Below are answers to some of your questions. We add them as new questions come in.     'SO ASK AWAY...'            Send new questions to Bob at bob.arnett@alisprotect.com

1. What exactly is Medicare?                                                     

   Medicare is a national health insurance program in the United States, begun in 1965 under the Social Security Administration and now administered by the Centers for Medicare and Medicaid Services. It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the SSA, and people with end stage renal disease and amyotrophic lateral sclerosis.   medicare.gov

2. Who is eligible for Medicare?                                                                                                                           

   Medicare is an insurance program that primarily covers seniors ages 65 and older and disabled individuals who qualify for Social Security, while Medicaid is an assistance program that covers low- to no-income families and individuals. Some may be eligible for both Medicaid and Medicare, depending on their circumstances

3. What are the different parts of Original Medicare                                                                                  

   Medicare is composed of Part A, Part B, & Part D.  In general, Part A covers things like hospital care, skilled nursing facility care, hospice, and home health services. Part A also has a monthly premium, however, it is paid for if you worked 10 years or 40 quarters in your life time. Medicare Part B covers most tests, items and services like lab tests, outpatient surgeries, and doctor visits – as well as supplies, like wheelchairs and walkers. Part B has a monthly premium that normally comes out of your Social Security and a one time annual deductible. Part D covers Prescription Drugs (Rx) and it has a monthly premium and an annual deductible. (Part A has a fixed deductible that you pay, Part B your part is 20% of the bill and Part D has many different plans to choose from.)                                                                    This is Original Medicare only, without any kind of supplement to help cover what Medicare doesn't cover.

4. Does Medicare have penalties?                                                                                                                     

   Yes, Part B has a 10% penalty per year if you do not choose to take Part B when you turn 65 unless you have other credible coverage. The Part B premium is $164.90 per month (2023). Say you don't take Part B for 2 years you will pay $16.49 x 2 years or $32.98 PLUS the going monthly premium for Part B for the rest of your life.                                                        Part D also has a penalty, Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($32.74 in 2023) times the number of full, uncovered months you didn't have Part D or creditable coverage. (.01% x $32.74 = .3274 x e.g.14 months no Rx coverage = $4.58 per month, forever)

5. Can income affect Medicare?                                                                                                                 

   Yes, However, as far as qualifying to have Medicare it does not affect it. The way it affects Medicare is by having a higher level of Income your monthly premium for Part B may increase. OR, there are programs for low income that can help to decrease or remove the monthly Part B premium and also lower prescription drugs costs. This is a Federal program called Extra Help, or Medicare Savings Programs by the State. Also known as Extra Help, Low Income Subsidy or LIS. These programs must be applied for through the Dept of Health & Welfare or Social Security.

6. How does Social Security affect Medicare?                                                                                                

   Social Security retirement benefits are available as early as age 62, but most people don't become eligible to receive Medicare benefits until age 65. If you happen to want to retire right at age 65 and therefore want to start getting Social Security and Medicare benefits at the same time, then it's easy to coordinate those benefits. Call Social Security.

7. Does taking my Social Security early affect my Medicare                                                                     

   It does make your Medicare a smoother transition but it is not necessary. By taking Social Security early you are in the SS system and they simply send you a letter when you turn 65 asking you if you wish to take your Part B. If yes, generally you do nothing and the Part B premium starts coming out of your SS check on your birth month SS payment. Depending on if you are still working, or not, and have employer credible medical coverage, or not, things change and you need to coordinate with Social Security. There are some situations where your Part B premium invoice can be mailed to you and you may pay it directly to Medicare. It is highly recommended for you to log in to the Social Security, www.ssa.gov, and Medicare, medicare.gov, websites and set up your own personal account.

8. If I didn't work during my lifetime will I qualify for Medicare benefits?                                   

   There are cases where folks do not work in their lifetime or for some reason do not contribute to FICA, the Federal Insurance Contribution Act. When this happens Part A is not funded. Part A does have a monthly premium if these FICA payments were not collected through the years. In the case of a homemaker they are credited through the spouses contribution as long as the time limit was reached for their marriage. Some situations can get pretty complicated so contact your local Social Security dept. for clarification in your situation.

9.  Will I be able to access Medicare benefits if I retire at 62 or before 65 sometime?                                          

   NO,     Basically, Medicare has nothing to do with Social Security. Medicare is Healthcare for folks that are 65 and/or older. It is also for folks of all ages that are deemed disabled through the disability process. For the majority of people Medicare begins at 65 years old. Social Security is income related not medical.

10. What are SHIBA and Medicare.gov and how can I use them?                                                              

    In Idaho we have a program that works with the Idaho Department of Insurance called SHIBA, Senior Health Insurance Benefits Advisors. Their phone number is 1 800 247 4422. They answer all kinds of questions or can direct you where you need to go. Also Medicare.gov is a great resource as well.  It is also a good idea to find a knowledgeable local agent that can show you the plans available in your areas since different parts of Idaho have different plans available. An agent can help you understand and enroll with the plan that fits your specific needs. An agent can also save you a lot of time and frustration when trying to cut through all the available information.

11. How is my birth month determined?                                                                                                            

    This is a term that simply means the month you were born, however, regardless if you were born on the 2nd or the 31st it is your birth month and your Medicare benefits will start on the first day of that month. There is, however, a positive hitch in this get-a-long. If your birthday happens to fall on the 1st of the month you will be able to get an effective benefit start date of the 1st of the previous month, e.g. If your DOB is June 1st you can get a start date for your Medicare of May 1st.

12. Can I continue to work after I turn 65 and how does it affect my Medicare                                  

    Yes, Medicare can be delayed if your employer offers coverage that is as good as or better than Original Medicare. It has to do with your Part B. Normally at 65 you will start taking and paying for your Part B. That can be delayed if the employer offers coverage as good as or better that what Medicare offers. If you started taking your Social Security at 62 you would be sent a letter before your 65th birthday asking you if you want to start taking your Part B. If you like your employer coverage you can turn your Part B down. Some folks don't take their Social Security until they are 66 up to 70. In that case, if they want Medicare, they will be billed by Medicare and will pay their Part B premium quarterly. Otherwise the Part B will be taking out of their Social Security or Railroad benefit if they are taking it.

13. Can a Medicare agent make contact with you about Medicare if you did not reach out first?  

    Short answer NO. There are definite rules for agents to follow when it comes to their dealings with Medicare Beneficiaries, A Medicare beneficiary is someone that qualifies for Medicare. A new rule came out in 2019 saying agents can contact beneficiaries via email, if, there is an unsubscribe link at the bottom of the email. Agents are definitely not allowed to call on phone or cold call at home or business. Even if the agent is given a referral from a client that does not give the agent the right to contact the beneficiary. The beneficiary must contact the agent. When the agent is at an appointment they must fill out what is called a Scope of Appointment. This explains what will be covered and that the beneficiary signs and is good with the agent there talking to them about Medicare. A new scope is needed every time they meet. The agent must keep that scope in their records for 10 years.

14. What is a Medicare Advantage plan?  

    If you currently are enrolled in Original Medicare, Part A and Part B, you can choose to enroll in Medicare Part C, more commonly known as Medicare Advantage. Medicare Advantage plans are offered by private health insurance companies to provide and coordinate Medicare Part A and Part B benefits (hospital and medical) for beneficiaries. Most of them include a Prescription Drug plan and also may include other benefits such as dental, vision hearing health club memberships and other kinds of benefits. The monthly premium is generally low to zero.

15. What is a Medicare Supplement?

    A Medicare Supplement otherwise known as a Medigap plan is an insurance plan also delivered by a private company to pay what Medicare does not cover i.e. the deductibles, copay's and coinsurances. You would still be under Original Medicare but instead of being a Part C (Medicare Advantage) it is considered Part E and fills in where Original Medicare leaves off. There are different Plans available, the most common are Plan F, G, & N,. Currently the Plan F is only available to folks born before January 1, 2020. The Plan F was considered the Cadillac. The Plan G is the pretty much the same, however, there is a one time deductible of $203 (2021) and covers just about 100% of what Original Medicare does not cover after that. It does have a monthly premium of around $150 or $200 per month, depending on the company, at age 65 and goes up, from time to time, as you get older. These plans are all the same as far as the plan coverage is concerned, However, different companies can charge what they want for them. There are different reasons for this so look for a good price and strong company together. If by chance, you loose your coverage because the company goes out of business or something you will be given an opportunity to re-enroll without answering health questions or a guaranteed issue plan. If you drop your plan to get another plan you will have to answer health questions. When you turn 65 you do not have to answer health questions because it is your Open Enrollment. Medigap plans do not have Drug coverage, you need a Stand alone plan called a PDP.

16. What is the difference between copay and coinsurance?

    A Copay is a charge the insurance plan sets as a dollar amount i.e. $5.00 to see your Primary Care Physician or $40 to see a Specialist. A test may have a copay or even a coinsurance depending what the test is. Coinsurance is a set percentage the insurance company sets for different situations i.e. MRI's, PET Scans, Procedures etc. These will change depending on the plan you have.

17.  How do I set up my SSA.Gov account online?

    Click on link https://www.ssa.gov/site/signin/en/  Select MY SOCIAL SECURITY, then on CREATE NEW ACCOUNT. Follow the steps from here to create your account. 1.      Agree to Terms by Checking Box. 2.      Personal Information (Name, Social, Birthday, Address, Phone + Email). 3.      Identity Verification – Select “Input your ID Information.” 4.      Type of ID – Select “Driver’s License” + enter DL Information. 5.      Extra Level of Security – Select “NO”. 6.      Get your Activation Code – Select “TEXT MESSAGE” (selecting the mail option will not allow you to continue until you receive a verification code in the mail). 7.      Enter Activation Code you receive via text. 8.      Create Username + Password + Answer 3 Security Questions -WRITE THIS DOWN SO YOU DO NOT FORGET. 9.      Congratulations you have successfully set up your “my Social Security account”.

18.  How do I apply for Medicare Part A & B?

    Click on link https://www.ssa.gov/  
    Click on the RETIREMENT box,
    then click on APPLY ONLINE FOR RETIREMENT BENEFITS  

       

    Follow the steps from here to complete your application for Part A + Part B.

    1. Agree to Terms by Checking Box.
    2. Select START a NEW APPLICATION.
    3. Who is Completing This Application? – select “I Am”.
    4. Do You Have a my Social Security account? – select “Yes”.
    5. Sign In -using username + password you just created your account with.
    6. Select YES for the cell phone verification (confirm that they have the correct number as they show the last 4 digits of your #).
    7. Enter Activation Code you receive via text.
    8. This is where the application starts so answer the questions on each page.

    VERY IMPORTANT – you will be issued a “Re-Entry” number at the beginning of the application. 
    This is needed if you have to stop the application and finish it later so go ahead and write the number down and then continue to answer the questions. You will be asked if you want to sign up for Social Security Benefits – you can select NO if you are going to wait for benefits.

    You will be asked if you are signing up for Medicare Part B – select “YES” - Selecting YES will also enroll you in Part A. Make sure you complete all questions until you are given the option to SUBMIT.  At that point it allows you to review your information. Once you SUBMIT, it will give you that Re-Entry number again but this time as a confirmation code that you have completed the application.

19. What is a Deductible?

    A Deductible is an amount of money the insurance company sets as an initial out of pocket $ you pay before the plan begins to pay.

20. When can I change plans?

    Every year on October 15th thru to Dec 7th you have what is called 'AEP' or the Annual Enrollment period. During this window you can select a new Advantage Plan that will become effective January 1st of the next year. If you change your mind during that window you may pick another plan and it will take precedence over the one you picked 1st. From January 1st thru March 31st you have what is called 'OEP' Open Enrollment Period. This period of time allows you to pick another plan if for some reason you don't like the one you have. You can only do this one time during this period. There are other times you can change but they are usually because of something happening in your life, i.e. move out of the area, lost employer coverage, plan cancelled, moved in or out of a nursing home,  etc.

     

21. How do I apply for Extra Help for my Prescription Drugs?

    Find out if you Qualify.  https://www.ssa.gov/benefits/medicare/prescriptionhelp.html You should complete this application for Extra Help on the Internet if: •        You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance); and •        You live in one of the 50 States or the District of Columbia; and •        Your combined savings, investments, and real estate are not worth more than $30,950, if you are married and living with your spouse, or $15,510 if you are not currently married or not living with your spouse. (Do NOT count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.) If you have more than those amounts, you may not qualify for the extra help. However, you can still enroll in an approved Medicare prescription drug plan for coverage. EXCEPTION: Even if you meet these conditions, DO NOT complete this application if you have Medicare and Supplemental Security Income (SSI) or Medicare and Medicaid because you automatically will get the extra help If you need help completing this application, call Social Security toll-free at 1-800-772-1213 (TTY 1-800-325-0778).

22. How do I find the best Medicare Supplemental Coverage to fit my needs? 

    Call Bob or Sybil Arnett @ 208 570 8390 / 208 570 8266 and set up a time to meet. We will show you what  is available to you so you can make an informed decision.

23. Your income may have an impact on how much your monthly Part B will cost.                 

24. EXTRA HELP: If your income is within a certain threshold you may qualify for financial help with your Part B premium and  financial help towards your Prescription drugs.

    25.  What is a PDP? 

    A PDP is a Prescription Drug Plan. It is a stand alone plan that you can get if you only have Original Medicare or if you have a Medicare Supplement. They usually have a hefty deductible and then a tier price once you have met the deductible. The deductible is generally not applied to the Tier 1 & 2. It starts being applied on Tier's 3,4 & 5. The tiers are different levels of drug by cost.

Email:

bob.arnett@alisprotect.com  /  sybil.arnett@alisprotect.com

Or Call: Bob - 208 570 8390   /   Sybil - 208 570 8266

Mention Questions & Answers

or

Turning65inIdaho.Com

Back