Everyone who is a U.S. citizens, or a legal U.S. resident for at least 5 years, becomes eligible for Medicare upon turning 65.  People who have paid Medicare taxes through their jobs for at least 10 years will not have to pay a Part A premium and are automatically enrolled into Part A when they turn 65.  People who are already drawing Social Security benefits before 65 will also be automatically enrolled in Part B when they turn 65.

If you are already receiving Social Security or Railroad Retirement benefits, you will be automatically enrolled into Medicare Parts A & B when you turn 65. If you are waiting to draw  Social Security or Railroad Retirement benefits until after you turn 65, you’ll need to sign up for Medicare Part B during your Medicare Initial Enrollment Period. Your Medicare Initial Enrollment Period lasts for 7 months. It starts 3 months before you turn 65 and ends 3 months after the month you turn 65. Enrolling in Part B can be done either online through the Social Security website or by setting up an appointment with any local Social Security office. If you need help or have questions regarding your Medicare eligibility, please Contact Us here and we will be happy to assist you.

Certain people with qualifying conditions may be eligible to enroll in Medicare prior to turning 65. To qualify, you must be a U.S. citizen (or resident who has legally lived in the U.S. for at least 5 years) and meet any of the following conditions: 

1. You have been on federal disability for 24 months.

2. You’ve been diagnosed with Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig's disease)

3. You have been diagnosed with End-Stage Renal Disease (ESRD).

If you need help or have questions regarding your Medicare eligibility, please Contact Us here and we will be happy to assist you.

The Medicare Initial Enrollment Period is a seven-month period that begins 3 months before your 65th birthday, the month of your 65th birthday, and ends 3 months after the month of your 65th birthday. For example, if you turn 65 in July, your Medicare Initial Enrollment Period begins April 1st and runs until October 31st (April – June is the 3 month prior to your 65th birthday month, July being the month you turn 65, and August – October is the 3 months after you turn 65 in July). If you need help or have questions regarding your Medicare Initial Enrollment Period, please Contact Us here and we will be happy to assist you.

If you chose to delay enrollment in Medicare because you have been working and have been covered by a creditable employer sponsored health plan (“creditable” means as good or better than Medicare), you can enroll in Medicare at any time as long as you do not have a break in coverage from your employer health coverage for more than 63 days. People in this situation qualify for a Medicare Special Enrollment Period by virtue of having, and then losing, creditable employer health coverage (either voluntary or involuntary). Qualifying for a Medicare Special Enrollment Period allows you to enroll in Medicare Part B as well as any Medicare supplement, Medicare Advantage or Medicare Part D drug coverage available in the area in which you reside. If you do not qualify for a Medicare Special Enrollment Period you may be subject to late enrollment penalties and can only enroll in Medicare Part B during the Medicare General Enrollment Period which runs from January 1st to March 31st and your Medicare coverage won’t begin until July 1st. This is why it is important to make sure the insurance you have through your employer is considered “creditable” if you decide to delayed your enrollment in Part B. You can find out if you employer health plan is creditable be asking your HR department or benefits administrator. If you need help or have additional questions, please Contact Us here and we will be happy to assist you.

The Medicare Annual Enrollment Period (AEP) runs from October 15th until December 7th every year. This is the time that people who are already enrolled in Medicare Parts A & B can add, drop or change either a Medicare Advantage plan or Standalone Part D Prescription Drug plan. The new coverage will begin January 1st. If you need help or have questions regarding the Medicare AEP, please Contact Us here and we will be happy to assist you.

The Medicare Advantage Open Enrollment Period (MA-OEP) runs from Jan. 1st until March 31st every year. This is for people who are currently enrolled in a Medicare Advantage plan and missed the opportunity during the AEP to change their Medicare Advantage to a different plan or disenroll from their Medicare Advantage plan and go back to Original Medicare.  People who enrolled in a Medicare Advantage plan during the AEP and have since discovered the new plan they enrolled in will not work for them can also use the MA-OEP to change their plan or disenroll and go back to Original Medicare.  People who are not enrolled in a Medicare Advantage are not eligible for the MA-OEP. If you need help or have questions regarding the MA-OEP, please Contact Us here and we will be happy to assist you.

No. Medicare Part A covers inpatient hospitalization and Medicare Part B covers physicians services. There are some doctor administered drugs (like chemotherapy for example) that are covered under Part B. However, most prescription drugs that are filled at a pharmacy (either retail or mail order) fall under Part D. 

There is only two ways to obtain Medicare Part D pharmacy drug coverage: 

1. Enroll in a Standalone Part D drug plan

-or-

2. Enroll in a Medicare Advantage plan that includes Part D pharmacy drug coverage. 

If you need help or have questions regarding Medicare prescription drug coverage, please Contact Us here and we will be happy to assist you.

No. Routine dental and vision care are not covered under Original Medicare. Some Medicare Advantage plans may offer routine dental and vision coverage as an extra benefit or as a supplemental add-on benefit for an additional premium.  Typically, the dental and vision benefits that are offered with Medicare Advantage plans tend to be limited in both benefits and provider choices. It may be worth looking into a standalone dental and/or vision plan to give you better coverage and much larger provider network options.  Click here to find dental & vision plans available in your area.

Long Term Care, sometimes referred to as “custodial care” or “nursing home care”, is not covered under Original Medicare.  Skilled Nursing, on the other hand, is covered under Medicare Part A for up to 100 days. The difference between Long Term Care and Skilled Nursing is that Skilled Nursing is meant for rehabilitation after a medical event (such as a complicated surgery or stroke), whereas Long Term Care is for older people who become frail enough to need help with activities of daily living (i.e.: eating, bathing, dressing, etc.). People who need help with Long Term Care are better served by purchasing Long Term Care insurance when they are young and healthy enough to pass medical underwriting. Those who require Long Term Care and do not have Long Term Care insurance will have to apply to their state’s Medicaid program to help them pay for Long Term Care expenses. To qualify for Medicaid Long Term Care benefits you must meet certain Federal poverty income and asset thresholds. 

Every Medicare Part D plan has a formulary (i.e., a list of covered drugs) that is required to cover at least 2 medications in each therapeutic category.  Drug formularies can be (and usually are) different between each Medicare Part D plan. Before choosing your Part D coverage, it’s a good idea to look up all of your medications on each plan’s formulary to make sure they are covered and are covered at the lowest possible cost share (i.e., deductibles, copays and coinsurance). You will also want to know if the drug coverage you are considering has any special rules for the medications you take – such as quantity limits or step therapy. If you need help or have questions regarding Medicare Part D drug coverage, please Contact Us here and we will be happy to assist you.

People who have Medicare Part A and/or B are also required to have Part D prescription drug coverage or have health insurance through an employer or union. The only way to acquire Part D coverage is to enroll in a standalone Part D plan or enroll in a Medicare Advantage plan that includes Part D coverage. If you have Medicare Part A and/or B and you go without Part D coverage for 63 days or more, or you have a break in employer or union health insurance for 63 days or more, you will incur a Part D LEP. The Part D LEP is 1% of the national average premium for Part D plans plus the number of months that Part D or employer/union health coverage was not in place. This penalty would be added to your monthly premium once you decide to enroll in Part D coverage and would also be applied for the rest of your life. If you would like to explore Part D coverage options, please Contact Us here and we will be happy to assist you.

Part D Extra Help is a Medicare financial assistance program for people with lower incomes and limited assets. It helps pay prescription drug costs. It is also called Low Income Subsidy or LIS. If you would like to know if you qualify for Part D Extra Help, please Contact Us here and we will be happy to assist you.

No. Medicare and Medicaid are both government programs that help people pay for health care, but they are not the same thing.

Medicare is a federal program that provides health care coverage for people who are 65 or older or have certain qualifying disabilities.

Medicaid is a joint state and federal program that provides health care coverage for individuals with limited incomes. "Dual eligibility" means you qualify for both Medicare and Medicaid.