Medicare FAQ

Q: I have insur­ance through my employ­er – do I need to sign up for Medicare?

A: If you are turn­ing 65, but still cov­ered under your employ­er, we rec­om­mend that you explore your options. As long as your employ­er has more than 20 employ­ees, you do not have to sign up for Medicare Parts A and B. How­ev­er, depend­ing on what you are pay­ing through your employ­er, it may make sense to tran­si­tion into Medicare. As long as you have worked for 40 quar­ters (10 years), your Part A has no pre­mi­um. Many choose to sign up for Part A even if they are still cov­ered by their employer’s insurance.

Q: I received a Medicare Card in the mail – but I didn’t sign up for Medicare. What should I do?

A: If you are receiv­ing Social Secu­ri­ty pri­or to your 65th birth­day, you will auto­mat­i­cal­ly be enrolled into Medicare Parts A and B. You will receive your Red, White & Blue Medicare card from Social Secu­ri­ty approx­i­mate­ly three months pri­or to your birth­day. You are not oblig­at­ed to accept the enroll­ment; how­ev­er, you do need to take action if you wish to delay your Part A and B enrollment.

Q: When should I sign up for Medicare Part B?

A: There is a 7‑month win­dow in which you can enroll in Medicare Part B. Three months pri­or to your 65th birth­day, the month of your birth­day, and three months fol­low­ing is the time peri­od in which you can enroll in Medicare Part B.

Q: Will Medicare affect my HSA?

A: Once you are enrolled in any part of Medicare, you are no longer eli­gi­ble to con­tribute to your HSA (nor is your employ­er able to con­tribute on your behalf). You are still per­mit­ted to use the funds you have accu­mu­lat­ed in your HSA for approved purchases.

Q: What is the dif­fer­ence between a Medicare Advan­tage plan and Medicare Supplement?

A: Medicare Advan­tage plans gen­er­al­ly offer low or no month­ly pre­mi­ums (you must con­tin­ue to pay Part B pre­mi­ums). These plans oper­ate with co-pays, deductibles and max­i­mum out-of-pock­­et thresh­olds. In most cas­es, Medicare Advan­tage plans have a net­work of doc­tors and hos­pi­tals you must uti­lize to max­i­mize your plan ben­e­fits. Addi­tion­al­ly, Medicare Advan­tage plans often include a Part D pre­scrip­tion plan.

Con­verse­ly, Medicare Sup­ple­ments gen­er­al­ly have high­er month­ly pre­mi­ums result­ing in low­er out-of-pock­­et expens­es. Unlike Medicare Advan­tage plans, Medicare Sup­ple­ments do not include pre­scrip­tion drug cov­er­age. Accord­ing­ly, a sep­a­rate Pre­scrip­tion Drug Plan (Part D) is often pur­chased on a stand-alone basis. Medicare Sup­ple­ment plans do not have des­ig­nat­ed net­works of doc­tors and hos­pi­tals which allows ben­e­fi­cia­ries to see any provider that accepts Medicare. Sup­ple­ment plans are fed­er­al­ly stan­dard­ized, mean­ing that all plans offered by insur­ance com­pa­nies are exact­ly the same.

Q: When can I change my Medicare Health Plan?

A: Open Enroll­ment is from Octo­ber 15th – Decem­ber 7th of every year. Dur­ing that time peri­od, you can enroll in a dif­fer­ent Medicare Advan­tage or Pre­scrip­tion Drug Plan for a Jan­u­ary 1st effec­tive date. This open enroll­ment does not apply to Medicare Sup­ple­ment (Medi­gap) poli­cies. You are free to switch those plans through­out the year, how­ev­er if you apply out­side of your 6‑month guar­an­teed issue win­dow, you are sub­ject to under­writ­ing and med­ical questions.

Q: What is the​‘Donut Hole’?

A: Pre­scrip­tion Drug Plans are fed­er­al­ly man­dat­ed to con­trol the cost of pre­scrip­tions. How­ev­er, some ben­e­fi­cia­ries go well above the antic­i­pat­ed cost dur­ing the year.

Per Medicare​.gov: Not every­one will enter the cov­er­age gap. The cov­er­age gap begins after you and your drug plan have spent a cer­tain amount for cov­ered drugs. Once you and your plan have spent $5,030 on cov­ered drugs in 2024, you’re in the cov­er­age gap. This amount may change each year. Also, peo­ple with Medicare who get Extra Help pay­ing Part D costs won’t enter the cov­er­age gap.

Once you’ve spent $8,000 out-of-pock­­et in 2024, you’re out of the cov­er­age gap. Once you get out of the cov­er­age gap (Medicare pre­scrip­tion drug cov­er­age), you auto­mat­i­cal­ly get​“cat­a­stroph­ic cov­er­age.” It assures you only pay a small coin­sur­ance amount or copay­ment for cov­ered drugs for the rest of the year.