Leaning More About Medicare

Robert Spafford  801 573-0001


Top 10 Medicare Questions


  1. How do I know which Medicare Coverage best suits my needs?

You need to understand your personal needs to answer that question. Everyone’s situation is a little different.

  1. What is the cost of Medicare?

The type of coverage you choose determines your cost. Typically you pay your Part B premium to Medicare. In addition to that you may pay other premiums, deductibles, co-pays and co-insurance. The full amount will depend on the Medicare coverage you choose and the health care services you use.


  1. If I’m planning on working past 65 how does that impact Medicare?

If you work past 65 and have employer coverage you may choose to enroll just in Part A. Generally, Part A is premium free if you or your spouse worked and paid Medicare taxes for at least 10 years. If your employer provides credible coverage you can postpone enrolling in Part B without any penalty.


  1. Does my Medicare coverage include Dental and Vision insurance?

Traditional Medicare does not include Dental or Vision but some Medicare Advantage Plans do. You can also purchase supplemental Dental and Vision Insurance.


  1. What type of coverage is available in addition to just Medicare Part A and B?

Two option are available. A Medicare Supplement, called Medigap that is offered by private insurance companies. There are also Medicare Advantage Plans that is an alternative. Each type of plan provides additional coverage to Traditional Medicare. 


  1. What type of Medicare Advantage Plans are available?

There are typically two types of Medicare Advantage Plans. An HMO that has a network of providers you need to use for the lowest cost much like your insurance plans you have now. And a PPO which will help pay for costs outside of their network but it is still less expensive to stay within the PPO network.


  1. Is financial help available to help pay for Medicare?

There are federal and state programs available to help pay for some or all of your Medicare costs. They include Extra Help, Medicare Savings Programs and Medicaid. The qualifications for each is based on your income and assets.


  1. Do I have to make a decision every year or do the Medicare plans automatically renew?

Your Medicare plan will automatically renew every month or year depending on the plan you choose. CMS (Center for Medicare and Medicaid Services) recommend you review your plan annually typically during AEP (Annual Enrollment Period) which is October 15 to December 7 to determine if the plan still meets your needs.


  1. What’s the difference between Medicare and Medicaid?

 Medicare is generally for people who are older or disabled. Medicaid is for people with limited income and resources. Medicare is a federal government program whereas Medicaid is run by the state.


  1. I’m disabled.  Am I still able to qualify for Medicare before I’m 65?


After you qualify for disability you have to typically receive Social Security benefits for 24 months before you qualify.  There are exceptions for people with certain medical conditions.




The Four Most Important Things to Know About Medicare Before You Retire


  1. When do I need to enroll?

Perhaps the simplest enrollment occurs when you are already receiving Social Security benefits.


If you are already taking Social Security benefits, you will be automatically enrolled in parts A and B. You have the option to turn down Part B, since it has a monthly cost. If you keep it, the cost will be deducted from your Social Security. If you choose to turn down Part B you could incur a late enrollment penalty in the future and be limited as to when you can start you Part B benefits.


For those not yet receiving Social Security you will have to sign yourself up for parts A and B. There is a seven-month initial enrollment period beginning three months before the month you turn 65 and ending three months afterward.


If you are working and have health insurance through your employer, or if you’re covered by your spouse’s employer coverage, you may be able to delay signing up for Medicare. However, be mindful that you will need to sign up for Medicare within eight months of losing your employer’s coverage to avoid significant penalties when you eventually enroll.


  1. What options are available through Medicare?

Medicare offers a variety coverage options.


Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.


Part B covers certain doctors’ services, outpatient care, medical supplies and preventive services.


Part D adds prescription drug coverage to some Medicare programs.


Often referred to as “Part C,” Medicare Advantage Plans are approved by Medicare and run by private insurance companies. These plans often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services.


  1. What do I pay?

For Part B and Part D, your monthly payment depends on your income level. Part A, which pays for hospital services, is free if either you or your spouse paid Medicare payroll taxes for at least 10 years. If you did not pay the Medicare payroll taxes for at least 10 years, you will still be able to take part in Plan A, but it will cost a monthly premium.


Part B and Part D have surcharges when your adjusted gross income is more than $85,000 if you are single or $170,000 if married filing jointly. For example, Part B, which covers doctor visits and outpatient services will cost new enrollees about $134 per month if income is below these thresholds and will increase if income exceeds these thresholds.


Part D, which covers prescription drug costs, also has a monthly charge that varies depending on which plan you choose. In addition to premium costs, you’ll also be subject to co-payments, deductibles and other out-of-pocket costs. If you choose not to enroll in Part D you may incur a late enrollment penalty if you enroll in the future.


  1. Does Medicare cover everything?

While Medicare is meant to be a wide-ranging health benefit for you in your retirement years, it doesn’t cover everything. In fact, Medicare does not cover final expense, preventive vision, dental or hearing services. Because many seniors require services they enroll in additional plans outside of Medicare to get coverage for these needs.


Robert Spafford  801 573-0001


When you need supplemental coverage to take care of the gaps in Medicare, or when you aren’t sure what coverage you need, Contact Me, Robert Spafford @801-573-0001 or rspaff@gmail.com