Frequently Asked Questions
Below you’ll find answers to common questions people have about Medicare. If you still have questions, call us. We are here to help!
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Medicare has four parts – Parts A, B, C & D.
Parts A &B is known as Original Medicare. Benefits are provided by the federal government (not a private insurance company) and may not cover all of your healthcare needs. That is why many Medicare beneficiaries choose a Medicare Advantage plan (also known as Part C). Medicare Advantage plans are offered by private insurance companies, such as Allwell from Sunshine Health.
Medicare Part A is hospital insurance that helps cover:
- Inpatient care in hospitals
- Skilled nursing facility care
- Hospice care
- Home health care
Medicare Part B is medical insurance that helps cover:
- Services from doctors and other health care providers
- Outpatient care
- Durable medical equipment
- Many preventive services
Medicare Part C includes Medicare Advantage plans offered by private insurance companies as an alternative to Original Medicare. If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Medicare Advantage plans include all the benefits of Medicare Parts A and B, PLUS extra benefits not available through Original Medicare. Medicare Advantage plans vary but they may include additional benefits such as:
- Vision benefits
- Dental benefits
- Hearing benefits
- Fitness or gym membership
The additional benefits provided by Medicare Advantage plans vary by plan so it is important for Medicare beneficiaries to look for a plan that meets their full healthcare needs.
Many times these plans will have little or no premium.
Most Medicare Advantage plans have a network of doctors, hospitals and other providers you need to use in order to get the lowest cost of care. If you don’t use the network providers, you may pay more for the costs associated with your care.
Private insurance companies must be approved by the government to offer a Medicare Advantage plan.
Medicare Part D helps cover the cost of prescription drugs. Prescription drug coverage is NOT included in Original Medicare so beneficiaries who want this coverage must enroll in either a Medicare Advantage plan that includes prescription drug coverage (MAPD) or purchase a separate Prescription Drug Plan (PDP). If you do not have creditable prescription drug coverage (drug coverage at least as good as Medicare), for 63 days or more after the end of the Initial Enrollment Period for Part D coverage, you will have to pay a Late Enrollment Penalty (LEP).
Part D plans are offered by Medicare-approved private insurance companies that must follow rules set by Medicare.
Medicare Advantage Prescription Drug (MAPD) plans, like Allwell, combine Part A (hospital insurance) and Part B (medical insurance) coverage along with Part D (prescription drug coverage) into one complete plan to fit your needs.
Medicare and Medicaid are two different programs.
Medicare is America's health insurance program for people age 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). Originally established in 1965, the program helps to cover the cost of health care for nearly 49 million people.
Medicaid is a joint federal and state program that helps pay medical costs for people who have limited income and resources. Eligibility rules and coverage are determined by each state.
Some people qualify for both Medicare and Medicaid and are called "dual eligibles." For more information or to see if you qualify, contact your Medicaid office. You can also visit https://www.medicare.gov/contacts/, or call 1-800-MEDICARE (1-800-633-4227) and say “Medicaid” to get the phone number. TTY users should call 1-877-486-2048.
D-SNP stands for Dual Eligible Special Needs Plan. This is a type of Medicare Advantage plan available to people who qualify for both Medicare and Medicaid. These plans allow people who are eligible to enjoy better coverage by combining Medicare and Medicaid benefits under one plan and insurance company. These plans also include prescription drug coverage.
To be eligible for enrollment in a D-SNP, you must meet specific eligibility requirements. As an example, the type of D-SNP you qualify for may depend on the level of Medicaid eligibility you receive.
The Medicare program is largely funded by the government through payroll taxes paid for by both employees and employers. You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. You pay a premium each month for Part B. Some people with higher annual incomes pay a higher Part B premium. These amounts can change each year.
Depending on which type of Medicare Advantage plan coverage you choose, you may pay a monthly premium, which could be deducted from Social Security checks or paid directly to your insurer. Many times, Medicare Advantage plans are available with no additional monthly premium beyond the cost of Original Medicare. If you join a Medicare Advantage (MA) Plan you must continue to pay the monthly Medicare Part B premium. You also pay deductibles, coinsurance and copayments that are different from Original Medicare. The costs vary from plan to plan.
If you have lower income, and are eligible for Medicare, your state Medicaid program may assist you with premiums and cost sharing.
To be eligible to enroll in a Medicare Advantage Plan, you must:
- Have Medicare Part A and Part B
- Live in the plan’s service area
- Not have End-Stage Renal Disease (ESRD) (with limited exceptions)
- Be a U.S. citizen or lawfully present in the United States
Medicare beneficiaries can only enroll in Medicare Advantage plans during certain times of the year. When you first become eligible for Medicare, you can sign up during your Initial Enrollment Period. During the Annual Election Period (also known as Open Enrollment), anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. Generally, you may not make changes at other times unless you meet certain special exceptions, such as if you move out of the plan’s service area, want to join a plan in your area with a 5-star rating, or qualify for extra help with your prescription drug costs. See below for more information.
- Initial Enrollment Period (IEP) is the seven-month window around your 65th birthday. Use this time to review your options and select the plan with coverage that best fits your needs. When you first become eligible for Medicare, you'll likely be automatically enrolled in Original Medicare by the Social Security Administration. You'll have time to select supplemental or prescription drug coverage, decline Part B coverage, or choose to purchase a Medicare Advantage plan in place of Original Medicare.
- Annual Election Period (AEP) happens between October 15 and December 7 each year. This is a designated time period each year for everyone eligible for Medicare to update their coverage. During the AEP, you have the option to keep your current plan, choose a different plan, or return to Original Medicare. Your coverage will begin on January 1st of the following year, as long as the plan receives your request by December 7th.
- Special Enrollment Period (SEP) is a period of time surrounding an event in your life that affects your Medicare coverage. In most cases, you must stay enrolled for the calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan during an SEP. If you move out of our plan’s service area, have Medicaid, qualify for Extra Help, or experience the loss of health insurance coverage that was previously provided through a job, spouse or union health insurance, you may qualify for an SEP. If you are eligible for a Medicare Advantage Special Needs Plan (SNP), you do not need to wait for an enrollment period.
There are several ways! You can enroll by phone, by mail/fax or enroll online. Visit our How to Enroll page for more details.
Yes- you may change your coverage during the Annual Election Period: October 15 – December 7. To switch to Original Medicare, contact your current plan provider, or call 1-800-MEDICARE. TTY users should call 1-877-486-2048. Medicare can be reached 24 hours a day/7 days a week.
To switch to a new Medicare Advantage Plan, simply join the plan you choose during one of the enrollment periods. You'll be dis-enrolled automatically from your old plan when your new plan's coverage begins.
Yes! In most cases, your current Medicare coverage will renew automatically each year unless you make changes to your coverage. You may choose to change your coverage during the Annual Election Period: October 15 – December 7.
If you are a member of a Dual Eligible Special Needs Plan (DSNP), your renewal is contingent upon your Medicaid eligibility.
If you qualify for a Special Enrollment Period, you can change plans according to the situation that is allowing you a Special Election Period.
Original Medicare includes hospital insurance (Part A) and medical insurance (Part B). Your coverage under Original Medicare will include deductibles, coinsurance and copayments for various services. Original Medicare does not cover prescription drugs and may not cover services for vision care, dental or hearing.
Medicare Advantage plans offer the same coverage as Part A and Part B but many also include extra benefits such as dental, vision and hearing care. Many of your services in a Medicare Advantage plan will be covered by a copayment or coinsurance, which allows you to know exactly what your healthcare expense will be. Not all Medicare Advantage plans are alike, so you have to look for the one that has the benefits, services and costs that work for you.
General Medicare Questions
Get answers to general medicare questions including Medicare basics, coverage and enrollment.