Frequently Asked Questions

Do You Have Questions About Medicare?

Here is a list of the most frequently asked questions regarding Medicare enrollment.

There are a few ways to enroll into Medicare when eligible.

  1. If you are receiving retirement benefits from Railroad Retirement Board or Social Security, you will be automatically enrolled In Parts A and B when you turn 65.
  2. If you are receiving disability benefits and under the age of 65, you will be automatically enrolled after 24 months of receiving disability benefits. One exception is if you have End Stage Renal Disease, you can apply for Medicare if you had a kidney transplant or are receiving regular dialysis treatments. Lastly, if you have ALS, you are automatically enrolled in the same month your disability benefits begin.
  3. If you aren’t receiving retirement benefits prior to or on your 65th birthday, you must sign up during your Initial Enrollment Period (IEP) through ssa.gov, in person at a local Social Security office, or through the mail.

Note: If you are working past 65 with creditable health coverage, you can elect to delay your enrollment into Medicare under a Special Enrollment Period.  Make sure your coverage is creditable and your employer group is over 20 employees.

  1. Medicare General Enrollment Period is from January 1st – March 31st of each year.  This is for those individuals that did not enroll in Parts A and B during their IEP but are eligible to enroll in Medicare. However, these individuals do face the risk of a penalty for not enrolling when first eligible under their IEP. Beneficiaries approved during this period would begin coverage the first day of the following month that they enrolled.
  2. Enrollment into Medicare Part D  prescription drug coverage, does not occur automatically and is considered optional. However, if you do not enroll when first eligible, you would face a penalty for missing your Initial Enrollment Period. These plans are available through private insurers and provide benefits under this program to Medicare eligible beneficiaries. To enroll, you must live in the service area of the plan and have Medicare Part A and/or Part B. You can find information on Part D here on our website, or contact one of our experienced  Medicare insurance professionals for guidance. You can also find more information on Part D on medicare.gov.

Medicare Part B is optional.  However, failure to enroll when first eligible can place penalties on your future premiums. Therefore, it might feel optional, but also mandatory due to the penalties one might incur for failure to comply with Medicare’s enrollment periods should you choose to enroll at a late date.  By not enrolling, you are declining coverage for physician services, preventative care, ambulance services, diagnostics and durable medical equipment. The penalty to not enroll during your initial election period will be an increase of 10% for every 12 months you could have had the coverage.

Note: Carefully review your eligibility and benefits with an independent Medicare insurance agent as well as evaluating your  employer coverage before enrolling or delaying Part B enrollment.

  1. If you qualify for premium-free Part A, you can enroll at any time and your coverage will begin as early as 6 months before the month you filed, but not earlier than the month you met all Part A requirements.
  2. Relating to Parts A and B, you can enroll during the General Enrollment Period, which runs from January 1st – March 31st of each year.  If successful, your benefits would begin on the first day of the following month that you enroll.  If within 12 months of your initial eligibility, you can avoid facing a penalty for late enrollment into Part B.  If beyond 12 months, you would incur a 10% penalty for each period of 12 months you went without coverage.  Note: Individuals enrolling in Part A during the GEP would typically not be eligible for premium-free Part A.  There is a 10% penalty for Part A late enrollment;  however, it would last for only twice as long as the period they went without Part A, not forever like the Part B late enrollment penalty.
  3. Relating to Part D, after you’ve enrolled in Parts A and/or B during the General Enrollment Period (GEP), you can apply for a stand-alone Part D plan between April 1st and June 30th.  If you do, your benefits would start on July 1st of that calendar year.  Note: You would face a Part D penalty of 1% for each month you went without coverage.
  4. If you choose to enroll in Part A and/or Part B during the GEP, but chose to not enroll in Part D, you can apply for Part D coverage during the Annual Enrollment Period (AEP).  AEP runs from October 15th – December 7th of each calendar year.
  5. You can also choose to enroll in a Medicare Advantage plan during the Annual Enrollment Period (AEP) from October 15th – December 7th of each calendar year.  You would have to have enrolled in Parts A and B during the General Enrollment Period.
  6. If you enrolled in Parts A and B during the General Enrollment Period, you can apply for a Medicare Supplement plan once you are approved for coverage.  Note:  you will be subject to medical underwriting and can be denied enrollment into these plans for pre-existing medical conditions.
  1. There are a couple of reasons  you might choose  to enroll in Medicare when you first turn 65 despite being employed.  First, per CMS, if your employer has less than 20 employees, Medicare will become your primary payor of claims and your employer coverage will shift to a supplemental position when you turn 65.  Second, if your employer coverage for both medical and prescription is not deemed creditable.  If you remain on a plan that does not meet or exceed Medicare standards, you could face penalties when you finally decide to enroll in Parts A and B as well as Part D.  If you fail to enroll when first eligible, you can face the loss of guaranteed issue associated with Medicare Supplements. Note: This isn’t always the case, but due to the risk and penalties, please check with your employer or your spouse’s employer to better understand your options.
  2. If you work for an employer with over 20 employees and the coverage is creditable for Parts A, B and D, you have the option to delay your enrollment. If you meet this criteria, by delaying enrollment you will not incur any penalties for Parts A, B and D.  You would be eligible to enroll in Medicare Parts A, B and D under a Special Enrollment Period (SEP) when you finally lose coverage. Qualifying for an SEP through loss of employer coverage, you will have an 8-month period in which to enroll into Medicare Parts A, B and Medicare Supplement. Note: If you elect to enroll in Part B while working, please discuss this with your employer as well as find out the impact on your Medigap Open Enrollment Period – once it’s started, it cannot be changed or restarted.
  3. If you seek to enroll in Medicare Advantage or Part D under your SEP, you can enroll in these plans from the month that you lose coverage and the two months that follow.  The individual in this scenario can apply for an effective date or start date of these plans up to three months from the date they completed their enrollment request. Note: You must be enrolled in Parts A and/or B for Part D plans and you must be enrolled in Parts A and B for Medicare Advantage.

If you worked past 65 and delayed enrollment into Part B because you had creditable coverage, you have an 8-month window in which you can enroll into a Medicare Supplement policy with no medical underwriting.

The Annual Enrollment Period (AEP), is an important time of year for Medicare beneficiaries. From October 15th – December 7th of each year, beneficiaries can make changes to their coverage. Changes during this period can include:

  1. Switch from one Medicare Advantage plan to another.
  2. Switch from one Part D plan to another.
  3. Change from Original Medicare to Medicare Advantage.
  4. Change from Medicare Advantage to Original Medicare.
  5. Enroll in a Part D plan if you missed your Initial Enrollment Period.
  6. Opt out of your Part D coverage.

Don't see an answer to your Medicare question? Contact us today and we can answer your questions directly.