Frequently Asked Questions
This section will constantly evolve and expand as time goes by.
We've listed a number of very common questions or concerns below. As time goes on, we will add more to the list. This is an on-going process that we will continue to explore. If you have any particular question that you can not find answers for on our website, please do not hesitate to reach out to us. If you read anything on our site that you would like more clarification, we would be happy to provide that as well.
I was told that Medicare Part B coverage (Doctor visits, outpatient services, etc.) was OPTIONAL. Why is there a penalty for late enrollment?
Part B is options only because certain situations allows you to delay enrollment. If you or your spouse are employed and covered by an Employer Group Health Insurance (EGHI) policy, enrolling in Medicare Part B is not required and is optional. Some may still opt to be covered through Medicare insurance instead of their EGHI. A late enrollment penalty can be assessed for every full 12 months without Medicare Part B (once eligible), if not enrolled in you or your spouse's EGHI. Cobra insurance DOES NOT HELP prevent this penalty. The penalty is a permanent 10% increase in your Part B premium for each full 12 months without proper coverage. Enrollment into Medicare Part B is further restricted, once you miss your Initial Enrollment Period and are not covered with a qualifying EGHI plan.
I do not currently take any prescription drugs and was told that Medicare Part D was OPTIONAL. Why am I now being told there is a late enrollment penalty?
This is a common issue that many were not properly aware of. You are not required to enroll in Medicare Part D, but unless you have had creditable prescription drug coverage, you are subject to a late enrollment penalty. The formulas are complicated, but we can clarify for you if necessary. Examples of creditable coverage includes some EGHI through you or your spouse's employer, VA, TriCare, etc. The penalty for not having creditable coverage or enrollment in Medicare Part D can be very small, but the calculations grow with every month that passes without proper insurance. The penalty is permanent, unless you qualify for Extra Help through Social Security. Contact us for details or help either avoiding the penalty or steps to take to prevent its growth. Here's a video that introduces the Part D late enrollment Penalty.
Still have questions or need additional assistance?
How do some people qualify for Medicare before turning 65?
Generally speaking, most must wait until they turn 65, however some medical conditions like ALS or End Stand Renal Disease can prompt Medicare Enrollment. For those who are permanently disabled and qualify for SSDI, they will be automatically enrolled in Medicare with an effective date on the 25th month of their disability. SSDI qualification requires appropriate work history. Those without necessary work history will only qualify for SSI and therefor will not be eligible for Medicare until age 65. (Some people who qualify for SSDI may get additional SSI, so having the SSDI portion indicates they had sufficient work history and will qualify for auto-enrollment). You are not allowed to opt into coverage without a qualifying event.
I travel a great deal, or plan to travel during retirement. Isn't a Medicare Supplement most suited for me?
Sometimes Medicare Supplement Plans are most suited for those who travel a significant amount. Coverage allows them to see any provider in the Country who accepts Medicare patients.
That being said, even Snow Birds who live in Arizona 4-5 month of the year have successfully used Medicare Advantage plans for coverage. Why? Medicare Advantage plans still provide worldwide coverage for urgent care and emergency services. Those in relatively good health tend to wait to see specialists, once they return to Washington. While traveling, they still have full access to urgent care and emergency services. Some Medicare Advantage Plans also include travel benefits allowing you to utilize doctor networks Nationwide. This aids those with more pressing needs to see specialist, while out of town. Some people may still prefer the flexibility of Medicare Supplement plans or may have chronic conditions requiring more frequent use of specialist. We can help evaluate your options, when we schedule a FREE consultation.
I qualify for both Medicare and Medicaid. My prescription costs are good and I pay nothing to see a doctor. I've heard of Special Needs Plans that I can add. Why do I need to add anything? Would adding additional coverage affect my current coverage under Medicaid?
Nobody NEEDS to add additional insurance coverage if covered by both Medicare and Medicaid (referred to as Dual Eligible). They simply WANT that added benefits that come FREE with Dual Special Needs Plans (DSNP). Adding a DSNP does NOT affect coverage with Medicaid, since Medicaid coverage is coordinated by such plans. It does not affect prescription drug costs, since the pricing is established by the Extra Help program and transfers automatically to any DSNP plan. What additional benefits may be included? The list is long and may differ depending on which plan you choose. Go to our Low Income Assistance page to read more. Please contact us for plan availability, determining eligibility, and for personalized guidance. It's extremely rare that Dual Eligible individual do not benefit significantly by adding a DSNP. It's most likely they didn't know about such plans, or received bad advice from someone unqualified to answer plan specific questions.