Medicare FAQs

Medicare is a Federally funded health insurance program for people over the age of 65 or those that have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). 

Most people pay into the Medicare system through their income taxes. Medicare is accepted by roughly 93% of primary care physicians, as well as the vast majority of hospitals. It generally covers preventative services, and helps with the cost of medically necessary services.

You have an initial enrollment window that opens three months before your 65th birthday, and closes three months after.

Call our office at 970-300-9252.

If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare once you turn 65. If you are not receiving Social Security benefits, then you will need to enroll during your enrollment window (three months before to three months after your 65th birthday). 

If you have missed this initial enrollment window then you can sign up during the open enrollment period which occurs from October 15–December 7 each year.

As long as you enroll in Medicare during your enrollment window around your 65th birthday and don’t have a lapse, you will not be penalized. You must enroll in Medicare Part B and Medicare Part D (Medicare prescription drug plans) during this window as well, or you may pay a higher premium as a penalty when/if you do enroll. This penalty increases the longer you go without enrolling in Part B and Part D, once you are eligible.

If you are still working after 65 and have health insurance through your employer, you may be able to keep your insurance and not be penalized when you switch to Medicare. You will need to check with our office at 970-300-9252  to see if your current insurance meets the requirements to avoid penalties. 

You may also enroll in Medicare while you are still on your employer’s insurance plan. In that case, one policy covers you first, and the other will pay second. 

Medicare is health insurance provided by the federal government for anyone aged 65 or older, and some people under the age of 65 with certain conditions or disabilities. 

Medicaid provides assistance to people with fewer resources and/or limited income. Unlike Medicare, Medicaid is a joint Federal and State program that offers health-based benefits.

You sign up once you’re eligible and you are able to make changes to your plans one a year during the open enrollment window which occurs from October 15–December 7 each year. You can switch between having coverage through Original Medicare (Parts A, B, and D as well as Medicare Supplements) and having coverage through Medicare Advantage (also known as Medicare part C). 

Unlike traditional insurance, Medicare does not cover spouses or dependents. Therefore you and your spouse may have different plans. Medicare only covers medically necessary and preventative medical services.

The cost of Medicare varies between individuals based on if/how long you have paid into Medicare through your taxes, and what type of plans you choose. 

Most people can obtain Medicare Part A (Hospital) without paying a monthly premium, but you will need to pay the deductible for each benefit period before Medicare starts to cover some costs.

Medicare Part B (Medical) charges a monthly premium and has a yearly deductible that you will need to pay before benefits kick in. 

Generally after your deductible is met, Medicare will pay 80% of covered costs. Many people choose to obtain Medicare Supplement insurance to cover the costs that are not covered by Part B. There are 10 Supplemental Medicare Plans to choose from, and each has their own premium.

Medicare Part D (Prescription Drug) also charges a monthly premium that is based on the plan you choose. Higher-income consumers may pay more for this insurance. 

Medicare Advantage Plans (Medicare Part C) are provided through insurance companies instead of through the Medicare system so monthly premiums vary. These plans roll Medicare Part A, Part B, and often Part D into one plan so you may save money overall on your premiums.

Premiums are the amount of money charged by Medicare or other insurance companies for access to the insurance plan. Think of it as the price of a season ticket to the Denver Bronco games. You pay for the whole season upfront, even if you don’t actually attend games. 

Deductibles are the amount of money you are responsible for paying when you receive services before the benefits kick in. Think of it as a minimum purchase requirement. Perhaps at the Broncos game, you don’t get your 20% discount on hotdogs until you’ve bought $50’s worth. This would be your hot dog deductible.

Out-of-pocket expenses are expenses not covered by your insurance and are sometimes capped by insurance companies.

Out-of-pocket expenses often include deductibles, copays, and coinsurance. In our Broncos game example, the $50’s worth of hotdogs you bought would go towards your out-of-pocket expense limit, as would the 80% you would pay on each hot dog once you start getting your discount. If the limit was $500 and you reached it, the stadium would start giving you (medically necessary) hotdogs for free until the end of the season.