• Medicare FAQs

  • If your Medicare card is lost, stolen or damaged, you can request a replacement Medicare card through the Social Security Administration in the following ways:

    • Online at www.ssa.gov.
    • By phone at 1-800-772-1213 (TTY users, dial 1-800-325-0778), Monday through Friday, from 7AM to 7PM.
    • In person at your local Social Security office (Covid 19 will have closed them – check before you go)

    Your new red, white, and blue card will be mailed to the address that Social Security has on file for you within 30 days. 

    If you have moved and have not reported this information to Social Security, you will need to report your address change before they can process your request for a replacement card.

    No, but we recommend it because many of the tasks you’d like to accomplish can be done online.

    This depends on your situation. If you’ve worked at least 10 years (40 quarters) under Medicare-covered employment and paid Medicare taxes during that time, you qualify for premium-free Medicare Part A.  If your spouse has enough employment quarters, you can also qualify for premium-free Medicare Part A based on his or her work history. So enrolling in Part A may be of benefit to you.

    If you don’t have enough work history to get Medicare Part A without paying a premium, you can decide to delay enrollment if you already have health coverage through an employer or union (or through your own work or your spouse’s employer). Medicare Part B always comes with a monthly premium, so you may similarly choose to delay your Part B enrollment if you or your spouse are still working and have employer-based group coverage.

    Remember, if you don’t sign up for Medicare when you’re first eligible and don’t have group coverage based on current employment, you could have to pay a late-enrollment penalty later when you do enroll. The late-enrollment penalty applies to Medicare Part B (and Part A, if you have to pay a premium for it).

    If you do decide to wait until you stop work to enroll in Medicare Part A and/or Part B, you’ll have an 8-month Special Enrollment Period to sign up for Medicare that starts once active employment ends. You can also enroll in Medicare at any time that you are still working and have employer-based coverage.

    There are four main types of Medicare Advantage plans, but Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans are the most common types. Here is a comparison of the two varieties:

    • HMO plans require that beneficiaries see health-care providers, doctors, and hospitals within the plan’s network except in urgent and emergency situations. In some plans, known as HMO Point-of-Service (HMO-POS) plans, beneficiaries may be able to go out-of-network for certain services, but may have to pay a higher cost.
    • PPO plans do not require that beneficiaries use in-network providers and do not require a referral to see a specialist. However, using out of network doctors will come with higher cost.
    • HMO plans may require that beneficiaries choose a primary care physician and most of the time this doctor will have to refer you to see a specialist.
    • PPO plans do not require that beneficiaries choose a primary care physician. Nor do they require a referral to see a specialist.

    Both HMO and PPO plans generally include prescription drug coverage through a Medicare Advantage Prescription Drug plan (MAPD).

    The Centers for Medicare & Medicaid Services (CMS) created a Star Rating system to help beneficiaries compare performance and quality in Medicare Advantage, Medicare Prescription Drug, and Medicare Cost plans.

    Medicare plans are rated on a scale of 1 to 5, with a 5-star rating being the highest score. More stars indicate better performance and quality:

    • 5-star rating: Excellent
    • 4-star rating: Above Average
    • 3-star rating: Average
    • 2-star rating: Below Average
    • 1-star rating: Poor

    For Medicare plans providing health coverage, such as Medicare Advantage or Medicare Cost plans, each plan is given an overall summary rating based on how it performs across five main categories:

    • Staying healthy
    • Chronic conditions management
    • Member experience
    • Member complaints
    • Customer service

    For Medicare Part D stand-alone Prescription Drug plans and Medicare Advantage plans that include drug coverage, Medicare star ratings are also based on the following criteria:

    • Member experience
    • Member complaints
    • Customer service
    • Drug safety and drug pricing accuracy

    For more information on the criteria Medicare considers when rating its plans, visit Medicare.gov. Keep in mind that plan ratings can change from year to year. 

    All Medicare Advantage plans offer, at minimum, the same coverage as Original Medicare, Part A and Part B. These plans are sold by private insurance companies with the ability to set their own prices and must be approved by the Centers for Medicare & Medicaid Services (CMS).

    CMS pays each plan a capitation rate for each beneficiary each month.  A Medicare Advantage plan may offer a monthly premium as low as $0, but you should keep in mind that there may be other costs you could be responsible for. If you are enrolled into a Medicare Advantage plan, you will need to continue paying your Medicare Part B premium. Additional costs you may be responsible for include prescription drug costs, copayments, coinsurance, and annual deductibles. It is recommended that beneficiaries compare all of the different costs associated with Medicare Advantage plan coverage before enrolling into a plan in their service area.

    The Centers for Medicare & Medicaid Services (CMS) reported in 2015 that about 10,000 people became eligible for Medicare each day.  But what is the difference between the two options?

    Original Medicare, Part A and Part B, is the government health insurance program for those 65 and older, and for people who qualify by disability.

    Part A:

    • Part A is hospital insurance – it covers your care as hospital inpatient.
    • You may not need to pay a monthly premium if you’ve worked at least 10 years while paying Medicare taxes.
    • A deductible applies.
    • You also have to pay coinsurance or copayments once you have paid the deductible.

    Part B:

    • Part B is medical insurance – it may cover preventive services, doctor visits, lab tests, medical equipment and supplies and other medically necessary services.
    • You typically have to pay a monthly premium.
    • An annual deductible applies to many services.
    • You typically pay a 20% coinsurance for most services, although some services are free.

    Original Medicare comes directly from the government but as you can see there are costs not covered by Medicare.  In this case you might want to consider a secondary insurance known as a Medicare Supplement accompanied by a Prescription Drug Plan. 

    The Medicare Advantage program (also called Medicare Part C) gives you a way to get these benefits through a private insurance company, which has been paid a capitation rate by the government. These insurance companies contract with Medicare to deliver your Part A and Part B benefits. You would still pay your Part B premium.  You could be liable for copays, coinsurance, or deductible, the total of which would never go beyond the Maximum Out of Pocket amount.

    Original Medicare doesn’t cover everything. Routine dental care, hearing aids, and eyeglasses are statutorily excluded from Medicare coverage. It would take an act of Congress to include routine dental services, hearing aids, and eyeglasses in Medicare program coverage.
    Medicare coverage of dental care
    Medicare doesn’t cover routine dental care, such as oral exams, cleanings, fillings, bridges, or crowns. However, there are a few situations where you may be covered for dental services:

    • Dental services may be covered if they are an essential part of another Medicare-covered procedure. For example, if you hurt your jaw in an accident, Medicare may cover jaw reconstruction if it is medically necessary to treat your injury.
    • Medicare may cover extraction of teeth to prepare the jaw for radiation treatment for jaw-related neoplastic diseases.
    • Medicare may cover dental examinations prior to a complicated procedure (such as a kidney or heart transplant) that requires an oral exam. You’ll be covered under Medicare Part A or Part B, depending on whether the oral exam is performed in an inpatient or outpatient setting.

    Some Medicare Advantage plans may include benefits beyond what Original Medicare covers, including routine dental services. Medicare Advantage plans vary in terms of the benefits covered, so check with the specific plan if you’re interested in dental coverage.
    Medicare coverage of hearing aids
    Medicare doesn’t cover hearing aids or exams to get fitted for them. You’ll pay 100% of the cost if you have Original Medicare, Part A and Part B.

    You may be able to get coverage for hearing care (including hearing aids) through a Medicare Advantage plan. Since benefits vary, check with the individual Medicare Advantage plan.
    Medicare coverage of eyeglasses
    Medicare doesn’t typically cover eyeglasses or contact lenses. However, Medicare Part B may cover corrective lenses after you have cataract surgery to implant an intraocular lens. You’ll be covered for either one set of glasses or contact lenses following your surgery if you get these items from a supplier that is enrolled with the Medicare program. If you upgrade your frames, you’ll pay any extra costs.

    In most other situations, you’ll pay the full cost for eyeglasses and contact lenses. You may be able to get coverage for routine vision services (including glasses or contact lenses) through a Medicare Advantage plan.

    Your Medicare effective date depends on when you sign up for Medicare. The earliest date on which you’re first eligible for Medicare, is the 1st of the month of your 65th birthday (if born on the 1st then your eligibility is moved 1 month earlier).  You have a 7-month open enrollment period. It includes 3 months before your 65th birthday, your birthday month, and three months after your 65th birthday month.

    For example, say your birthday is August 31. Your initial enrollment period will begin three months prior to your birthday month, or in this case, May. If you sign up in May, June, or July, your coverage will start on August 1.

    You are eligible for Medicare at age 65 or the 25th month of receiving disability benefits.  

    You may be automatically signed up if you are already receiving Social Security benefits. If you have any questions about when your Medicare coverage starts, you can contact Social Security at 1-800-772-1213, Monday through Friday, from 7AM to 7PM. For TTY services, call 1-800-325-0778.

    If you worked for a railroad, you can call the Railroad Retirement Board at 1-877-772-5772, Monday through Friday, from 9AM to 3:30PM. For TTY services, call 1-800-325-0778.

    If awarded Social Security Disability Income before the age of 65 years, then you are entitled to Medicare 24 months after you go on benefit.

    First, a quick rundown on what Medicare Part C and Part D refer to.

    Medicare Part C refers to Medicare Advantage, an option that provides an alternative way to get your Medicare benefits. Offered by private insurance companies approved by Medicare, Medicare Advantage plans must provide the same coverage that Original Medicare, Part A and Part B, cover — but many Medicare Advantage plans offer extra benefits (such as routine dental and vision services).

    Most Medicare Advantage plans include prescription drug coverage. These plans are known as Medicare Advantage Prescription Drug plans.

    Medicare Part D refers to prescription drug coverage that’s available as a stand-alone plan. Because Original Medicare (Part A and Part B) doesn’t cover prescription drugs except in limited situations, you should consider enrolling in a stand-alone Medicare Part D Prescription Drug Plan. These plans are available from private, Medicare-approved insurance companies.

    Usually, if you have Medicare prescription drug coverage, you’re either enrolled in Original Medicare and in a Medicare Part D Prescription Drug Plan, or a Medicare Advantage Prescription Drug plan.

    If your Medicare Advantage plan doesn’t have prescription drug coverage, you might be allowed to add a Medicare Prescription Drug Plan. But you may want to contact your Medicare Advantage plan before making any changes.

    Bottom line: If your Medicare Advantage plan includes prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D Prescription Drug Plan at the same time.

    Medicare benefits start once you reach the age of 65 (unless you qualify by disability). You’re automatically enrolled at age 65 if you’re already receiving Social Security or Railroad Retirement Board benefits.

    If you’ve worked at least 10 years (40 quarters) while paying Medicare taxes, there is no monthly premium for your Medicare Part A (hospital insurance) benefits. But if you haven’t worked, or worked less than 10 years, you may qualify for premium-free Part A when your spouse turns 62, if she or he has worked at least 10 years while paying Medicare taxes. However, to be eligible for Medicare, you need to be 65 years old. You also need to be an American citizen or legal permanent resident of at least five continuous years.

    So, to summarize with an example:

    • Bob is 65 years old. He’s on Medicare, but he pays a monthly premium for his Medicare Part A benefits. He only worked for seven years and no longer works.
    • His wife, Mary, has worked for over 30 years.
    • Mary turns 62. Now, Bob no longer has to pay a Medicare Part A monthly premium.
    • Mary still has to wait until age 65 to be eligible for Medicare (unless she qualifies by disability).

    If you retire at age 62, you may be able to continue to get medical insurance coverage through your employer, or you can purchase coverage from a private insurance company until you turn 65. While waiting for Medicare enrollment eligibility, you may contact your State Health Insurance Assistance Program to discuss your options.

    Medicare Part D is optional but can help cover your prescription drugs. There are certain times when you can sign up for it. If you delay signing up for Medicare Part D coverage at the Medicare age 65, you may be faced with a late enrollment penalty.

    When you enroll in Original Medicare (Medicare Part A and Part B), you may also want to decide if you want to sign up for prescription drug coverage under Medicare Part D. Since Original Medicare usually doesn’t cover medications you take at home, you have the option of signing up for Medicare Part D coverage.

    If you are turning 65 and still working, you can stay with your employer’s health insurance plan. Or you can get benefits through a spouse’s employer coverage.

    Before you apply for Medicare, be aware that you might have several insurance options. For example, you may be able to:

    • Drop your employer coverage and enroll in Original Medicare, Part A and Part B. If you take this route, you would want to decide whether to buy a Medicare Supplement and enroll in a Part D prescription drug plan.  Or, enroll in a Medicare Advantage Plan which can include drug coverage.
    • Keep your employer coverage and enroll in Medicare Part A only.  Medicare and employer coverage will need to coordinate benefits. 
    • Stay with your employer coverage and apply for Medicare later. Keep in mind that being eligible for Medicare doesn’t mean you have to take it. However, you might want to enroll in Medicare Part A (hospital insurance) as soon as you’re eligible, especially if you qualify for premium-free Part A. You generally qualify for Part A without paying a premium if you’ve worked at least 10 years while paying Medicare taxes.

    Later, when you finish active employment, you can apply for Medicare Part B. To avoid a late enrollment penalty when enrolling in Medicare Part B, make sure you apply for Medicare during your Special Enrollment Period (up to 8 months after end of active employment).

    To get the best value with health coverage for your situation you’ll need to do a little research to determine the right arrangement for you. An independent insurance broker could help you quantify your choices.

    Also consider whether your cost for employer coverage includes coverage for your spouse. If it does, you’ll want to factor in the cost for your spouse to get coverage elsewhere before you decide to drop your employer coverage. Medicare coverage is for individuals, not married couples or families.

    Medicaid is a joint federal and state program that helps pay medical bills for people with low income and limited resources. Eligibility for Medicaid depends on income level and family size.

    Medicaid coverage differs from state to state. In all states, Medicaid pays for basic home health care and medical equipment. Medicaid may pay for homemaker, personal care, and other services that are not covered by Medicare. There are Medicaid programs that pay some or all of Medicare’s premiums and may also pay deductibles and coinsurance for certain people who qualify for Medicare and need financial assistance.  

    Check with your insurance broker who can help you gain access to the right benefits.

    All Medicare Advantage plans offer, at minimum, the same coverage as Original Medicare, Part A and Part B. These plans are sold by private insurance companies with the ability to set their own prices and must be approved by the Centers for Medicare & Medicaid Services (CMS).

    CMS pays each plan a capitation rate for each beneficiary each month.  A Medicare Advantage plan may offer a monthly premium as low as $0, but you should keep in mind that there may be other costs you could be responsible for. If you are enrolled into a Medicare Advantage plan, you will need to continue paying your Medicare Part B premium. Additional costs you may be responsible for include prescription drug costs, copayments, coinsurance, and annual deductibles. It is recommended that beneficiaries compare all of the different costs associated with Medicare Advantage plan coverage before enrolling into a plan in their service area.Medicare Advantage vs Original Medicare