Questions & Answers
What is Original Medicare?
Original Medicare refers to Medicare Part A and Medicare Part B, which are managed by the federal government. People are able to see any doctor that accepts Medicare and the government will pay a portion of the cost.
When am I able to receive Medicare benefits?
You are able to receive benefits when:
1. You turn 65 years old
2. If you are disabled and have been collecting Social Security Disability for 24 consecutive months.
How can I apply for Medicare?
There are two ways in which you may apply for Medicare:
1. Automatically - if you are collecting Social Security benefits you will automatically receive Original Medicare (both Part A and Part B) 3 months prior to your 65th birthday.
2. If you are not receiving Social Security benefits, when you turn 65 you will have to apply for Original Medicare. You may do so by visiting the Social Security Administration's website or visit your local Social Security office. Your initial enrollment periods will begin three months prior to your 65th birthday and will extend three months after your 65th birthday.
What are the parts of Medicare?
There are four parts to Medicare:
Part A (Hospital Insurance): this primarily covers hospital stays and some stays in skilled nursing facilities.
Part B (Medical Insurance): this covers doctors' visits, lab tests, and outpatient procedures, ambulance, and durable medical equipment to name a few.
Part C (Medicare Advantage): these are health plans offered by private insurance companies that provide Medicare benefits.
Part D (Prescription Drug Coverage): this helps cover the cost of prescription drugs (including many recommended shots or vaccines).
*Parts A and B are collectively referred to as "Original Medicare”*
What is the cost of Medicare?
Medicare Part A is considered free for a majority of eligible individuals but does have a deductible of $1484 per benefit period, as well as coinsurance requirements if your hospital stay lasts more than 60 days or if your skilled nursing stay extends beyond 20 days.
Part B has a monthly premium of $148.50 (or higher, depending on income) Medicare Part B has an annual deductible of $203 for 2021. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment (DME).
Part D, which are prescription drug coverage plans, have monthly premiums that vary by the plan (higher-income consumers may pay more).
What does Medicare not cover?
Medicare does not cover things such as long-term care, eye exams or glasses, most dental care, medical care overseas, cosmetic surgery, massage therapy, acupuncture, hearing aids, gym memberships, routine foot care, and prescription drugs. Medicare only covers 80% of your medical services, you are responsible for the other 20%. Some Medicare health plans may cover some of the services that Original Medicare does not.
What are Medicare Supplement Plans?
About Medicare Supplement Plans Rochester NY (Medigap Plans)
Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, such as copayments, coinsurance, and deductibles. Get your consultation schedule today to enroll in the best medicare supplement plan in Rochester NY.
What if I have health insurance through an employer? Do I have to enroll in Medicare when I turn 65?
This will depend on the type of health insurance you have. If you have insurance through your employer or your spouse's employer and the primary insured is still working, you may not be required to enroll in Medicare as long as the company sponsoring your coverage has at least 20 employees. In this case, you'll have a special enrollment period after you (or your spouse) retire or leave that employer.
If your insurance is through an employer that you have already retired from, you will need to sign up when you turn 65. If you are required to sign up for Medicare Part B, and you do not, you will be charged with a permanent penalty of 10% of the Medicare Part B premium for every year you were supposed to enroll but did not.