Here are answers to some frequently asked questions about Medicare.
Your initial enrollment to Medicare is a 7-month window. You have 3 months before your birthday, the month of your birthdate and then 3 months after your birthday to sign up. The first of the month of your birthday is when it starts. For example, if your birthday is July 7, it would be July 1st. The exception is if your birthday falls on the 1st of the month, then your eligibility is on the 1st of the month before.
If you have credible coverage as good as Medicare there will be no penalty.
Annual open enrollment, also known as AEP, is October 15th to December 7th with a January first start date. This is the time every year when every senior can change their prescription drug plan and their advantage plan.
A+B+D=C. An advantage Plan is all inclusive and known as Part C. It includes part A (Hospital) Part B (Doctors, testing etc.) and Part D (prescription drugs)
The difference is that in an HMO you can only use in network providers. PPO, you can use out of network providers if they accept the assignment, but you will have to pay additional fees.
Some Medicare advantage plans offer Part B give back. You may qualify for assistance if you have low income.
Everyone can join these advantage plans but an analysis needs to be done to see if this option is best for you by seeing if your doctors are in network and your medications are in formulary.
It’s when you keep your original Medicare and you complement with a plan that fills in the gaps. It does not include a drug plan. You need to have a separate drug plan.
You can change the plan anytime that you want or need to. It must be changed before the first of the month for it to start the following month.
You can go to medicare.gov, put your information in and the government will tell you which is the best Medicare options for your medications.
Everyone has to have a drug plan or you will receive a penalty. The penalty will be 1% of the national premium for every day you have not signed up for a drug plan.
The Elderly Pharmaceutical Insurance Coverage Program (EPIC) is an assistance program for medications and is income based. If you make under $100,000 as a couple or $75,000 single you qualify for the program. It will complement your current drug plan, not replace it.
No. Medicare does not cover aides in the home. If you need aides, you can self-pay, have long term care insurance or VA benefits (Aid & Attendants), or qualify for Medicaid.
A new program for 2025 for Prescription Drug costs. The TRUE-OUT-OF-POCKET cost for medications for 2025 will be $2,000.00.
It is when a Medicare recipient can set up a payment plan for cost of their medication. This program is offered through the Prescription Drug Plan.
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