare open enrollment period).
Does Medicare cover drugs?
Original Medicare (Medicare Part A and Part B) does not cover most prescription drugs that you would take at home.
If you wish to get insurance coverage for prescription drugs, you can purchase a Medicare Prescription Drug Plan (Medicare Part D). Medicare Prescription Drug Plans are sold separately from Original Medicare. They are offered by private insurance companies that contract with the federal government and adhere to certain federally mandated criteria.
Some Medicare Advantage (Medicare Part C) plans also cover prescription drugs. Check with your Medicare Advantage plan provider to ensure your drugs are covered before purchasing a Medicare Advantage plan.
Does Medicare cover transplants?
Both Medicare Part A and Part B cover services related to getting a medically necessary transplant, including heart, lung, kidney, pancreas, intestine and liver transplants. Part A also covers stem cell transplants under some conditions.
For a list of what Medicare does and does not cover, use our comprehensive guide.
Does Medicare cover preventative care?
Yes, Medicare Part B covers preventive care.
You are also covered for one introductory “Welcome to Medicare” preventive visit within your first 12 months of enrolling in Medicare Part B. At this visit, you and your doctor can review your medical and social history and do simple tests to check the status of your vision, body mass index, blood pressure, mental health and more.
The introductory “Welcome to Medicare” visit is not required for you to be covered for annual wellness visits.
What is the difference between a Medicare wellness exam and a regular physical?
A Medicare Annual Wellness Visit is similar to a regular physical, which is generally characterized by checking for signs of “physical” issues by inspecting different parts of the body rather than by performing specific tests or procedures. However, the Annual Wellness Visit focuses less on identifying new issues and more on updating your personal prevention plan.
Your Annual Wellness Visit may include:
This patient guide offers more information about your Annual Wellness Visit and how to take advantage of what Medicare covers.
Does Medicare pay for eye exams and glasses?
No. Original Medicare does not pay for routine eye exams or glasses. There are some circumstances in which Medicare may cover glasses or eye exams, such as after cataract surgery, but generally it does not.
Use this comprehensive list to find out more about Original Medicare does and does not cover.
Does Medicare pay for dental services?
Original Medicare does not pay for routine dental care, such as cleanings and cavity fillings. However, if you experience a dental emergency that requires hospital care, Medicare Part A will generally pay for your care.
Use this comprehensive list to find out more about Original Medicare does and does not cover.
Will Medicare cover dental services that are medically necessary?
Yes. Medicare will generally pay for oral health care that is medically necessary, such as in an emergency that requires hospital care. Original Medicare does not cover routine dental care, such as fillings and cleanings.
Use this comprehensive list to find out more about Original Medicare does and does not cover.
Does Medicare cover vaccines?
Medicare Part B covers vaccines for seasonal flu, pneumonia and hepatitis B. It will also cover other immunizations if you have been exposed to certain diseases that would require a vaccine, such as tetanus. All other vaccines may be covered under Medicare Part D (Medicare Prescription Drug Plans).
Learn more about immunization recommendations for seniors.
What home modifications are covered by Medicare?
Medicare Part B will cover adding certain types of medical equipment to your home if it can be classified as durable medical equipment (DME). Medicare considers an item to be DME when it is used for a medical purpose, can withstand repeated use, is useful to someone only because they are sick or injured and is expected to last at least three years.
Some examples of DME include patient lifts, hospital beds, oxygen tanks and commode chairs.
Medicare does not cover modifications to the home that are seen as convenience items, such as walk-in bathtubs or shower chairs.
For more information about what Original Medicare does and does not cover, refer to this guide.
What is the Medicare PACE program?
Programs of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that provides care for the elderly at home and in the community rather than in a nursing home.
To qualify for PACE, you must:
Are accidents in a foreign country covered by Medicare?
If you only have Original Medicare (Medicare Part A and Part B), you almost always Medigap policies provide some emergency foreign medical coverage.
If you have Medigap Plan C, D, E, F, G, H, I, J, M or N, you are covered for 80 percent of foreign travel emergency health care costs after you meet the deductible.
If you have Medicare Advantage, check with your provider about your benefits for care during foreign travel.
Does Medicare cover hospice?
Medicare Part A should cover most of your hospice care, but it has some coverage limits. Read this article to learn more about hospice services covered by Medicare. For a comprehensive list of what Medicare does and does not cover, view this guide.
Does Medicare cover in-home care?
Medicare covers in-home health care in certain situations when the care is deemed medically necessary by a doctor. Generally, Medicare will not cover in-home care indefinitely.
This article explains more about Medicare’s coverage for in-home care.
Will Medicare cover the cost of my walker and/or wheelchair?
If your walker or wheelchair is medically necessary and prescribed by your doctor, Medicare Part B will cover it as durable medical equipment.
If your medical device supplier accepts assignment, you will pay 20 percent of the Medicare-approved amount for the cost of your wheelchair or walker after you meet your Part B deductible.
Does Medicare cover funeral costs?
No. Original Medicare (Medicare Part A and Part B) does not cover funerals or burial expenses.
For more information about exactly what Original Medicare does and does not cover, use this guide.
Does Medicare cover alcohol-dependency counseling and smoking cessation coverage?
Yes. Medicare Part B covers up to eight (in-person) counseling visits per year to help you quit using tobacco products. If your doctor accepts assignment, these sessions will not cost you anything.
You can get screened for alcohol dependency once per year. If your doctor determines that you developed a dependency, Medicare can cover four in-person counseling sessions per year to help you in recovery.
For more information about what Original Medicare does and does not cover, use this guide.
How will federal health care reform affect my Medicare coverage?
Because Congress has not yet agreed on a new set of health care reforms, there is no way to tell exactly how Medicare will change in the future. Some changes to Medicare have been included in previous bills, but nothing has passed as of yet.
Keep following updates from Congress to learn more about health care legislation changes that may happen down the road.
How do I file a Medicare appeal?
You’ll be able to see whether Medicare has approved or denied payment for a service in the Medicare Summary Notice that you receive in the mail every three months. You can also ask your doctor, provider or supplier for any documents that may help your case.
If you are appealing for the first time, fill out this form from cms.gov and file it with the billing company that sent you the Medicare Summary Notice. Include any supporting documents you have. Send a copy to the Medicare contractor’s address, which should be listed on the Medicare Summary Notice.
File any appeals within 120 days of the date you received your Medicare Summary Notice.
How do I get a new Medicare card?
You can replace your Original Medicare card if it has been lost, stolen or damaged by calling the National Social Security Hotline at 800-772-1213.
If you get your Medicare benefits through a Medicare Advantage plan (such as an HMO, PPO or PDP), you will need to call your insurance carrier to get a replacement card for your plan.
How can I change my address and/or phone number for Medicare’s records?
You can update your Medicare contact information (such as your phone number and address) through the My Profile tab on your My Social Security account. You can change your information here even if you do not receive Social Security benefits.
If you do not want to change your information online, you can also do it over the phone by calling the Social Security Administration at 1-800-772-1213 or in person at your local Social Security office.
Who do I contact if a family member on Medicare dies?
To report the death of a person with Medicare, contact Social Security at 1-800-772-1213. Make sure you have access to the person’s social security number when you call.
How do I report suspected Medicare fraud?
If you suspect that someone is using your information to bill Medicare for services or care that you did not receive, you should report to Medicare the incident as potential fraud. Looking at your statements from Medicare closely can help you detect any instances where a provider may have billed Medicare incorrectly in order to get payment for services it did not provide.
If you suspect fraud, you can:
How do I know which Medicare plan is right for me?
When it comes to Medicare benefits, you have a few different coverage options. The first step to choosing which option is right for you is to decide if you want Original Medicare or Medicare Advantage.
If you choose Original Medicare, you can also purchase Medicare Supplement Insurance and a Medicare Part D Prescription Drug Plan.
What is Medicare Supplement Insurance (Medigap)?
Medicare Supplement Insurance (also known as Medigap) is sold by private insurance companies to help pay for some of the out-of-pocket costs associated with Medicare Part A and Part B, such as deductibles, copayments and coinsurance. There are up to 10 standardized Medigap plans in most states, each offering a different combination of benefits.
You cannot have a Medigap plan if you have a Medicare Advantage plan (Medicare Part C).
Why do I need Medigap insurance?
Medicare does not cover 100 percent of your health care costs. Depending on how much you go to the doctor or hospital, you could be responsible for thousands of dollars in out-of-pocket costs, including deductibles, copayments and coinsurance. Medigap (also known as Medicare Supplement Insurance) can help cover some of these costs.
Medigap plans may seem unnecessary if you are healthy, but that doesn’t mean you shouldn’t consider buying one. If you purchase a Medigap plan during your Medigap open enrollment period (the six-month period after you are both 65 and enrolled in Medicare Part B), insurance companies cannot use your medical history to decide how much to charge you for a Medigap policy. If you wait to purchase a policy after your Medigap open enrollment period ends, insurance companies can charge you higher premiums or deny your application altogether.
Where can I find Medicare Supplement Insurance plans and rates?
A licensed agent can help you compare Medicare Supplement Insurance plans and rates in your area. Speak with a licensed agent at 1-844-907-2326.
Do I need to go through underwriting to get a Medicare Supplement plan?
Whether or not the cost of your Medicare Supplement (Medigap) plan will be based on medical underwriting depends on when you enroll in your plan. If you sign up for Medigap during your Medigap open enrollment period (the six-month period that begins when you are both 65 and enrolled in Medicare Part B), you have something called a guaranteed-issue right.
During your Medigap open enrollment period, insurance providers are prohibited from denying your application or using your age, sex or medical history in order to decide how much to charge you for a Medigap policy. Buying a policy during your open enrollment period ensures that you will pay the same amount for your Medigap policy as people with good health, even if you have pre-existing conditions.
However, if you miss your open enrollment period (and do not qualify for guaranteed-issue rights), insurance companies can use medical underwriting to decide how much to charge you for your policy, or they could deny your application altogether.
Learn more about your Medigap open enrollment period to make sure you buy your Medigap policy at the best time.
Do I have to re-enroll in Medigap or Medicare Advantage each year?
No. You do not have to re-enroll in your Medigap or Medicare Advantage plan each year to maintain your current coverage.
What is the difference between Medicare Supplement plans and Medicare Advantage plans?
A Medicare Advantage (Part C) plan allows Medicare beneficiaries to receive Medicare benefits through a private insurance plan rather than the federal government. These private health insurance policies include all of the same benefits as Original Medicare, and may include others (vision, hearing, and dental services, and Medicare Part D prescription drug coverage). You can enroll in Medicare Advantage during the same enrollment period as Original Medicare.
Can I enroll in Medicare Supplement Insurance if I also have Medicare Advantage?
You cannot have both a Medicare Supplement Insurance (Medigap) and Medicare Advantage plan at the same time.
Use this guide for more information about how Medigap and Medicare Advantage work.
When can I switch from Medicare Advantage to Medicare Supplement Insurance?
If you want to switch from a Medicare Advantage plan to Original Medicare with a Medicare Supplement Insurance plan, you can only do so during certain times.
You can switch from Medicare Advantage to Original Medicare with Medigap during the annual election period (also called the Medicare Open Enrollment Period) from Oct. 15 through Dec. 7. You can also do so during the Medicare Advantage Disenrollment Period (Jan. 1 to Feb. 14).
Keep in mind that unless you qualify for a guaranteed issue right, the insurance company you buy a Medigap plan from will use medical underwriting to determine the price of your premium and if you qualify for coverage.
View this guide for more information about switching from Medicare Advantage to Medicare Supplement Insurance.
Can spouses or dependents be covered under one Medigap plan?
You cannot cover more than one person with a single Medigap policy (also known as Medicare Supplement Insurance). Medigap plans work differently than traditional employer group coverage, which can cover more than one person, such as a spouse or dependent child.
If you are eligible for Medicare and Medigap and your spouse is not (because he or she is under 65, for example), your spouse will need to stay on an employer policy or purchase a private plan from the insurance marketplace for coverage. The same rule applies for dependents in your care.
You and your spouse can sign up for Medigap separately during your individual Medigap open enrollment periods. Your Medigap open enrollment period lasts for six months and begins the day you are both 65 and enrolled in Medicare Part B. Signing up at this time will prevent you from paying more for your premiums for the length of your policy or being denied coverage based on pre-existing conditions.
In some cases, you and your spouse may be eligible for a small spousal discount if you both purchase a Medigap policy from the same insurance provider. This is not the same as sharing a plan, but is rather an incentive from insurers to encourage you to purchase more than one plan from the same company. Check with Medigap providers before purchasing to see if this is an option for you.
Can I keep my Medigap plan if I move?
Whether or not you can keep your Medigap plan if you move out of state depends on the type of plan that you have. Certain Medicare SELECT plans have restricted networks that will not cover visits to doctors outside of your local network. If you have a Medicare SELECT plan, you may have to switch to a different plan in order to keep your coverage when you move.
Medigap plans in Minnesota, Massachusetts and Wisconsin are standardized differently than they are in the rest of the country. If you are moving to or from one of these states, check with your Medigap provider to make sure you can keep your coverage.
It is always a good idea to check with your provider before you move to ensure you can keep your coverage, regardless of the type of Medigap policy you have. Read this article for more information about moving with a Medigap policy.
Are there Medicare Supplement Insurance low income programs?
Unlike the Extra Help low-income subsidy for people with Medicare Part D, there are no specific low-income programs to help people pay for a Medicare Supplement Insurance (Medigap) plan. Individual Medigap plan providers may offer some health insurance discounts, but it is not guaranteed and would vary based on the insurance company.
What is the difference between Medicare Supplement plans F, G and N?
Medicare Supplement (Medigap) Plans F, G and N offer some of the most comprehensive Medigap coverage. These plans include many of the same benefits, but have a few key differences.
The chart below details the differences between the 10 standardized Medigap plans:
The main differences between Plans F, G and N have to do with coverage for the Medicare Part B deductible and excess charges.
The Medicare Part B deductible is $233 a year in 2022. If you choose Medigap Plan G or Plan N, you will be responsible for paying this out of pocket. Medigap Plan F covers this cost.
Medicare Part B excess charges can occur if you see a medical provider that charges more than the Medicare-approved amount for services (you can avoid this by choosing providers who accept assignment). If you choose Medigap Plan N, you would have to pay these excess charges if they occur. Medigap Plan F and Plan G cover these costs.
Will I be able to keep my Medicare Supplement Plan F after 2020?
New beneficiaries who become eligible on or after Jan. 1, 2020 will no longer be able to buy Plan F or Plan C.
If you already have Plan F or Plan C before that date, you will be able to keep your plan. If you became eligible for Medicare before Jan. 1, 2020 and don’t yet have Plan F or Plan C, you may be able to still buy it after the law goes into effect if it’s available where you live.
How does tobacco use impact Medigap rates?
If you enroll in a Medigap plan when you have guaranteed-issue rights (such as during your Medigap open enrollment period), tobacco use and other pre-existing conditions will not affect how much you pay for a Medigap policy. During your Medigap open enrollment period, insurance companies are legally required to sell you a Medigap policy, cover all of your pre-existing conditions and charge you the same amount as other people in your area for the same policy.
Your open enrollment period lasts six months and begins the day you are both 65 and enrolled in Medicare Part B.
If you miss your Medigap open enrollment period, you can still sign up for a Medigap policy, but insurance companies will be allowed to take your health status and past medical history into account when deciding how to set your premium costs. If you use tobacco, you may have to pay more for a policy than nonsmokers.
What is Medicare Advantage?
Medicare Advantage (Medicare Part C) is a way to get your Medicare benefits through a private insurance company that contracts with the federal government. Most Medicare Advantage plans offer additional benefits beyond what is offered by Original Medicare, such as dental, vision or prescription drug coverage.
Medicare Advantage plans are not the same as Medicare Supplement Insurance plans. You cannot have both at the same time.
What are the benefits of having a Medicare Advantage plan?
Generally, Medicare Advantage plans will offer additional benefits not covered by Original Medicare, such as dental, vision and prescription drug coverage. Medicare Advantage plans must offer at least the amount of coverage offered by Original Medicare. Depending on the type of plan you purchase, you may be limited to a set network of doctors and providers.
What is a Medicare HMO?
Health Maintenance Organization (HMO) plans are a type of Medicare Advantage plan that require you to stay within a specific network of providers when seeking medical care, with the exception of emergency care. If you venture outside of your network, you will be responsible for all costs in most situations.
Unlike Original Medicare, which is managed by the federal government, Medicare HMO plans are sold by private insurance companies. Learn more about Medicare HMO plans by reading our guide, What Are HMO Plans and How Do They Work?
What is a Medicare PPO?
Preferred Provider Organization (PPO) plans are a type of Medicare Advantage plan. They are more flexible than HMO plans, as they offer coverage for medical care outside of your plan network. However, choosing to stay within your plan’s network can provide you with lower health care costs.
Like Medicare HMO plans, Medicare PPO plans are sold by private insurance companies.
Can I change my primary care physician if I have Medicare Advantage?
If you have a Medicare Advantage HMO plan, you will need to choose a new primary care physician from the plan’s network of doctors in order to be covered. You will need to check with your plan to see its list of in-network doctors. Once you choose a new physician, contact your insurance provider directly to notify them of your switch. The company should send you a new insurance card listing the details of your new primary care doctor.
If you have a Medicare Advantage PPO plan, you may be charged less if you choose a new physician from your insurance company’s list of preferred doctors. You should be able to find the list of preferred doctors on your plan’s website.
Be sure to always call your new physician to make sure they are accepting new patients before changing your primary care doctor.
What if my doctor is not in my Medicare Advantage plan network?
If you have a Medicare Advantage plan, you may be required to choose a primary care doctor from a list of physicians in your plan’s network. If you have a Medicare Advantage HMO plan and your doctor is not included in the plan’s network of doctors, you may have to choose a new primary care doctor in order to get coverage.
To avoid having to find a new doctor or pay more for health care, you should make sure your doctor is included in your Medicare Advantage plan’s network before you purchase a policy.
What happens if my doctor leaves my Medicare Advantage network?
If you do not want to find a new provider, you have some options for switching your coverage when your doctor leaves your Medicare Advantage network.
If your doctor leaves your plan network but is part of another Medicare Advantage plan provider’s network, you can switch to another Medicare Advantage plan during the annual election period (also called Medicare Open Enrollment) from Oct. 15 to Dec. 7.
If your doctor decides to stop accepting your Medicare Advantage plan but still accepts Medicare, you can switch from Medicare Advantage to Original Medicare during the annual election period or the annual Medicare Advantage Disenrollment Period (Jan. 1 to Feb. 14).
Depending on your situation, you may be eligible for a special enrollment period to sign up for a new plan.
Find out more about what to do when you doctor leaves your Medicare Advantage network.
Can I get Medicare Part C and Part D plans at the same time?
Medicare Part C — also known as Medicare Advantage — and Medicare Part D serve two different functions. You could potentially enroll in both types of insurance coverage simultaneously, but you may not need to.
Medicare Advantage plans provide all of your Original Medicare benefits (Part A and Part B) under one plan from a private insurer rather than from the government. These plans often include prescription drug coverage, making it unnecessary to also sign up for a standalone Medicare Part D plan.
If your Medicare Advantage plan does not include prescription drug coverage, you may be able to purchase a Medicare Part D Prescription Drug Plan, but you should contact your Medicare Advantage provider before you make that decision.
How do Medicare plan star ratings work?
Medicare uses something called a “Star Rating System” to measure the performance of Medicare Advantage and Medicare Prescription Drug Plans (Part D). Under this system, plans are rated from one to five stars based on how well they perform in several different categories, including customer service and quality of care.
Are there any zero dollar premium plans?
There is such thing as a $0 premium Medicare Advantage plan. With these plans, you typically will be responsible for costs such as copayments, coinsurance and your Medicare Part B monthly premium. Compare all of your Medicare options before choosing a plan, as they will each come with different costs and coverage amounts.
How can I get Medicare prescription drug coverage and when?
You can choose to sign up for a Medicare Prescription Drug Plan (Part D) during your Initial Enrollment Period. Prescription drug coverage is optional and offered at an additional cost as a stand-alone benefit by private insurance companies to anyone with Medicare. You can also obtain prescription drug coverage through a Medicare Advantage plan that offers it.
In addition to your Initial Enrollment Period, you can add, switch or drop a Part D plan during Open Enrollment (October 15 ‒ December 7) each year.
How much is Medicare Part D?
Original Medicare does not cover most prescription medications. For that, there is Medicare Part D. Medicare Part D, or Medicare Prescription Drug coverage, is separate insurance you can purchase from private insurance companies if you need help covering the cost of prescription drugs while on Medicare. Or you can obtain prescription drug coverage through certain Medicare Advantage plans.
The price of your plan will vary based on the drugs you need covered and the pharmacy you go to. Your plan will likely also include a yearly deductible, copayments or coinsurance. All of these factors could influence the amount you pay each year for Medicare Part D.
People with limited financial resources may qualify for Extra Help to cover the costs of prescription drugs. Learn more about income requirements and the costs of drugs with Extra Help.
Can I get any additional help paying for prescription drug costs?
If you have a Medicare Prescription Drug Plan (Part D) and have limited financial resources to pay for medications, you may qualify for Extra Help from Medicare. The Extra Help program can help cover costs such as Part D plan deductibles, premiums and other costs.
You can apply for Extra Help through the Social Security Administration. You may also automatically qualify if you receive full Medicaid benefits, get help from Medicaid to pay your Part B premiums or receive Supplemental Security Income (SSI)
If you do not qualify for Extra Help, you can talk to your doctor about switching your prescriptions to cheaper, generic alternatives. You can also ask if the company that makes your drugs offers a pharmaceutical assistance program.
Do I need prescription drug coverage if I have Medigap?
Medicare Supplement Insurance plans do not cover prescription drugs. You may want to consider purchasing Medicare Part D prescription drug coverage if you’re considering buying a Medigap plan.
Does prescription drug coverage from Medigap keep me from having to pay a Medicare Part D penalty?
In order to avoid a penalty for signing up late for Medicare Part D (prescription drug coverage), you must have what Medicare considers “creditable” drug coverage from another source, such as from a group plan from your current employer.
If you have a Medigap policy that offers creditable drug coverage (purchased before Jan. 1, 2006), you do not need to sign up for Medicare Part D. Keep in mind that Medigap plans sold after Jan. 1, 2006 no longer offer prescription drug coverage.
If your Medigap plan does not offer drug coverage, you should sign up for Medicare Part D during your Medicare Initial Enrollment Period to avoid paying extra for your Part D premiums.
Your Medigap plan provider should send you a notice each year confirming that your drug coverage is still creditable. You should keep these notices in your records in case you ever decide to switch to a Medicare Part D plan.
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