Originial Medicare
What are the parts of Original Medicare?
Part A
Part B
Where should someone go to enroll in Medicare?
Social Security Administartion online or their local office.
Can an individual enroll in Medigap (supplemental) and Medicare Advantage?
No.
What is Part D/PDP and who sells it?
Prescription Drug Coverage, it is sold by private insurance companies.
Medicare Advantage is also know as:
Part C
What makes someone eligible for Medicare?
Their age of 65 or over or those with certain disabilities.
How many quarters does an individual have to work to qualify for premium free Part A?
40 quarters contribution to Social Security
How many Medigap policies are available in Virginia?
10 but two of them have age restrictions
Limited Income Subsidy is also known as?
Extra Help
When does the Medicare Advantage Open Enrollment take place?
January 1st - March 31st of each year
When should someone enroll in Medicare?
During the 7 month initial enrollment:
3 months prior to their 65th birthday, the month of their birthday, or 3 months after their birthday.
OR
During Special Enrollment Period (8 months after employer group health insurance ends)
What is the deductible for Part A and Part B? (list 1)
Part A- $1,600
Part B- $226
How long does an individual have to enroll in a Medicare Supplement?
6 months after initial or special enrollment
Who sets the premiums for Part D/PDP plans?
Private insurance companies.
When is the Annual Election Period?
October 15-December 7
What is the cost for Part A and Part B?
Part A can be premium free if eligible (worked 40 quarters).
Part B has a premium that is income based ranging from $164.90-$560.50 in 2023.
In 2023, Part A premium is either $278 or $506 each month, depending on how long you or your spouse worked and paid Medicare taxes.
Where can I locate providers that accept Medicare?
Providers can be located using the look up tool on the Medicare.gov website.
Who is eligible for Plan F?
Individuals who turn 65 prior to January 1, 2020.
What is the maximum deductible allowed for Part D/PDP plan as set by Medicare?
$505, in 2023
What are three most common types of Medicare Advantage Plans?
Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
Private Free-For-Service (PFFS)
Point of Service (POS)
Why should someone enroll into Medicare during Initial Enrollment Period
To avoid a penalty or delay in coverage:
The penalty for Part A results in higher premium for the twice the number of years the individual was eligible for Part A but not enrolled.
The penalty for Part B is an additional 10% of the Part B premium for each full 12- month period that the individual could have had Medicare Part B but did not take it. This is a lifetime penalty.
When does the General Open Enrollment Period take place?
January 1st - March 31st of each year
When does underwriting apply on a Medicare Supplement?
If an individual is outside of their guaranteed issue period or if they are upgrading to a different Medicare Supplement plan.
Is there a penalty for late enrollment?
If so, what is it?
Yes.
The penalty is calculated by Medicare by multiplying 1% of the "national base beneficiary premium" times the full, uncovered months the individual did not have Part D or credible coverage. The monthly premium is rounded to the nearest $.10 and added to the monthly Part D premium.
$32.74, 2023 national base beneficiary premium
How many appeals does Medicare Advantage have?
5
Level 1: Reconsideration from your plan
Level 2: Review by an Independent Review Entity (IRE)
Level 3: Hearing before an Administrative Law Judge (ALJ)
Level 4: Review by the Medicare Appeals Council (Appeals Council)
Level 5: Judicial review by a federal district court