7 popular Medicare questions asked before enrolling

Published by Medicare Made Clear®

Medicare can seem like a daunting topic to cover. To help with this, we hosted an online presentation to provide an overview of Medicare basics and give viewers the chance to ask questions. We received great questions and decided to share the answers with you. Here are the top seven Medicare questions asked before enrolling during the Medicare Annual Enrollment Period.

Question 1: I’ll be turning 65 soon, when should I start the process of applying for Medicare? 

Answer:  Your Medicare journey begins three months before the month of your 65th birthday. This marks the beginning of what is called your Initial Enrollment Period. This period lasts seven months total, and includes the three months before the month you turn 65, the month in which you turn 65, and the three months after.

If you are receiving Social Security or Railroad Retirement Board benefits when you first become eligible for Medicare, then you’ll be automatically enrolled in Part A and Part B and will get your Medicare card in the mail.

If you aren’t receiving Social Security benefits when you become eligible for Medicare, you may enroll online or by visiting your local Social Security office.

It’s a good idea to start learning about Medicare in the months leading up to your Initial Enrollment Period so you are ready to make your coverage choices. Your coverage will begin on the first of your birthday month if you enroll during the three months before. If you enroll later, then your coverage start date will be later, too.

Question 2: I’m retiring soon. What do I do about Medicare between now and my retirement?

Answer:   If you retire or lose employer coverage before age 65, you’ll need other health coverage until you reach Medicare eligibility age and have your seven-month Initial Enrollment Period.

If you are 65 or older when you retire or lose employer coverage, you may qualify for what is called a Special Enrollment Period (SEP). Learn more about your Special Enrollment Period here. During this time, you have up to eight months to enroll in Part B without incurring a late enrollment penalty.

In addition, there are two important things to note:

  • First, during this same time period you only have two months to enroll in a Medicare Advantage (Part C) or Medicare Part D prescription drug plan. If you miss it, you could end up paying a late enrollment penalty that’s added to your monthly premium for as long as you have Part D. That can really add up, so pay attention to this timing. You can get drug coverage through a Medicare Advantage plan or by adding a standalone Part D plan to Original Medicare.
  • Second, it’s important to talk with your employer plan benefits administrator before you make Medicare decisions. You’ll need a written notice of “creditable coverage” from the plan to qualify for a SEP and avoid late penalties. The notice certifies that the plan provides coverage at least as good as Medicare.

Question 3: I’m over 65 and retiring in the next 3 to 6 months. I have Medicare Part A, but how do I get Part B?

Answer:  When you’re over 65 and retiring soon, getting Part B is fairly simple. If you qualify for a Special Enrollment Period (see question 2 above), you’ll have up to eight months to enroll in Part B without penalty. If you don’t actually quality for an SEP, you will have a Part B late penalty. To get Part B, you will enroll directly with Social Security, which you can do online, in person or on the phone.

If you will have additional coverage under an employer retirement plan, you’ll want to understand how that plan works with Medicare. Talk with your employer benefits administrator before making any Medicare decisions.

Question 4: I’ll be 65 soon but plan to keep working full-time. Is it better to keep my employer’s health insurance or to get Medicare?

Answer:  First you need to know if you are able to delay Medicare. You are required to take full Medicare benefits – both Parts A and B – at age 65 if your company has less than 20 employees. Generally if an employer has 20 or more employees, and the coverage you have is considered creditable, you can delay without penalty. However, some larger employers may have requirements as well. This is especially true if you keep working but have health insurance through your spouse’s employer. Your spouse’s employer may require you to get Medicare at 65 if you want to stay on the employer plan.  

Talk with the employer plan benefits administrator to understand how Medicare might work with your current coverage and to find out if you can delay.

Question 5: Is Medicare mandatory?

Answer:  No. Medicare is not mandatory. But even though you're not required to get Medicare, if you do decide to enroll after your Initial Enrollment Period and don't qualify for a Special Enrollment Period, you could face late enrollment penalties for Medicare Part A, Part B, Part C or Part D.

Question 6: Am I limited on the doctor I can choose? Are referrals required with Medicare?

Answer:  Your choice of doctor depends on what Medicare coverage you have. You can see any doctor that accepts Medicare if you have Original Medicare (Parts A & B). Most Medicare Advantage plans have provider networks, and some plans may require referrals to specialists. Both Original Medicare and Medicare Advantage plans cover most emergency care when and where it’s needed.

Question 7: What does Medicare Part A cover? (Does Part A cover custodial care? Does Part A cover outpatient visits?)

Answer:  Medicare Part A covers the hospital charges and most of the associated services received while you’re admitted as an inpatient.

Medicare Part A coverage includes:

  • A semi-private room
  • Hospital meals
  • Skilled nursing services
  • Care on special units such as intensive care
  • Drugs, medical supplies and medical equipment used during your inpatient stay
  • Lab tests, X-rays and medical equipment when you’re an inpatient
  • Operating room and recovery room services
  • Some blood transfusions (in a hospital or skilled nursing facility)
  • Rehab services such as physical therapy received through home health care
  • Skilled health care in your home if you’re homebound and only need part-time care
  • Hospice care

Medicare Part A does not cover custodial care such as help with bathing, dressing and eating, but due to new Medicare regulations, some Medicare Advantage plans (Part C) may begin offering some of these services in the home starting in 2019.

Medicare Part B covers doctor visits, even when you’re in the hospital, and outpatient services.

Want to keep learning more? Click here to continue learning about Medicare.

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