Sherie Killgo

Listed below are general answers to frequently asked questions.  Click on the question that interests you, and you will automatically be taken to the answer for that question.  Depending on your situation, there may be more to take into consideration.  Thus, I have included a link to additional information for the majority of the questions.

The best resource for finding official answers to anything related to Medicare is  www.Medicare.gov 

1. What is the difference between Medicare and Medicaid?

2. What is the difference between Original Medicare (Parts A & B) and Medicare Advantage (Part C)?

3. Why do some friends tell me Original Medicare is better and other friends tell me Medicare Advantage plans are better?

4. What is Part D?

5. When can I sign up for Medicare?

6. Should I sign up for Medicare at age 65?

7. If I have other health coverage, will Medicare still pay my medical bills?

8. I was told if I don’t sign up for Medicare when first eligible I will have to pay a penalty?

9. A friend told me it is to my benefit to delay enrolling in Part B if I have other coverage?

10. What is the difference between a Medigap Policy and a Medicare Supplement Plan?

11. I’ve been told all Medigap plans are the same?

12. My friend and I are both on Medicare.  She only pays $5 for her prescription and I always pay $10 for the exact same medication? 

13. Can I ever change my Medicare coverage?

14. I’ve been told those with higher incomes will pay more in premiums for Part B and Part D coverage?

15. Does Medicare pay for care received in a nursing home?

16. What happens if I don't have a long-term care plan to help pay for services not covered by Medicare?

17. If someone needs long-term care and wants to apply for Medicaid, how will this impact their spouse who is healthy and living independently?

18. As I approach retirement, is it too late for me to purchase a long-term care plan or other products that could be helpful for my future needs?

1. What is the difference between Medicare and Medicaid? Medicare is the federal health insurance program for people who are age 65 or older.  People younger than age 65 with certain disabilities may also qualify for Medicare.  Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services.  Depending on the situation, some people are eligible for both Medicare and Medicaid, but generally, the majority of people are only eligible for Medicare.

To learn more about Medicare, click the following link:

What's Medicare? | Medicare.gov

To learn more about Medicaid, click on the following link:

Medicaid | Medicare.gov

2. What is the difference between Original Medicare (Parts A & B) and Medicare Advantage (Part C)? Original Medicare includes Part A (hospital insurance) and Part B (medical insurance).  Medicare Advantage combines both Parts A & B into a Plan C which include a variety of plan designs offered by private companies approved by Medicare.   These plans generally provide coverage based upon a network of contracted providers.  You cannot be enrolled in both.  Medicare beneficiaries will either be enrolled in Original Medicare or Medicare Advantage.

Your Medicare coverage choices | Medicare.gov

3. Why do some friends tell me Original Medicare is better and other friends tell me Medicare Advantage plans are better? I am not surprised when I hear different opinions, because both offer different advantages. Determining which type of plan would work best for you will depend on your personal situation and needs. Before considering any option, I always start by asking retirees if they are willing to change doctors. Some doctors don’t participate in Medicare at all, but many doctors accept both Original Medicare and some Medicare Advantage plans. However, there are some doctors who will accept only one type of Medicare coverage - Original Medicare OR Medicare Advantage Plans.

4. What is Part D? Part D is the plan that provides Prescription Drug coverage.  Those enrolled in Original Medicare (Part A & Part B) will need to enroll in Part D to obtain prescription coverage.  For those enrolled in a Medicare Advantage Plan (Part C), prescription coverage is usually included.  If a Plan C does not include prescription coverage, you may be able to add a Part D plan depending on the plan type. 

Drug coverage (Part D) | Medicare.gov

5. When can I sign up for Medicare?  You have a 7 month period to sign up for coverage when first eligible - 3 months prior to your 65th birthday, your birthday month, and 3 months after your birthday.  The date you sign up will determine when your coverage will begin.  If you miss your initial enrollment, you can sign up during the General Enrollment Period (GEP) from January 1 - March 31. Your coverage will be effective the first of the following month when enrolling during the GEP. Some people may qualify to enroll even later if they had coverage with a large employer since turning 65 (refer to questions 6-9 below).

When does Medicare coverage start? | Medicare.gov

6. Should I sign up for Medicare at age 65?  Basically, it depends on your situation.  Many people sign up for Part A coverage because there usually isn’t a monthly premium if you or your spouse paid Medicare taxes for a certain amount of time while working.  However, depending on your situation there could be reasons you may not want to sign up for Part A at age 65 (e.g. if you are enrolled with a large employer plan and want to continue contributing to a Health Savings Account). A monthly premium does apply to Part B, so depending on your situation you may or may not sign up for Part B at age 65 (refer to questions 7-9 below).

Working past 65 | Medicare.gov

7. If I have other health coverage, will Medicare still pay my medical bills?  It depends on what your other coverage is.  Generally, if you are still working for an employer with more than 20 employees, Medicare will be your secondary coverage and your employer coverage will continue to be primary, that is, pay first.  If your company has under 20 employees, generally Medicare becomes your primary coverage so you will need to sign up for coverage at age 65 to avoid any late enrollment penalty.  These are general rules, so make sure and talk with a Benefit Representative from your company as you are approaching age 65.  There are also many other reasons someone might have other coverage (e.g. company retired benefits; military benefits, etc...).  Click on the link below to see examples on how Medicare works with other coverages.

How Medicare works with other insurance | Medicare.gov

8. I was told if I don’t sign up for Medicare when first eligible I will have to pay a penalty?  It depends on your situation.  Different rules apply to someone over 65 that has continued to have active employer group coverage (see prior questions) either because they are still working or their spouse is still working.  However, for someone who does not have other coverage, or meet certain other restrictions, the following link explains the different late enrollment penalties that could apply for Part A, B or D coverage. 

Late enrollment penalties | Medicare.gov

9. A friend told me it is to my benefit to delay enrolling in Part B if I have other coverage?  It certainly can be.  For example, if you have employer coverage that will continue to pay primary, that is pay first, it may not be in your financial interest to also pay a premium for Part B.  Depending on how comprehensive your primary coverage is, you may or may not have charges reimbursed under Part B.  In addition, delaying your enrollment into Part B will delay your initial Medicare Supplement Open Enrollment Period when an insurance company can’t use medical underwriting to deny you coverage or charge you more for a Medigap policy.  Thus, most people do not enroll in Part B until they are ready to use the coverage.  However, make certain you understand your particular situation so you aren't surprised later on with a Part B late enrollment penalty (see prior question).  

Working past 65 | Medicare.gov

When can I buy Medigap? | Medicare.gov

10. What is the difference between a Medigap Policy and a Medicare Supplement Plan?  Nothing, these are just two different terms used in the insurance industry to describe the same coverage.  Medigap policies are sold by private insurance companies to help “supplement” your coverage under Original Medicare by paying some of your cost sharing requirements.  Thus, you will often hear these terms used interchangeably.  Only Medicare beneficiaries enrolled in Original Medicare can purchase a Medigap policy.  You cannot purchase a Medigap policy to cover your cost sharing requirements under a Medicare Advantage plan, but you could purchase some stand-alone ancillary plans to help cover some of your cost sharing requirements.  

What's Medicare Supplement Insurance (Medigap)? | Medicare.gov

11. I’ve been told all Medigap plans are the same?  Absolutely not!  See the link below from Medicare.gov that shows the different Medigap policies available today.  Each insurance company decides which of these plans they want to sell. Some companies may offer additional discount programs for other health and wellness programs along with their Medigap plan. However, the primary consideration for purchasing a Medigap plan should be for the coverage that will be provided to supplement your cost sharing under Original Medicare. Premiums will vary greatly among different companies.

How to compare Medigap policies | Medicare.gov

12. My friend and I are both on Medicare.  She only pays $5 for her prescription and I always pay $10 for the exact same medication?  Such a scenario is possible. Prescription coverage is received via a private insurance company either under a Medicare Advantage Part C plan or a stand-alone Part D plan.  Each company has its own prescription formulary, which is a list of covered drugs with different payment tiers.  In addition, one company may cover a prescription that perhaps another company does not cover.  It is a good idea to compare your medication listing to the new coverage plans available each year during annual enrollment. Some retirees prefer to do this research on their own, but others prefer to give me their list of medications and ask me to navigate through the online search.    

Explore your Medicare coverage options | Medicare.gov

13. Can I ever change my Medicare coverage?  Absolutely! There are limits on when someone can make a change in their Medicare Advantage and/or Prescription Drug Plan (PDP), but special circumstances can sometimes allow someone to make changes during the year.  In addition, each year Annual Enrollment occurs from October 15 - December 7 in which retirees can make a change to their coverage to be effective January 1st. 

For those enrolled in Original Medicare, changes can be made at any time of the year to a Medigap policy, but you will usually be required to answer health questions as part of the underwriting process and the insurance carrier would have to approve your application.  Underwriting requirements for a Medigap plan also apply during Annual Enrollment. There are a few exceptions to the underwriting requirements, so please contact me to discuss your particular situation.

Joining a health or drug plan | Medicare.gov

14. I’ve been told those with higher incomes will pay more in premiums for Part B and Part D coverage?  That is correct.  This is called the Income Related Monthly Adjustment Amounts (IRMAA), and it applies whether you are enrolled in Original Medicare or a Medicare Advantage Plan.  IRMAA is based upon your Modified Adjusted Gross Income from two years prior.

If you have to pay IRMAA when you first begin your Medicare coverage, this does not necessarily mean you will always be required to pay IRMAA. Likewise, someone who did not previously have IRMAA apply could find that change in a future year if there was a large increase in their finances from two years prior (e.g. capital gains after selling investments, withdrawals from a taxable retirement account, etc.). 

If there has been a life-changing event that caused your income to reduce from two years prior, such as no longer working, you may file an appeal with Social Security to see if there can be an adjustment to your IRMAA amount. Appeal instructions will be included in the letter you will receive from Social Security informing you that IRMAA will be applied.

15. Does Medicare pay for care received in a nursing home?  It depends on the type of care being received. Medicare will pay for skilled nursing care needed immediately after a 3 day admission in a hospital. For example, if someone leaving the hospital needs additional therapy to regain strength before going home, Medicare would provide some coverage for up to a maximum of 100 days per benefit period. However, once this coverage period is used, or if the care changes from skilled nursing needs to custodial care, benefits will not continue to be paid. Medicare does not pay for long-term care.

SNF Care Coverage | Medicare.gov

16. What happens if I don’t have a long-term care plan to help pay for services not covered by Medicare? Essentially, you will pay for the cost of such services out of your own pocket. However, it is possible you may have other resource options you could consider such as Veteran benefits (sometimes even available for the spouse of a Veteran), obtaining a settlement on an existing life insurance policy, establishing an Immediate Need Annuity, etc... Each situation is different and would need a detailed evaluation. Because various scenarios require different expertise, if I am unable to help you, I would refer you to an expert who could help with your particular situation. Ultimately, if you end up spending down your assets for such care, it is possible you could qualify for help from Medicaid. But again, this would be an area that you would need to speak to an expert about qualifying for Medicaid.

How can I pay for nursing home care? | Medicare.gov

17. If someone needs long-term care and wants to apply for Medicaid, how will this impact their spouse who is healthy and living independently? It is possible the spouse would qualify for some protections under spousal impoverishment rules. You would want to become familiar with the www.Medicaid.com website. However, once again, this is an area in which you should speak to an expert about Medicaid such as an elder law attorney.

Spousal Impoverishment | Medicaid.gov

18. As I approach retirement, is it too late for me to purchase a long-term care plan or other products that could be helpful for my future needs? As we age, it is natural to begin looking at our financial security from a different perspective. Some people might have done some proactive planning years earlier with the help of an estate planning attorney or financial planner, but for those who haven’t, it is definitely worth your time and effort to take a realistic look at your options in retirement. Depending on your situation, I may offer you some suggestions or I may refer you to someone else. You won’t know what you qualify for or what the rates will be until you make an application. So don’t delay, start asking questions if you need help in this area.