Frequently Asked Questions

What are my coverage choices? 

Original Medicare (Parts A & B) is provided by the Federal Government. It helps pay for Hospital stays (Part A) and Doctor visits and outpatient care (Part B), but it doesn't pay for everything.

 

How much does Medicare cost?

Part A has no premium as long as you or your spouse paid Medicare taxes for at least 10 years.

The Part B standard premium for 2024 is $174.70 per month. most people pay the standard premium, but if your income two years ago was higher than the limit, you will have to pay the standard premium plus an income related monthly adjustment amount (irmaa)
– see next question. If you are receiving social security benefits, the premium will be deducted monthly from your benefit payment. If you are not yet receiving social security benefits, you will be billed quarterly for the Part B premium, and you can pay by a variety of ways, including check, money order, credit or debit card, medicare easy pay or your bank’s online bill pay service.

 

How do I enroll in Medicare?

If you are already getting benefits from Social Security or the RRB, you'll automatically get Part A and Part B starting the first day of the month you turn 65. (If you are born on the 1st day of the month, your effective date will be the 1st day of the prior month).

If you are automatically enrolled, you'll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability.

If you are not receiving Social Security benefits you need to sign up for Medicare when you become eligible. You can enroll up to 90 days before your effective date by going to www.medicare.gov, by visiting you local Social Security office, or by calling 1-800-MEDICARE (1-800-633-4227).

 

What is covered by Part A?

Part A covers hospital stays and inpatient care, including semi-private room, meals, drugs, medical supplies, lab tests, operating room and recovery room services and hospice care up to 60 days. It is not completely free because you are responsible for the Part A deductible which is $1,632 per admission in 2024.

 

What is covered by Part B

Part B covers physician services (including in the hospital), annual wellness visit, lab services, x-rays and diagnostic tests, physical therapy, occupational therapy, preventive services like flu shots and mammograms, mental health care, durable medical equipment like wheelchairs and walkers, ambulatory surgery center services, ambulance and emergency room services and more.

Medicare pays 80% and the patient pays 20% of Part B charges and the annual Part B deductible for 2024 is $240.

To help reduce your financial risk, you may add coverage by enrolling in private medicare plans such as:

•  Medicare Supplement Plans (also called Medigap), which pay some of the out-of-pocket costs that come with Original Medicare.
•  Medicare Prescription Drug Plans (also known as Part D), which are designed to work with Medicare Supplement Plans and which help pay for prescription medications. Original Medicare does not pay for prescription drugs.
•  Medicare Advantage Plans (also known as Part C), are offered by private insurance companies and combine Part A and Part B coverage in one plan; they often include prescription drug coverage too, along with additional benefits not covered by Original Medicare, like routine vision, dental care, hearing exams and hearing aids (for a copay), and fitness club memberships.

 

If I enroll in a Medicare Supplement Plan along with Original Medicare parts A & B, can I choose my own doctors?

Yes, you can choose any doctor, hospital or other medical provider as long as they accept Medicare. There are no networks to be concerned about. If a provider accepts Medicare, it must accept any Medicare Supplement Plan.

 

What is a Premium?

A premium is a fixed fee that you pay for your Medicare coverage. You can pay a premium to Medicare, to a private insurance company or to both, depending on the coverage you choose. Most premiums are charged monthly.

 

If I want to enroll in a Medicare Advantage Plan, what do I need to be aware of?

Medicare Advantage Plan (HMOs) have networks, and you must stay in the network in order to have services paid for. If you use a provider outside the network you will be responsible for all charges. There are more than fifty Medicare Advantage HMO plans available in San Diego County for 2024, and a couple Medicare Advantage PPOs. The PPO allows you to go outside the network for services, but you will pay a higher copay in order to do so.

 

How do I decide between Medicare Supplement Plans and Medicare Advantage Plans?

This is a very common question, and the answer depends on what your medical needs are and what fits into your budget. We are very experienced at helping our clients sort out their options and make informed choices.

 

What are the qualifications for enrolling in Medicare?

You must be 65 or older, or if under 65, receiving disability benefits from Social Security or the Railroad Retirement Board (RRB) for at least 24 months. If you have ALS (Amyotrophic Lateral Sclerosis) you'll get Part A and Part B automatically the month your social security disability benefits begin.

You must be a U.S Citizen or a legal resident for at least 5 years in a row, including the 5 years just before enrolling in Medicare.

 

What if I am still working at 65 and don't want to enroll in Medicare at that point?

As long as you are covered by an employer group health plan, whether as an employee or a spouse, you are not required to enroll in Part B. You should enroll in Part A at age 65 because it has no premium, and it may prove to be useful if you are hospitalized.

 

What are the income limits for the Standard Part B premium?

For 2024, you will pay the standard premium for Part B if your income in 2022 was under $103,000 filing as an individual or $206,000 filing jointly. We can help you compute your premium and IRMAA if you are above the limit, just give us a call.

 

Does IRMAA apply to Part D prescription coverage also?

Yes, it does. You will pay a Part D IRMAA if your income from two years ago was above the income limits for standard premium shown above. This applies whether you enroll in a standalone Part D plan or you get your Part D coverage through a Medicare Advantage prescription drug plan (MAPD). We can help you compute your Part D IRMAA if you are above the limit, just give us a call.