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 on Medicare due to disability enroll in a Medicare Supplement plan?
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
What providers are in the BlueCare network?
Any provider that accepts Medicare is in the BlueCare network.
Can Part D be deducted from an individual's Social Security?
No. Unless beneficiary requests
If an individual purchases a Medicare Advantage Plan, do they also need to purchase a prescription drug plan?
No, all of Medicare Advantage plans come with prescription drug plan or without. Beneficiaries cannot have an MA plan plus a PDP.
When should someone enroll in Medicare?
3 months prior to their 65th birthday, the month of their birthday, or 3 months after their birthday.
Is there a deductible for Part A? Part B?
Yes.
Part A- $1,364.00
Part B- $185.00
How long does an individual have to enroll in a Medicare Supplement?
8 months after employement or group coverage ends whichever is first
Who sets the premiums for Part D/PDP plans?
Private insurance companies.
What is the Annual Election Period?
October 14-December 7
Does basic Medicare have a premium? If so what is it?
Part A can be premium free if eligible (worked 40 quarters).
Part B has a premium that is income based.
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?
$545
What are the three most common types of Medicare Advantage Plans?
Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
Private Free-For-Service (PFFS)
Are there penalties if someone does not enroll in Medicare when initially eligible? If so what is the penalty amount and how long does it last?
Yes.
The penalty for Part A is 10% of the current Part A premium, it will continue for twice the number of years the individual was elgible for Part A but did not enroll.
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 penalty lasts as long as the individual has Part B.
What is MACRA?
Medicare Access and CHIP Reauthorization Act, signed into law in 2015. CMS stated that MACRA enacts a new payment framework that rewards healthcare providers for giving better cares instead of more service.
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.
$34.70, 2024 national base beneficiary premium
Of those who are enrolled in Original Medicare Part A and Part B and live in the service area what group is ineligible to enroll in Medicare Advantage?
Prior to 2021, those who have End Stage Renal Disease (ESRD).
Beginning in 2021, people with End-Stage Renal Disease (ESRD) can enroll in Medicare Advantage Plans
. Medicare Advantage Plans must cover the same services as Original Medicare but may have different costs and restrictions