Frequently Asked Medicare Questions

Most Common Medicare Questions Answered

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John E Chambers
August 21, 2021
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Medicare is not new.

Yet, many people feel overwhelmed about the health insurance policy, especially with various plan options available and each having its set of rules.

When should you sign up? Is it mandatory to do so? What if you have a better health insurance policy? What if you want to keep working after the retirement age?

To help demystify how the system works, this article will provide answers to these and many other frequently asked Medicare questions.

Answers to 15 Most Common Medicare Questions

Is Medicare Enrollment Automatic?

medical enrollment

You will be automatically enrolled in Original Medicare (Parts A and B) if you are receiving disability benefits, Social Security, or Railroad Retirement. Part A is usually free but standard Part B premium amount is $148.50 in 2021. You can decline Part B if you don’t want it.

If you are not receiving Social Security, you become eligible for Medicare when you turn 65. An Initial Enrollment Package will be sent to you a few months to your 65th birthday to sign up for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).

Enrolling in Medicare at 65 is a great choice. But if you have an insurance plan that covers your bills and pays to Medicare, you do not need to sign up for Medicare. However, most insurance plans do not provide 100% coverage, so enrolling in Medicare provides extra coverage.

Can You Get Medicare If You Have Never Worked?

Yes, you may still qualify for premium-free Medicare Part A through other means besides your work history.

You can qualify for premium-free Medicare Part A through your spouse’s employment history. However, this is subject to certain conditions, including:

  • You must be a U.S. citizen or lawful permanent resident (green card holder) who is 65 years or older. If you are under 65 years, you must have a disability or medical condition.
  •  Your spouse must have worked for a minimum of 40 quarters and is eligible for retirement benefits or Social Security disability benefits.
  • If you are currently married, it must be for at least one year.
  • If you are divorced, you must have been married for at least ten years to your former spouse, and they must be eligible for retirement benefits or Social Security disability benefits.
  • If you are a widow or widower, you must have been married to your late spouse for at least nine months before your spouse passed away. Also, you must be currently single to qualify and your late spouse must have been eligible for retirement benefits or Social Security disability benefits before they passed away.

Is Medicare Mandatory?

is medicare mandatory

No, Medicare is not necessarily mandatory, although it is automatically offered when you reach age 65 or have certain disabilities. While no part of it the program is mandatory, it can be difficult to opt-out of the healthcare policy.

You may have good reasons to delay enrollment in Medicare Parts B, C, and D if you have creditable coverage. But it is mandatory to enroll for Medicare Part A if you sign up for Social Security. That’s because both programs are linked.

When is It Considered Late to Enroll in Medicare?

The initial enrollment window for Medicare, known as Medicare Initial Enrollment Period (IEP), spans over seven months. Ideally, your IEP starts three months before you turn 65 and runs through the next three months after your birth month.

Enrollment is automatic for many people, but some people choose to delay Medicare enrollment, especially if you are still working during your IEP.

Keep in mind that there are late enrollment penalties. The penalty for Medicare Part A is 10% of your monthly premium for twice the number of years you delayed enrolment. For example, you may be required to pay a penalty for two years if you delay for one year before enrolling in Medicare Part A.

However, a late-enrollment penalty in Medicare Part A doesn’t apply for most people because it is usually free.

Also, the penalty amount can be up to 10% of your Medicare Part B premium for every 12 months you are eligible but didn’t sign up.

But you don’t have to worry about late-enrolment penalties if you’re still working during your IEP and have group health insurance. You will get a Special Enrolment Period (SEP) that allows you to sign up for Medicare later on.

Note that certain people with disabilities or illnesses qualify for Medicare before age 65. If that is you, your IEP will likely be different, depending on your specific situation.

Do I Need to Enroll in Medicare if I’m Still Working at 65?

You don’t have to sign up for Medicare if you are still working at 65, at least, not right away. However, this is only advisable if you have a group health plan with an employer that has 20 employees or more.

In any case, it is best better to enroll in Medicare Part A because it is usually free and provides better coverage than most employer plans.

The only exception is if your employer’s plan is an HSA. You won’t be able to contribute to the plan if you sign up for Medicare.

How is Medicare Different from My Employer’s Retiree Health Insurance Plan?

insurance plan

Employers provide retiree health insurance plans to cover former employees as they retire. This health policy often pays most (or all) of the health expenses after Medicare pays its part of the medical services.

It is best to enroll in Medicare in addition to your employer’s retiree health policy to ensure that you are fully covered when you retire. In many cases, an employer’s health insurance plan may require eligible employees to enroll in Medicare Part A and Part B.

I Retired before age 65 and Went onto My Former Employer’s Retiree Plan. Should I Still Enroll in Medicare?

Yes, it is best to enroll in Medicare because most retiree plans work with Medicare health insurance when individuals turn 65. To enjoy the insurance benefits, you must sign up for Medicare.

If the retiree plan provides better coverage than Medicare, it may be worth keeping it as supplemental insurance.

Can I Enroll in Medicare Online? What Information Do I Need?

Yes, you can enroll in Medicare online. But it is not necessary to sign up for Medicare online. You can enroll in the program in person or over the phone. However, completing an online application is your best bet if you want to save time.

To enroll in Medicare online, first, visit the Social Security Administration’s website and create an account. Skip the option to sign up for Social Security if that’s not what you want.

Next, provide your basic information, including your name, telephone number, address, and Social Security number. You will also need some form of identification, such as your driver’s license or birth certificate.

People who were not born in the United States will need to provide proof of U.S. citizenship in addition to a permanent resident card number.

How Do I Update My Basic Information for Medicare Purposes?

If you have recently moved to a new address or change your name for whatever reason, it is necessary to update the information for Medicare purposes.

To do that, you need to furnish Social Security Administration with the new name and address. In turn, Social Security will inform Medicare of the new information.

Individuals enrolled in the Medicare Managed Plan should contact their plan for and changes in their names and addresses.

It is also important for those on Original Medicare Plan to notify their Part B carrier of the changes in their basic information.

When Can I Get Medicare If I am Disabled?

healthcare for disabled

People with disabilities are eligible for Medicare after receiving Social Security Disability Insurance (SSDI) benefits for 24 months.

During the 24-month Medicare qualifying and waiting period, disabled persons may be eligible for health insurance coverage through their previous employers.

You are automatically enrolled in Medicare after 24 months of receiving Social Security disability benefits.

Is Medicare Free for Disabled Recipients?

In most cases, Medicare is not free for people with Social Security disability benefits. They still have to pay premiums, copays, and deductibles for the different Medicare parts.

I Have an HSA. Can I Still Enroll in Medicare?

Health Saving Account (HSA) allows you to save tax-free funds to cover healthcare expenses both in your working and retirement years. But you and your employer can no longer contribute to HSA once you enroll in Medicare.

However, your HSA contributions will not be affected when you enroll in Medicare, and you can use the funds to pay for expenses, as long as they are qualified medical expenses.

Considering the benefits of HSA (withdrawals are tax-free and contributions grow tax-free), it may be a great idea to hold off enrolling in Medicare. But this is something that you want to consider if you have a group health plan and you still want to work beyond your 65th birthday.

Can I Disenroll from Medicare if I Get a Job that Offers Better Health Benefits?

Yes, you can disenroll from Medicare Part B if you already signed up and then land a new job with better coverage than Medicare. You can re-enroll to Medicare Part B later when you retire and go off the retiree plan.

However, you must be enrolled in Medicare Part A if you are already receiving Social Security. Part is A is usually free, so there is no disadvantage to having it. Keep in mind that if your new employer offers an HSA plan, you won’t be able to contribute to the plan.

Can I Keep My Doctor if I Enroll in Medicare?

Can I Keep My Doctor if I Enroll in Medicare

Most doctors accept Medicare, so it is possible to keep the same doctor. But you should ask your doctor beforehand (before you turn 65) if he or she accepts Medicare.

Some physicians will continue to offer their services to existing patients who go on to Medicare, but will not accept new Medicare patients.

For this reason, it is usually a good practice to build a good relationship with a doctor who accepts Medicare. This is particularly the case if you find out that you can’t keep your current doctor when you eventually go on to Medicare.

What are the differences between Medicare and Medicaid?

Medicare and Medicaid are often easily confused, which makes this one of the most frequently asked Medicare questions.

In a nutshell, Medicare and Medicaid are government-sponsored health insurance policies designed to meet the health needs of different sets of American citizens.

Medicare is a federal government health care program for people who are 65 years and older. Younger people with disabilities can also get Medicare. The health policy covers medical care and treatment expenses for senior citizens and their families, regardless of their income level.

On the other hand, Medicaid is a health insurance policy jointly sponsored by the federal and state governments to cover the healthcare expenses of low-income families. The program covers the costs of routine medical care, treatment services, and hospitalization.

Individuals who have “dual eligibility” qualify for both Medicare and Medicaid. This often means lower healthcare costs with access to special Medicare plans and subsidized Medicaid benefits.

Conclusion

Whether you are eligible for Medicare or you still have a few more years ahead, it is best to start educating yourself about the health insurance policy.

Hopefully, these answers to the commonly asked Medicare questions have helped you to understand the process better.

In most cases, Medicare decisions are very personal, and what works for one person may not suit you. If you are unsure about what to do, it is best to work closely with your advisor to help you figure out the most ideal solution for your specific situation.

Reference:

John E Chambers

John E Chambers is an experienced financial advice expert. Born in Chicago, he has a master's in Industrial Finance, but he has spent decades offering investment advice to businesses and individuals alike. He is the founder of RetireeWorkforce.com and wants the website to be valuable for retirement advice. In addition, he writes articles that help users jump-start their retirement plans and choose the best investment options. If not pondering over stock market statistics or reading some magazines, you can find John spending time with his family. As an early retiree, John also offers unique insights into what post-retirement life is like.