Frequent questions on Medicare enrollment & plan choices

Q: I am approaching age 65. Do I need to inform Social Security Administration (SSA) to begin my Medicare, Parts A& B? When does Medicare begin?

 It depends on circumstances, so we will give four different answers below. Should this information appear baffling, just contact us at 215-794-7418 and we will navigate this with you, with no charge, as part of our agency’s service.

A1: If you will soon turn age 65, are already receiving Social Security income and wish Medicare Parts A &B to begin on the first day of your age 65 birth month — You are all set! SSA will automatically enroll you for Medicare Part A and Medicare Part B. You will receive your Medicare card as early as three months before your 65th birthday month. Note that if you were bon on the first day of the month, then Medicare will begin one month before your age 65 birthday month.

A2: If you will soon turn age 65, are not yet receiving Social Security income, but wish to begin Medicare coverage on the first day of age 65 birth month —   You must inform SSA that you wish to receive Medicare, with Part A and Part B.  As early as three months before your age 65 birth month, you may apply for Medicare Part A and Part B  by: applying online at: www.ssa.gov/benefits/medicare; visiting a local Social Security office; or phoning Social Security at 1-800-772-1213 to schedule an appointment.

Applying online is the easiest method. Follow the prompts at the above link to “Apply Online.” Here you will need to establish a User ID and a password, unless you have already created these at the your Social Security log in portal: https://secure.ssa.gov/RIL/SiView.action

If you already have a User/Password for your Social Security site, then you may then use these at the “Apply for Medicare site.” Coverage then starts on the first day of your age 65 birth month, unless you were born on  the first of a month, in which case coverage begins on the  first day of the month before your age 65 birth month.

A3: If you will work past age 65, will continue health insurance coverage on an employer group health plan and the employer has more than 20 employees – No action necessary now — 

Warning — Do not apply for Part A if you are still working, covered by an employer group health plan, and you have a Health Savings Account (HSA), coupled with an employer high-deductible health insurance plan. If you begin Part A under these circumstances, you will lose the HSA tax deduction. 

A4 – If you will work past age 65, will continue health insurance coverage on an employer group health plan and the employer has fewer than 20 employees — You must inform SSA that you wish to receive Medicare, with Part A and Part B.  As early as three months before your age 65 birth month, you may apply for Medicare Part A and Part B by: applying online at: www.ssa.gov/benefits/medicare; visiting a local Social Security office; or phoning Social Security at 1-800-772-1213 to schedule an appointment.

Applying online is the easiest method. Follow the prompts at the above link to “Apply Online.” Here you will need to establish a User ID and a password, unless you have already created these at your Social Security log in portal: https://secure.ssa.gov/RIL/SiView.action

If you already have a User/Password for your Social Security site, then you may then use these at the “Apply for Medicare site.” Coverage then starts on the first day of your age 65 birth month, unless you were born on  the first of a month, in which case coverage begins on the  first day of the month before your age 65 birth month.

To enroll for Medicare Part B past age 65, we will assist you with the use of two forms: 

1. CMS40B Form– Application for Enrollment in Medicare Part B; 
2. CMSL564 Form– Request for Employment Information

For clarification on enrollment rules and timing, please feel free to call us toll-free at 888-959-1335.

Q: Does SSA charge for Medicare?

A: Yes.  The standard charge, for 2025, is $185/month, for Part B. Most people do not need to pay for Part A.  For some persons, considered high-income households, SSA will apply a surcharge beyond the $185/month. The surcharge system, called IRMAA,  has five brackets. Generally speaking, these IRMAA charges begin when a single tax filer earned more than $106,000 in Year 2023 adjusted gross income. For tax filers married/jointly, the IRMAA charges begin at Year 2023 AGI of $212,000.

Please follow these links for additional info on SSA charges:

• Part B and Part D IRMAA Charges

Q: If I get hit by SSA with an IRMAA high-income surcharge, based on my AGI from 2022, am I stuck with his surcharge the rest of my life?

A: If your income remains high for the rest of your life, you will experience some kind of IRMAA surcharge. SSA and IRS will examine your federal income tax returns from two years prior, to see Modified Adjusted Gross Income (MAGI) and from there the decision is made on IRMAA for the current year.

However, if your current year MAGI is expected to be lower than it was two years prior and if you have experienced a qualifying life event (retired; part-time work now; divorce; death of spouse), then we will fille form SSA44 to reduce or eliminate IRMAA for you. We will help here.

About Medicare Medical Coverage

Q: What is meant by Medicare “Part A?”

A: Medicare Part A is generally hospital insurance coverage. Part A covers inpatient hospital stays, skilled nursing facility care, hospice,  and limited home healthcare services

Medicare does not charge a monthly premium to most people for Part A, as long as you have worked “40 quarters” in your life, or have been married, for ten years, to someone who has worked “40 quarters.” If you don’t meet this test, you usually will be able to activate Medicare Part A, but there is a monthly charge for it.

During 2025, Part A hospital deductible will be $1,676 per stay, but Medicare Supplemental Plans F, G, and N will pay this for you.

Q: What is meant by Medicare Part B?

A: Medicare Part B is often called  outpatient insurance. It covers physician services; outpatient hospital; emergency room; diagnostic tests; physical therapy; durable medical equipment; outpatient cancer treatments; ambulance; mental health counselling and much more.

For 2025, Medicare Part B asks that you pay the first $257 per calendar year in a deductible and then asks you to pay 20% of the Medicare allowed charges for services.

 Have no fear of the 20% open-ended financial risk here — Medicare Supplemental Plan G  will pay these charges for you. Medicare Supplemental Plan N will also pay these charges, but will  ask you to shoulder  two copays types–$20 at the outpatient  doctor and $50 at the Emergency Room.

 Q: Must I opt for Medicare Part B?

A: Part B coverage is not mandatory, but it would be foolish to opt out of coverage unless you have Group Health coverage at your workplace (with more than 20 employees) and this coverage offers comparable benefits. Also, you must pay the Part B premium in order to access additional private Medicare medical coverage.

Q: Okay, so I have enrolled in Medicare Parts A & B…. now what happens?

A: Most persons, when seeking an individual Medicare plan, will now choose between what are called Medicare Advantage Plans and Medicare Supplemental plan.

Q: What are Medicare Advantage plans?

A: Medicare Advantage plans are private health insurance plans that act as primary payer for Medicare.  In exchange for a monthly premium paid to a health insurance company, you agree to a series of medical co-pays and you agree to use a network of doctors and hospitals. These plans are HMOs and PPOs, similar to what you may have now with health insurance. For the most part, the concept of Medicare paying the 80% of medical charges and the insurer paying the 20%…is not valid here. You put away the Medicare card and you use the insurer’s Medicare Advantage card for your medical and prescription needs.

 The good news on Medicare Advantage is that many of these plans have no monthly cost for the insurance premiums – meaning that you often do not have to pay a premium to the insurance company to receive this  coverage.  Further, many of the plans include valuable ancillary benefits beyond what Medicare covers. These add-on benefits can include: no-cost, quarterly allowance for over-the-counter medicines/supplies; dental insurance; vision/eyeglass insurance; hearing aid benefit; and Silver Sneakers gym/YMCA benefits.

Q: Do Medicare Advantage plans include prescription coverage?

A: Medicare Advantage Plans will often bundle prescription coverage as part of the plan package, but plans are also offered without prescription coverage. Prescription co-pays vary based on the whether the prescription is a generic or a name-brand.

Q: Why do some people opt for Medicare Advantage coverage?

 A:  Some people opt for Medicare Advantage because of insurance premium savings and because of the add-on benefits. With Medicare Advantage plans, by not paying any insurance premiums, you should expect to save significant money versus paying insurance premiums for Medicare Supplemental coverage and stand-alone Part D drug coverage. The insurance premiums savings can often exceed $2,000 per year. Further, Medicare Advantage may offer  add-on benefits:  no-cost, quarterly allowance for over-the-counter medicines/supplies; dental insurance; vision/eyeglass insurance; hearing aid benefit; and Silver Sneakers gym/YMCA benefits. In return for these insurance premiums savings and valuable dd-on benefits, , you must be willing to accept  copays and seek care in a specific health network.

Q: What are Medicare Supplemental Plans (Medigap)?

A: Medicare Supplemental Plans are “secondary” insurers to Medicare because they pay the “gap” – the payment due to doctors/hospitals that Medicare doesn’t pay. When you seek medical care with a Medicare Supplemental plan, you will show the health care providers your Medicare Card and your Medicare Supplemental card.

Q: What is a Medicare Supplemental Plan G?

A: Plan G means…

• Medicare is primary payer and the plan is the secondary payer. 

• Good at any doctor/hospital in the entire USA as long as they accept Medicare –No referrals required.  No claims forms. No paperwork.

• Annual $257 Part B deductible.  After this deductible is met, no other charges for Medicare covered services.

• Standardized plans …so the same benefits/access to doctors with each insurer.  All Plan G coverage is exactly the same with insurer – by law.        

Q: What is a  Medicare Supplemental Plan N?

 A: Medicare Supplemental Plan N is a Medicare Supplemental Plan with some co-pays.  In return for lower monthly premiums than Plan G:

• $257 calendar year Part B Deductible

• $20 co-pays per outpatient doctor visit

• $50 co-pay per emergency room visit

• Possible 15% Excess charge if use non-Medicare doctor who agrees to accept Medicare for your needs. This is not allowed in PA.

Q: With Medicare Supplemental, why might a person  sometimes choose Plan N versus Plan G?

A: Plan N can often be $30-$40 per month lower cost that Plan G. Let’s say we save $35/month with Plan N, by foregoing Plan G.  Annualized, we save $420 in insurance premiums.  In return for this saving, we then must pay a $20 copay at the outpatient Medicare doctor and $50 copay at the Emergency Room. If we visit the outpatient Medicare doctor 21 times in a calendar year—the Plan N ends up costing the same as Plan G.  But what if we don’t visit the doctor 21 times in one year? What if we visit 6 times?  With six visits, we pay  a total of $120 for copays, but we have saved $420 for insurance premiums.   We are ahead $300 here – and this type of savings is the basis for considering Plan N.

Q: Do Medicare Supplemental Plans include prescription drug coverage?

A: No. The strategy here is simply to choose a separate stand-alone prescription plan to complement the Medicare Supplemental plan. Easy to do.

Q: Why do some people opt for Medicare Supplemental coverage, coupled with a Part D plan, and forego using Medicare Advantage coverage?

A:  Medicare Supplemental persons generally want to avoid medical copays associated with Medicare Advantage coverage. They also want the freedom to seek care in every hospital in the USA and to see any Medicare -accepting doctor in any state.  In return for these benefits, Medicare Supplemental people must pay insurance premiums.

 We answer all of your Medicare Enrollment questions: 888-959-1335 toll-free

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