Medicare is broad in scale and complex in nature. It comprises an alphabet soup of parts and plans.
Then there are the many policy combinations, eligibility guidelines, and enrollment periods.
We understand Medicare.
Here, we take on common questions and answer them in detail. Our goal is to remove any confusion or doubts you have about Medicare, so you can move forward with making your decision.
Medicare In-Depth FAQ’s
If you earn a certain level of income, the law requires an adjustment to your monthly Medicare Part B (medical insurance) and Medicare prescription drug coverage premiums.This is called an income-related monthly adjustment amount.These beneficiaries, who...read more
The first opportunity you have to enroll in Medicare is called your Initial Enrollment Period. The steps you should take to enroll in Medicare Part A (inpatient insurance) and Part B (outpatient medical insurance) depend on how you became eligible for...read more
A Special Enrollment Period (SEP) allows you to enroll in Medicare outside of the standard Medicare enrollment periods. The Part B SEP is available only if you have delayed enrollment in Part B because you have employer group coverage. For example, when...read more
The Annual Wellness Visit is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. Medicare Part B covers the Annual Wellness Visit if you have had Part B for over 12 months and you have not received...read more
Preventive care is the care you receive to prevent illness, detect medical conditions, and keep you healthy. If you meet the eligibility requirements and guidelines for a preventive service, Part B of Original Medicare or your Medicare Advantage Plan must cover that...read more
Many preventive services are provided with diagnostic treatment or health care services.A service is considered preventive if you have no prior symptoms. In some cases, Medicare only covers preventive care if you possess certain risk factors.This is unlike...read more
The Welcome to Medicare visit is a one-time appointment you can receive when you are new to Medicare. The goals of the visit are promoting general health and disease prevention.During the course of your preventive visit, your provider should:Review your...read more
The Annual Wellness Visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan to help you avoid illness, based on your current health and risk factors.Keep in mind that the Annual Wellness Visit is not...read more
Emergency services these are covered inpatient and outpatient services you receive from a qualified provider. An emergency medical condition has symptoms that are severe enough that someone with an average knowledge of health and medicine could reasonably...read more
If you have Original Medicare, Part B covers emergency room services anywhere in the U.S. Emergency room services are typically provided when you have a medical condition that requires immediate action, such as an injury or sudden illness. Medicare...read more
Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Medicare considers an emergency to be any situation when your health is in serious danger and you cannot be transported safely by other means. If...read more
In limited cases, Medicare Part B covers transportation in an air ambulance. The service must be medically necessary, meaning that you require immediate and rapid ambulance transportation that could not be provided by a ground ambulance. More specifically,...read more
If you have a Medicare Advantage Plan, your plan likely has a network of providers. A network consists of doctors, hospitals, and medical facilities that contract with a plan to provide services. When you receive non-emergency, non-urgent services from an...read more
Opt-out providers do not accept Medicare and have signed an agreement to be excluded from the Medicare program. Usually, this means that Original Medicare (or your Medicare Advantage Plan) will not pay for care that you receive from an opt-out provider,...read more
Medicare generally does not cover medical care that you receive while travelling outside the U.S. and its territories. However, Original Medicare and Medicare Advantage Plans must cover care you receive outside the U.S. in certain circumstances:Medicare...read more
Medicare Advantage and Part D plans must work to maintain access to health care services and prescription drugs during emergencies for plan members living in affected areas. Plans must meet certain requirements following the declaration of a disaster,...read more
If I Delayed Enrollment in Part B Because I Had Insurance Through Current Employment, When Can I Enroll in Part B?
If you declined Medicare Part B or delayed enrolling in it because you were covered by insurance through the current employment of yourself or your spouse (or, in some cases, certain family members if you are eligible for Medicare due to disability), you...read more
If you missed enrollment in Medicare during your IEP and you cannot use the Part B SEP to email, you likely need to enroll using the General Enrollment Period (GEP). The GEP takes place January 1 through March 31 of each year. During this period, you can...read more
Open Enrollment is a period when you can change your Medicare coverage, It occurs each year from October 15 to December 7.During this time, you can:Join a new Medicare Advantage Plan or a stand-alone Prescription Drug Plan (Part D).Switch between Original...read more
There are times when you may be able to change your Medicare health or drug coverage. The length of the Special Enrollment Period (SEP) and the effective date of the new SEP vary depending on the circumstances that trigger your SEP. The plan and, in some...read more