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Frequently Asked Questions

Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers certain doctors; services, outpatient care, medical supplies, and preventive services. You can join a separate Medicare drug plan to get Medicare drug coverage (Part D). You can use any doctor or hospital that takes Medicare, anywhere in the U.S. To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage or enroll in a Medicare Advantage Plan.
Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D. In most cases, you’ll need to use doctors who are in the plan’s network. Plans may have lower out-of-pocket costs than Original Medicare. Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.
Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare. Generally, you must have Original Medicare – Part A (Hospital Insurance) and Part B (Medical Insurance) – to buy a Medigap policy. These plans normally do not include Dental, Vision, Hearing.
All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes,” like drugs to treat cancer or HIV/AIDS. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Medicare drug coverage typically places drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.
Some people get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) automatically, and some have to sign up for it if you are already taking Social Security benefits 4 months before you turn 65. If not Contact Social Security to sign up for Medicare. You can either: Sign up for just Part A (Hospital Insurance) and Part B (Medical Insurance). Apply to get benefits from Social Security (or the Railroad Retirement Board). You’ll get Part A automatically once you start getting benefits. You’ll choose if you want Part B when you apply for benefits.
Ways to sign up:
Online (at Social Security) – It’s the easiest and fastest way to sign up and get any financial help you may need. (You’ll need to create your Secure my Social Security account to sign up for Medicare or apply for benefits.) If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772- 5772. About 2 weeks after you sign up, you will receive a welcome package with your Medicare card.

It’s important to sign up for Medicare coverage during your Initial Enrollment Period, unless you
have other coverage that’s similar in value to Medicare (like from an employer). If you don’t, you
may have to pay an extra amount, called a late enrollment penalty.
Late enrollment penalties:
Are added to your monthly premium.
Are not a one-time late fee.
Are usually charged for as long as you have that type of coverage (for most people, that’s a
lifetime penalty). The Part A penalty is different.
Go up the longer you wait to sign up – they’re based on how long you go without coverage
similar to Medicare.
Part B Penalty:
Generally, you won’t have to pay a Part B penalty if you qualify for a Special Enrollment Period.
You’ll pay an extra 10% for each year you could have signed up for Part B, but didn’t.

You may also pay a higher premium depending on your income.
Part D Penalty:
Generally, you won’t have to pay a Part D penalty if:
You have creditable drug coverage (coverage that’s similar in value to Part D) OR
You qualify for Extra Help
You’ll pay an extra 1% for each month (that’s 12% a year) if you:
Don’t join a Medicare drug plan when you first get Medicare.
Go 63 days or more without creditable drug coverage.
You may also pay a higher premium depending on your income.
After you join a Medicare drug plan, the plan will tell you if you have to pay a penalty and what
your premium will be.