FAQs

Working Past 65:

If you are still working and have health insurance through your employer, you may want to delay enrolling in Medicare Part B or Part D. This is because your employer's health insurance may provide better coverage than Medicare. However, if you delay enrolling in Medicare, you may have to pay a late enrollment penalty if you enroll later.
 

If you are not sure whether you should enroll in Medicare Part B or Part D, you should talk to your employer's human resources department or a Medicare counselor. They can help you understand your options and make the best decision for your needs.

Here are some things to keep in mind if you are working past 65 and considering Medicare:

• You can start getting Medicare benefits as early as age 65, even if you are still working.

• If you continue to work and have health insurance through your employer, you may not need to enroll in Medicare Part B or Part D.

• If you delay enrolling in Medicare, you may have to pay a late enrollment penalty if you enroll later.
   

You should talk to your employer's human resources department or a Medicare counselor to understand your options and make the best decision for your needs.

• Employer Coverage: If you have health coverage through your employer, it's important to understand how it coordinates with Medicare. Your employer can provide you with information about how their plan works with Medicare and whether it's primary or secondary coverage.

• Medicare Part D: If your employer doesn't provide prescription drug coverage that's considered creditable (as good as or better than Medicare's standard prescription drug coverage), it's advisable to enroll in a Medicare Part D plan to avoid future penalties.
   

It's essential to review your specific situation and consult with a qualified professional or contact the Social Security Administration or Medicare directly for personalized guidance regarding your eligibility and enrollment options.

 

What is the difference between Medicare and Medicaid?

Medicare and Medicaid (Called Medi-Cal in California) are both healthcare programs in the United States, but they serve different populations and have different eligibility criteria:

• Medicare:

Medicare is a federal health insurance program primarily for people aged 65 and older, as well as certain younger individuals with disabilities.

It consists of different parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plans), and Part D (prescription drug coverage).

Medicare is funded by payroll taxes, premiums, and general government revenue.

• Medicaid/Medi-Cal:

Medicaid is primarily funded by the federal government, but it is administered by individual states, which have some flexibility in determining eligibility criteria and benefits. Eligibility for Medicaid is based on income and other factors, and it varies by state. Medicaid is an important safety net program that helps millions of Americans access healthcare services that they might not otherwise be able to afford.
 

Medi-Cal is a joint federal and state program that provides free or low-cost healthcare coverage to low-income individuals and families in California.

It covers a broader range of services compared to Medicare, including doctor visits, hospital stays, prescription drugs, and preventive care.
 

Eligibility for Medi-Cal is based on income and other factors, and it is administered by the California Department of Health Care Services.
 

In summary, Medicare is a federal program that primarily serves older adults and certain individuals with disabilities, while Medi-Cal is a California-specific program that provides healthcare coverage to low-income individuals and families.

 

How do I qualify for Extra Help?

To qualify for Extra Help, a program that helps with Medicare prescription drug costs, you must meet certain requirements. These include having limited income and resources. You can apply for Extra Help through the Social Security Administration (SSA) either online, by phone, or in person at your local SSA office. They will evaluate your eligibility based on your income, assets, and other factors.

Here are some helpful resources for people who might be interested in learning more about Extra Help:

• Social Security Administration website: https://www.ssa.gov/medicare/part-d-extra-help

• Medicare website: https://www.medicare.gov/basics/costs/help/drug-costs

• State Health Insurance Assistance Program (SHIP): https://www.shiphelp.org/

 

I have group insurance; do I need Medicare?

If you have group insurance through your employer, you may be able to keep your employer's health insurance plan when you turn 65. However, you may also want to consider enrolling in Medicare Part A and Part B. Medicare Part A is free for most people, and Part B has a monthly premium. If you have group insurance through your employer, you may be able to get a credit on your Medicare Part B premium if you enroll in Medicare Part B during your Initial Enrollment Period.

If you are not sure whether you need Medicare, you should talk to a Social Security representative. A Social Security representative can help you determine whether you are eligible for Medicare and can help you enroll in Medicare if you are eligible.

 

Is COBRA creditable coverage?

It is important to know that COBRA is not considered creditable coverage for Medicare Part A and Part B. If you lose your employer-sponsored health plan and sign up for COBRA, and are eligible for Medicare but don't sign up, you will face Medicare late enrollment penalties if you want Medicare coverage in the future.

 

Does Medicare cover the RSV vaccine?

There should be no cost to you to get this vaccine. This means your pharmacy shouldn’t charge you a copay or deductible to get the RSV vaccine. If you have Medicare Part D, it should be free to you.
 
If you have Medicare Part D and your doctor or pharmacy tries to charge you for the RSV vaccine, you should call 1-800-MEDICARE (1-800-633-4227) for help.
 
If you have non-Medicare drug coverage (like drug coverage from an employer or union), you should check to see its coverage rules for the RSV vaccine. Because this is a newer vaccine, it may not be listed on an insurance plan’s list of covered drugs yet, so you should check with your plan before making an appointment. While the RSV vaccine is covered by Part D, your flu and COVID-19 vaccines will still be covered by Part B.

 

What type of questions should I ask regarding a Medicare Advantage plan?

"What is the provider network like?" - Inquire about the specific doctors, hospitals, and specialists included in the plan's network to ensure your preferred healthcare providers are covered.

 

"Are there any restrictions on prescription medications?" - Ask if there are any limitations or restrictions on the prescription drugs you currently take or may need in the future. This includes checking if your medications are on the plan's formulary.

 

"How does the plan handle out-of-network care?" - Understand how the plan covers out-of-network care, emergency services, or if you need to see a specialist who is not in-network. This can be crucial in case of unforeseen medical needs.

 

"What additional benefits are offered?" - Inquire about any extra benefits beyond basic medical coverage, such as dental, vision, hearing aids, fitness programs, or alternative therapies. These additional benefits can vary between plans and may be important to your overall healthcare needs.

 

"How does the plan handle prior authorizations and referrals?" - Ask about the process for obtaining prior authorizations for certain treatments or referrals to see specialists. Understanding these procedures can help you navigate the healthcare system more efficiently.

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Remember, it's essential to review the plan's Summary of Benefits and compare multiple Medicare Advantage options to find the one that best suits your individual healthcare needs and preferences.

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