FREQUENTLY ASKED QUESTIONS

Medicare is divided into four parts:

Part A (hospital insurance),

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

Part B (medical insurance)

• Medicare Part B covers medically necessary services like doctor's visits, outpatient care, preventive services, and durable medical equipment.

Part C (Medicare Advantage), and

Part D (prescription drug coverage).

Medicare and Medicaid are both government health care programs but they are very different. Medicare is generally for people who are older or disabled. Medicaid is for people with limited income and resources. When a person qualifies for both programs out-of-pocket costs can be minimal.

Initial enrollment typically begins three months before your 65th birthday and extends for seven months. There are also Special Enrollment Periods (SEPs) for certain circumstances.

It depends on the size of your employer. If your employer has 20 or more employees, you may be able to delay enrollment without penalties. If your employer has fewer than 20 employees, you generally should enroll in Medicare when you're first eligible to avoid penalties.

Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. These plans provide all your Part A and Part B benefits and often include additional benefits such as prescription drug coverage and dental and vision care.

Medigap (Medicare Supplement Insurance) is private health insurance designed to supplement Original Medicare (Parts A and B). It helps pay some of the healthcare costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.

You automatically get Part A and Part B after you get one of these:

• Disability benefits from Social Security for 24 months

• Certain disability benefits from the RRB for 24 months

You don’t need to sign up if you automatically get Part A and Part B. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 25th month of disability.

When you decide how to get your Medicare coverage, you might choose:

• A Medicare Advantage Plan (Part C)  

• Medicare prescription drug coverage (Part D)

There are specific times when you can sign up for these plans, or make changes to coverage you already have.

No, you do not pay the agent directly when signing up for Medicare. Agents who assist with Medicare enrollment and provide guidance on plan selection typically receive commissions from the insurance companies whose plans they sell. These commissions are built into the cost of the insurance premiums and are regulated by the Centers for Medicare & Medicaid Services (CMS).

In other words, the commission is paid by the insurance company, not by you as the Medicare beneficiary. This means that the assistance provided by the agent is typically at no additional cost to you. It's important to work with a licensed insurance agent who specializes in Medicare to ensure you're getting accurate information and assistance tailored to your needs.

Choosing the right Medicare plan depends on your individual healthcare needs, budget, and preferences. Factors to consider include your current health status, prescription drug needs, preferred doctors and hospitals, and any additional benefits you may want, like dental or vision coverage. It's often helpful to compare plans using the Medicare Plan Finder tool or to consult with a licensed insurance agent specializing in Medicare.