Question 1

What does Medicare cover?

Accepted Answer

Medicare Part A, B, C and D
Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Question 2

How and when do I enroll in Medicare?

Accepted Answer

In most cases, if a client is already getting benefits from Social Security or the Railroad Retirement Board (RRB), they will automatically get Part A and B starting the first day of the month they turn 65.  If their birthday is not the first day of the month, Part A and Part B will start the first day of the prior month. If a beneficiary is under 65 and disabled, they will automatically get Part A and B after they get disability benefits from Social Security or certain disability benefits from the Railroad Retiree Board for 24 months. Beneficiaries will receive a red, white, and blue Medicare card in the mail 3 months before their 65th birthday or their 25th month of disability.  If a beneficiary wants to opt-out of Part A and/or Part B they will need to follow the instructions that come with the card and send the card back to Social Security.  If they keep the card, they are confirming their enrollment into Medicare Part A and B and will begin to pay a Part B premium. If a beneficiary has ALS (Amyotrophic Lateral Sclerosis) they automatically get Part A and B the month their disability benefits begin. If a beneficiary is on dialysis their Medicare will start the first day of the fourth month of their dialysis treatment. If a beneficiary is getting a kidney transplant their Medicare coverage will begin the month they are admitted to a Medicare-certified hospital for a kidney transplant. If a beneficiary is not collecting Social Security benefits or Railroad Retirement Board benefits, they must enroll themselves into Medicare.  Beneficiaries can do so by:
Going online to medicare.gov or ssa.gov and create an account to complete their Medicare application
Go to their local Social Security office and apply for Medicare in-person
Or, meet with a Sunnyside Medicare agent and we can help you with the enrollment process in our office.

Question 3

What is a Prescription Drug Plan?

Accepted Answer

Medicare Part D (prescription drug coverage) can be added to Original Medicare when a beneficiary enrolls in a Medicare prescription drug program. Rather than having coverage provided by Original Medicare, some people opt to have their coverage through a Medicare health plan like a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO).  These plans are called Medicare Advantage plans, or Medicare Part C, and are offered by private insurance companies.  These plans may also include prescription drug coverage and other benefits not offered under Original Medicare.

Question 4

What is Medicare?

Accepted Answer

Medicare is the nation’s largest health insurance program, currently converging about (44) million Americans. Enrollment is expected to rise to 79 million by 2030.
President Lyndon Johnson signed the Medicare program into law on July 30th, 1965 and Medicare became effective July 1, 1966
Medicare is a federal health insurance program administered by The Centers for Medicare and Medicaid (CMS) for three groups of people:
Medicare-eligible due to age
Medicare-eligible to certain disabilities
Medicare-eligible with end-stage renal disease (ESRD)

Question 5

What are Medicare penalties for late enrollment?

Accepted Answer

If a beneficiary does not buy Part A when they first become eligible, they may have to pay a monthly premium penalty. The premium is subject to a 10% increase payable for twice the number of full twelve-month periods a beneficiary could have been enrolled in Part A but was not. The 10% premium surcharge will apply only after 12 months have elapsed from the last day of the Initial Election Period (IEP) to the last date of the enrollment period that was used to enroll. In other words, if it has been less than 12 months, the penalty will not apply. This penalty will not apply to beneficiaries who are working and covered by a group health plan through their employer or union, or during the 8-month period that begins the month after the employment ends or the group health coverage ends, whichever happens first.

Question 6

What is a Medicare Supplement Plan?

Accepted Answer

A Medigap policy is an insurance policy that helps supplement Original Medicare and is sold by private insurance companies. A Medigap policy can help pay for some or all of the remaining health care costs that Original Medicare doesn’t pay for at 100%. If a beneficiary had Original Medicare and a Medigap Policy, Medicare is primary and will pay its share of the Medicare-approved amount for covered health care costs.  The Medigap policy is secondary and will pay a portion or all of the remaining cost that Original Medicare does not pick up at 100%. All Medigap policies must follow federal and state laws designed to protect the Medicare beneficiary, and policies must be clearly defined as “Medicare Supplement Insurance.”  Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost and potential underwriting guidelines are the only difference between Medigap policies with the same letter sold by different insurance companies.

Question 7

What is a Medicare Ancillary product?

Accepted Answer

The idea of an ancillary product is to support your Medicare Supplement or Advantage plan. Since Medicare doesn’t cover every need with your health, an ancillary product could complement your plan to help fill in the gaps. Here are a few samples of ancillary products we use to fill in the most common gaps in coverage.

Medicare FAQ's

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