Frequently Asked Questions
 

What is Medicare?
When am I eligible to receive Medicare Benefits?
When do I sign up for Medicare?
What are the different parts to Medicare?
Does Medicare cover my prescription drugs?
What is a Formulary?
What is the difference between generic and brand drugs?
Will Medicare take care of my medical expenses?
Where do I go if I have additional question?

 

What is Medicare?

Medicare is the federal health insurance program for people 65 years or older, certain people with disabilities under age 65, and people with certain diseases. Medicare has several parts – Part A, which is hospital insurance, Part B, which is medical insurance and Part D, which is prescription drug coverage. Most people do not have to pay for part A, and part B is usually paid by a monthly deduction from your Social Security check.
 
Medicare is a critical source of health insurance for many Americans. Anyone who is eligible may receive Medicare benefits, regardless of any pre-existing conditions.

  

When am I eligible to receive Medicare benefits?
 
You are eligible for Medicare if you are a U.S. citizen or have been a permanent legal resident for five continuous years, and:
 
  • You are 65 years or older and eligible to receive Social Security; or
  • You are under 65, permanently disabled, and have received Social Security disability insurance payments for at least two years; or
  • You get continuing dialysis for permanent kidney failure or need a kidney transplant.
 
(Kaiser Family Foundation)
 
 

 

When do I sign up for Medicare?
 
Eligibility for Medicare normally begins upon turning 65, even if your eligibility for full Social Security benefits does not begin until later. If you choose to receive Social Security early, this does not affect when you become eligible for Medicare, but it may affect the enrollment process. This part may be very complicated, so we have grouped this information into categories, based upon age and circumstances.
 
  • If you are already receiving Social Security benefits when you turn 65, you will automatically be enrolled in both Parts A and B of Medicare, effective on the first day of the month that you turn 65. A Medicare card will arrive in the mail about three months before your birthday. You can choose to decline Part B coverage, but you should take it if you want to have full Medicare benefits and avoid paying a Part B premium penalty later on (unless you have health care coverage through you or your spouse’s current employer).
  • If you are not receiving Social Security benefits when you turn 65, you need to apply for Medicare if you want it. You will not be enrolled automatically. You may apply at any Social Security office during the initial enrollment period, which is a 7 month period that includes the three months before your 65th birthday, the month of, and three months after.
  • If you do not enroll in Medicare during the initial enrollment period, you must enroll during a general enrollment period, which is January 1st through March 31st of every year. Your coverage will begin on July 1st of the year you sign up. If you wait until after your initial enrollment period, you may have to pay a penalty for each year you delayed enrollment. This penalty will be added permanently to your Part B premium.
  • If you or your spouse are still working when you turn 65, and you have health care coverage through your employer, you may be able to delay enrolling in Part B. If you choose to do so, you must notify the government. Once you or your spouse stop working and are ready to receive Part B coverage, you must enroll within eight months of the time that you stopped working in order to avoid a late enrollment penalty charged by the government. Your coverage will begin the month after you enroll. You should check with your Social Security office before declining Part B to be sure you will not have to pay a penalty for late enrollment.
  • If you have continuation health care coverage from a former employer, sometimes call COBRA, you still should enroll in Medicare Parts A and B during your initial enrollment period. Your health insurance under COBRA typically ends as soon as you are eligible for Medicare.
Your Open Enrollment Period is a one-time only six-month period when you may buy any Medicare Supplement plan or Medicare Advantage plan that is sold in your state. It begins in the first month that you are covered under Medicare Part B and you are age 65 or older. During this period, you cannot be denied coverage or charged more due to past or present health problems.
  
What are the different parts to Medicare?
 
Medicare covers many health care needs for today’s seniors and others who qualify. Medicare looks vastly different than it did just a few years ago. Private companies approved by Medicare provide different ways to get your health care and prescription drug coverage. The Medicare plan that you select will affect your out of pocket expenses, benefits, ability to select a doctor, administrative convenience, and quality.
 
 
Part A
 
The part of Medicare that covers hospice care, home health care, skilled nursing facilities, and inpatient hospital stays.
 
 
Part B
 
The part of Medicare that covers physician fees, outpatient hospital care and other medical services not requiring hospitalization.
 
 
Medicare Advantage
 
Plans offered by private insurance companies that contract with Medicare to provide you with all your Medicare Part A and Part B benefits. Medicare Advantage Plans are HMOs, PPOs, or Private Fee-for-Service plans (PFFS). If you are enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan, and are not paid for under the Original Medicare Plan.
 
 
Medigap
 
 Medigap plans are supplemental insurance plans sold by private insurance companies to fill "gaps" in Original Medicare coverage. You can choose from a range of standardized plans, each offering different coverage. Beginning in 2010, there are 11 available Medigap policies (A, B, C, D, F, high deductible F, G, K, L, M, and N). To qualify for enrollment in a Medigap policy, you generally must have Medicare Part A and Part B. Medigap policies only work in conjunction with the Original Medicare plan and will not pay for costs associated with Medicare Advantage. People in Medicare Advantage plans should not purchase Medigap policies.
 
 
Prescription Drug Coverage (Part D)
 
Prescription drug coverage is available to all people who are eligible for Medicare. To receive coverage for prescription drugs, people must enroll in a private prescription drug plan, sometimes known as a "Part D plan." Plans are offered through insurance companies approved by Medicare. Part D coverage is optional, though you may be charged a penalty fee if you are without prescription drug coverage and later want to enroll in a Part D plan.
Does Medicare cover my prescription drugs?
Medicare offers insurance coverage for prescription drugs through Medicare prescription drug plans and other health plan options. Medicare’s prescription drug coverage will typically pay over half of your drug costs next year, for a monthly premium.  If you have limited income and resources, you may qualify for extra help. Most people who are eligible for this extra help will pay no premiums, no deductibles, and no more than $5 for each prescription. The amount of extra help depends on your income and resources.  
 
What is a Formulary?
A formulary is a select list of medications covered by an insurance plan. 
 
What is the difference between generic and brand drugs?
A generic medication contains the same active ingredients and they meet the Food and Drug Administration (FDA) specifications for identity, strength, quality and purity. So your body will absorb and use the generic medication in the same way as the brand-name drug. A generic medication generally costs less than brand medication (anthem.com).
 

 Original Medicare covers many health care services and supplies, but there are many costs ("gaps") it doesn't cover. There are several health care coverage plans that can help you pay for certain services above and beyond Original Medicare. For this reason, we recommmend that  everyone look at health insurance options that provides protection that exceeds original Medicare.

Where do I go if I have additional questions?
Call McGohan Brabender Senior Solutions (MBSS) at 1-877-222-1942 (Hours of Operation: 8:00a.m. - 5:00p.m. Monday through Friday) and one of our Customer Care team members would be happy to help you.