9. Is Financial Assistance Available For Medicare Costs?

medigap costYes. If you have limited income and assets, you may qualify for assistance with medical costs you receive under Medicare. You should contact Social Security at 1-800-772-1213 to see if you qualify.

Some programs you may qualify for include:

  • Medicaid helps pay costs not covered by Original Medicare (Part A and Part B). It may also include some added benefits that Original Medicare doesn’t cover, including prescription drugs, eye care or long-term care.
  • The Medicare Savings Program helps you pay your Original Medicare premiums, deductibles and coinsurance.
  • Programs of All-Inclusive Care for the Elderly (PACE) combines medical, social and long-term care services for people over the age of 55 who meet the qualifications to receive nursing home care, but live and get their services in the community. This program is not available in all states.
  • Prescription drug premium assistance programs help pay some or all Medicare Part D premiums, deductibles, copays and coinsurance.
  • Other programs may be available in your state.

10. Are There Penalties For Missing My Initial Enrollment Period?

question manYes. Missing your Enrollment Period can be costly.

Medicare Part A is premium free if you or your spouse worked and paid taxes for at least ten years. If you do need to pay a premium, the penalty is 10% of the Part A premium for signing up outside of your Enrollment Period. You will have to pay that penalty for twice the number of years you delay enrollment. In other words, if you wait for 4 years to enroll, the 10% premium penalty will need to be paid for 8 years.

If you do not sign up for Medicare Part B when you are first eligible, you will have to pay a 10% premium penalty for every 12 months you delay your enrollment. For example, if your Initial Enrollment Period ended September 30, 2010 and you signed up for Part B during the General Enrollment Period in March 2012, then your Part B premium penalty would be 20%. You waited a total of 30 months to sign up, but that included only two full 12-month periods.

In most cases, the Part B penalty will be attached to your premium for as long as you have Part B coverage.

You enroll in Medicare Part D by buying a standalone prescription drug plan or enrolling in a Medicare Advantage plan that includes drug coverage. This penalty is set by Medicare. For each month you delay, you may pay an additional 1% of the average premium per month. You will pay that penalty for as long as you’re enrolled in a Medicare Part D plan.

12. What Changes Can I Make To My Medicare Coverage During Open Enrollment?

medicare question2During the Open Enrollment Period you can make changes to your Medicare coverage. Here are your options:

  • Change from Original Medicare to a Medicare Advantage plan.
  • Change from a Medicare Advantage plan back to Original Medicare.
  • Switch from one Medicare Advantage plan to a different Medicare Advantage plan.
  • Switch from a Medicare Advantage plan that doesn’t offer drug coverage to one that does.
  • Switch from a Medicare Advantage plan that offers drug coverage to one that doesn’t.
  • Join a Medicare prescription drug plan.
  • Switch from one Medicare prescription drug plan to a different Medicare prescription drug plan.
  • Drop your Medicare prescription drug coverage completely.

13. General Enrollment Period

march 31stThe General Enrollment Period is an period of time where those who did not elect to enroll into Medicare during their Initial Enrollment Period can enroll. It runs every year from January 1st through March 31st.

14. Special Enrollment Period

special-enrollment-periodThere are a few situations in which you may be able to enroll into Medicare outside of the Initial Enrollment Period or the Open Enrollment Period. These include major changes in your life such as:

You retire and leave a health care plan that you had enrolled in through your employer or a union.

You relocate outside of the service area of your current health plan.

15. Initial Enrollment Period

Health benefit election formThe Initial Enrollment Period is your first opportunity to enroll into Medicare. It is the three months before your 65th birthday, the month of your birthday, and the three months following your birthday.

If you enroll before your 65th birthday, your coverage begins on the first day of your birth month.

For example, if your birthday is July 27th, and you enroll into Medicare for the first time in the May preceding your 65th birthday, your coverage will go into effect on July 1st.

If you enroll in the month where your birthday falls or later, your coverage will begin the first day of the following month.

For example, if your birthday is July 27th, and you enroll into Medicare for the first time on July 17th, your coverage will go into effect on August 1st.

16. When Can I Make Changes To My Medicare Coverage?

seniorwomanOnce you are enrolled into Medicare, you can make changes to your existing coverage once per year during the Open Enrollment Period. Open Enrollment starts on October 15th and extends through December 7th each year. Your changes will then take effect on January 1st the following year.

20. When Is The Medicare Open Enrollment Period?

open enrollmentMedicare Open Enrollment starts on October 15th each year and runs through December 7th. Your enrollment or any changes you make to your plan then take effect on January 1st of the following year.

For example, if you enroll in Medicare on December 1st, 2013, your coverage begins on January 1st, 2014.

24. Medicare Part D Coverage

medicare-part-dPrescription drug coverage is provided under Medicare Part D. It is issued by private insurers and is a policy you purchase separately. Plans will vary from insurer to insurer. Some have deductibles. Some do not. Once your deductible is met, the plan pays for some or all of your prescription drug costs up until an annual cost of $2,970. At that point you have reached the Medicare Donut Hole up until an annual cost of $4,750.

Previously, beneficiaries paid 100% of their costs inside the Donut Hole before Part D coverage kicked back in. Under Obamacare, participants now pay 52.5 percent of the cost for brand name drugs and 79 percent of the cost for generic drugs.


25. Medicare Part C Coverage

medicare-part-cMedicare Part C is also known as Medicare Advantage. These are private plans that are run through Medicare. Medicare requires that they be “equivalent” to Part A and Part B coverage. That equivalency does not mean they are identical in coverage to Part A and Part B. A Medicare Advantage plan may cover less of one thing but more of something else than what is covered under either Part A or B.

Some Medicare Advantage plans will provide you with significantly more coverage than anything provided by Part A and B, often including prescription drug coverage. In that way, they are similar to a Medicare Supplemental or Medigap plan. The difference between them though is that they are administered by Medicare rather than private insurance companies.