Dental coverage is often one of the hidden Medicare costs that many people are not expecting.

In this article, we’ll explain the rare circumstances when Medicare does cover dental care, outline your options for obtaining dental coverage, and compare Medicare Advantage vs. stand-alone dental plans.

Does Medicare Cover Dental Care?

The short answer is: Original Medicare does not cover most routine dental services (Medicare.gov Dental). This means no coverage for:

• Routine cleanings
• Fillings
• Extractions
• Dentures
• Dental implants

However, there are a few obscure situations where Medicare will pay for dental services. These exceptions are tied to medically necessary care, not routine oral health.

When Medicare Covers Dental Work

Medicare may cover certain dental services if they are integral to a covered medical procedure. Examples include:

1. Dental exams before surgery
   If you are scheduled for a heart valve replacement or organ transplant, Medicare may cover a dental exam because oral infections could complicate the surgery.
2. Jaw-related hospital care
   If you suffer a traumatic injury to the jaw or face, Medicare Part A may cover the hospital stay and medically necessary surgery.
3. Oral exams related to kidney transplant or other major procedures
   Medicare might pay for the dental exam itself if it’s a required part of a broader treatment plan.
4. Certain oral cancer treatments
   In rare cases, if dental work is part of oral cancer treatment, Medicare may provide coverage.

It’s important to note that even when Medicare covers dental services, it usually only pays for the medical side of the care—not follow-up dental treatment. For example, if you break your jaw in an accident, Medicare may cover surgery in the hospital but not the dental implants you need afterward.

Why Dental Coverage Matters in Retirement

Ignoring dental care can have serious consequences. Oral health is linked to overall health, and untreated issues can worsen conditions like diabetes, heart disease, and infections.

Since Medicare doesn’t routinely cover dental, many retirees are surprised at the out-of-pocket costs:

• Routine cleaning: $100–$200
• Filling: $150–$400
• Crown: $800–$1,500
• Dental implant: $3,000–$5,000

For those on fixed incomes, these costs can quickly add up. That’s why it’s critical to plan ahead for dental coverage when enrolling in Medicare.

Options for Dental Coverage with Medicare

If you’re asking “does Medicare cover dental?”, the real answer lies in supplemental options. There are two main ways to obtain dental coverage:

1. Medicare Advantage (Part C) with Dental Benefits

Medicare Advantage plans are offered by private insurers and replace Original Medicare with bundled coverage. Many Advantage plans include dental benefits.

Pros of Medicare Advantage dental coverage:

• Often included at no extra cost beyond your regular premium.
• May cover preventive services like exams, cleanings, and X-rays.
• Some plans include coverage for more expensive procedures (crowns, dentures, implants).
• Convenient “all-in-one” coverage.

Cons to consider:

• Dental benefits can be limited (annual maximums often $1,000–$2,000).
• Provider networks may be restricted.
• Costs vary significantly between plans and regions.

Best for: Those who like bundled coverage and are comfortable with provider networks.

2. Stand-Alone Dental (or Dental + Vision) Plans

If you stay with Original Medicare and a Medigap plan, you can purchase a stand-alone dental insurance policy. These are offered by private insurers and work independently from Medicare.

Pros of stand-alone dental plans:

• Greater flexibility—you can choose a plan that meets your dental needs.
• May include coverage for major services (crowns, bridges, implants).
• Often available as dental + vision packages, which adds extra value.

Cons to consider:

• Monthly premiums add to your overall healthcare costs.
• Waiting periods may apply before major procedures are covered.
• Benefits and networks vary widely.

Best for: People who want to keep Original Medicare and Medigap but still need comprehensive dental coverage.

Medigap and Medicare Advantage – How Do They Differ? | 65Medicare.org

Factors to Consider When Choosing Dental Coverage

When evaluating your options, consider:

• What services are covered? Preventive only, or also restorative and major dental work?
• Annual maximums: Many plans cap dental benefits at $1,000–$2,000 per year.
• Provider networks: Are your preferred dentists in-network?
• Premiums vs. out-of-pocket costs: Weigh the monthly cost of the plan against what you’re likely to spend without coverage.
• Bundled benefits: Do you want dental only, or dental + vision/hearing coverage?

Frequently Asked Question: Can I Use an HSA for Dental Costs?

Yes. If you contributed to a Health Savings Account (HSA) before enrolling in Medicare, you can use those funds tax-free for qualified dental expenses. However, once enrolled in Medicare, you cannot continue contributing to an HSA.

Key Takeaways

• Does Medicare cover dental? In most cases, no—Original Medicare does not cover routine dental care.
• Rare exceptions exist for medically necessary situations tied to surgery, hospitalization, or serious illness.
• To get dental coverage, you need to either enroll in a Medicare Advantage plan with dental benefits or purchase a stand-alone dental insurance plan.
• Evaluate your personal dental needs, provider preferences, and budget when choosing the best option.

Final Thoughts

Dental health plays a major role in overall well-being, but it’s an area where Medicare falls short. By understanding when Medicare does cover dental care—and more importantly, when it doesn’t—you can take steps to protect yourself financially and medically.

For most beneficiaries, the best path forward is deciding between a Medicare Advantage plan with dental benefits or a stand-alone dental plan that works with Medicare and Medigap. Planning ahead ensures you won’t be caught off guard by unexpected dental bills in retirement.

_________________________________
65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post Does Medicare Cover Dental? appeared first on 65Medicare.org.

One of the most important things to understand in this situation is the Special Enrollment Period (SEP)—a unique window that lets you sign up for Medicare without facing late penalties. This article explains how SEPs work, how they’re triggered, and what they mean for other coverage types like Medigap and Part D prescription drug plans.

Understanding Medicare Enrollment Basics

Most people first become eligible for Medicare at age 65. The Initial Enrollment Period (IEP) is a seven-month window that starts three months before your 65th birthday, includes your birthday month, and extends three months after.

If you miss your IEP and don’t have other qualifying coverage, you may have to wait until the General Enrollment Period (January 1 – March 31 each year) to sign up, and you could face permanent late enrollment penalties.

But here’s where working past 65 can make a big difference: if you have qualifying employer coverage, you can delay Medicare enrollment without a penalty—and you’ll get a Special Enrollment Period when that coverage ends.

If you are still working as you approach 65, start with the broader Turning 65 Medicare Guide, then use this article for the special enrollment rules that apply to employer coverage.

What Is a Special Enrollment Period?

A Special Enrollment Period (SEP) is a limited time during which you can enroll in Medicare outside your Initial Enrollment Period without penalty. SEPs exist to accommodate certain life events—one of the most common being the loss of employer-sponsored group health coverage.

If you’re working past 65 and have creditable coverage through your job (or your spouse’s job), you’re allowed to delay enrolling in Medicare Part B—and sometimes Part A—until that coverage ends. When you stop working or your group coverage ends, your SEP begins.

How the SEP Works When You’re Working Past 65

Here’s the key timeline:

• Length of the SEP: You have 8 months from the date your employment ends OR your group coverage ends—whichever comes first—to enroll in Medicare Part A and/or Part B.
• What counts as “group coverage”: Your insurance must be through an employer with 20 or more employees (for Medicare primary rules). If the employer has fewer than 20 employees, Medicare generally becomes primary at 65, and you may not be able to delay without penalty. This situation has its own nuances, so you should make sure you understand your specific situation before making any decisions about Medicare.
• When coverage overlaps: You can enroll in Medicare at any time while still covered by employer insurance, or you can wait until your SEP begins.

Common Mistakes to Avoid

• COBRA confusion: COBRA coverage is not considered active employer coverage for Medicare purposes. If you delay Medicare until COBRA ends, you could face penalties and gaps in coverage.
• Retiree coverage misunderstanding: Retiree health benefits also do not count as active employer coverage for delaying Medicare enrollment without penalty.

Part B Enrollment and Penalties

Part B covers outpatient care, preventive services, and doctor visits. If you miss your SEP, you could be charged a permanent late enrollment penalty of 10% of your monthly premium for each full 12-month period you were eligible but didn’t enroll. That’s why knowing your SEP window is critical when working past 65.

How SEPs Affect Medigap Enrollment

A Medigap plan (Medicare Supplement Insurance) helps cover the deductibles, copayments, and coinsurance that Original Medicare leaves behind.

• Initial Medigap Enrollment: Normally, you have a 6-month Medigap open enrollment period starting when you’re 65 or older and enrolled in Part B.
• If you delay Part B: Your 6-month Medigap enrollment period starts when you eventually sign up for Part B—whether that’s at 65, 68, or 72.
  This is good news: delaying Medicare because you’re working past 65 means you don’t lose your guaranteed-issue rights for Medigap. You’ll still be able to buy any plan available in your state without medical underwriting during that window.

How SEPs Affect Part D Prescription Drug Coverage

Part D covers prescription drugs. The rules for delaying are slightly different from Part B.

• You can delay Part D without penalty if you have creditable prescription drug coverage through your employer (or your spouse’s employer) while working past 65.
• When that coverage ends, you have a 63-day SEP to enroll in a Part D plan or a Medicare Advantage plan with drug coverage.
• If you miss that 63-day window, you’ll face a permanent late enrollment penalty—1% of the national base premium for every month you were without creditable coverage.

Timing Example: Working Past 65 and Retiring at 68

Let’s say you turn 65 in August 2025 but keep working until you retire in September 2028.

• August 2025: You become eligible for Medicare but stay on your employer’s group health plan, which is creditable.
• September 2028: Your employment ends. This triggers your SEP.
• By May 2028: You must enroll in Medicare Parts A and B (8 months after coverage loss) to avoid penalties.
• By late October 2027: You must enroll in Part D or a Medicare Advantage plan with drug coverage (63 days after coverage loss) to avoid penalties.
• Medigap enrollment: Your 6-month open enrollment for Medigap begins as soon as your Part B coverage starts. However, you can, and should if you want it to begin the same day as Part B starts, sign up for Medigap prior to Part B starting and schedule it to start simultaneously.

Key Tips for Smooth Transition from Employer Coverage

1. Confirm your coverage is creditable: Get a written statement from your employer’s benefits administrator.
2. Mark your SEP deadlines: Put them in your calendar before your retirement date.
3. Don’t rely on COBRA to delay Medicare: Enroll in Medicare when your active employment coverage ends.
4. Consider enrolling in Part A at 65: It’s usually premium-free if you’ve worked at least 10 years, but check with your benefits team first—especially if you have an HSA.
5. Review your prescription drug coverage: Make sure it meets Medicare’s creditable coverage standard to avoid Part D penalties.
6. Plan your Medigap timing: If you want a supplement, the 6-month window after your Part B start date is the best time to apply.

The Bottom Line

Working past 65 can be financially and personally rewarding, but it also requires careful Medicare planning. Special Enrollment Periods give you the flexibility to delay Parts B and D without penalties—as long as you have qualifying employer coverage and enroll within the SEP deadlines.

Missing these deadlines can result in lifetime penalties and coverage gaps. On the other hand, understanding your SEP rights lets you time your Medicare enrollment to fit your retirement plans, coordinate with other benefits, and ensure you have the coverage you need when you need it.

Need one-on-one help navigating your SEP while working past 65? An independent Medicare broker can review your situation, confirm creditable coverage status, and guide you through the enrollment process for Part B, Part D, and Medigap so you avoid costly mistakes.

_____________________
65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

• Medicare’s Hidden Costs (2026): The Bill You Never Saw Coming
• Pennsylvania Medigap Plans: A Complete Guide to Medicare Supplement Coverage in PA
• Wisconsin Plan G: Why Doesn’t It Exist?
• The Issue-Age Medigap Myth: Why “Age Doesn’t Matter” Isn’t the Whole Story
• Medigap Premium Increase Letter: How to Understand It and What To Do Next

The post Working Past 65: Medicare Special Enrollment Guide appeared first on 65Medicare.org.

What Is a Medicare Supplement Plan?

A Medicare supplement plan (Medigap) helps pay for expenses not covered by Original Medicare, such as:

• Medicare Part A and Part B deductibles
• Coinsurance and copayments
• Certain out-of-pocket costs for hospital stays and skilled nursing care

These plans are standardized (Plan G, Plan N, Plan F, etc.) and offered by private insurance companies. The Medicare supplement for disabled under 65 works the same as it does for someone over 65 — the difference lies in availability and cost.

Availability of Medicare Supplement for Disabled Under 65

Federal law does not require insurance companies to sell Medigap plans to people under 65. Instead, it’s left up to each state to set its own rules. Currently, most states require companies to offer at least one Medigap option to those under 65 who are on Medicare due to disability, but the type of plan, enrollment timing, and premium costs can vary widely.

States That Require Medicare Supplement for Disabled Under 65

Here is a state-by-state breakdown of where people under 65 can get Medigap coverage (and any notable rules):

States Requiring at Least One Medigap Plan for Disabled Under 65:

Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming.

Note: The available plan may be Plan A only in some states. Others require access to multiple plan types.

States Without Required Medigap Access for Disabled Under 65

If you live in a state without such requirements, companies may still voluntarily offer coverage, but you are not guaranteed a right to buy it outside of the age-65 open enrollment.

Examples: Arizona, Nevada, Alaska.

How Premiums Differ for Disabled Under 65

One of the biggest surprises for many people is that the Medicare supplement for disabled under 65 often costs much more than it does for those over 65. Insurance companies base their rates partly on claims risk, and people on Medicare due to disability tend to have higher healthcare usage. As a result, it’s common for under-65 premiums to be double or even triple the over-65 rate in some states.

Alternative Options if Medigap Is Too Expensive

If Medigap coverage is available but unaffordable, you might consider:

• Medicare Advantage (Part C): Often lower monthly premiums, but with provider networks and different cost-sharing.
• State Medicaid programs: If you meet income and asset limits, Medicaid can coordinate with Medicare to reduce out-of-pocket costs.
• Special Needs Plans (SNPs): Tailored Medicare Advantage plans for people with certain chronic conditions or Medicaid eligibility.

Why Enrollment Timing Matters

If your state offers Medigap to people under 65, you typically have a six-month open enrollment window starting with your Medicare Part B effective date. If you miss it, you might be denied coverage or charged higher premiums later.

When you turn 65, you get a new open enrollment period, even if you already had Medicare due to disability. This is often the best time to shop again — rates are frequently significantly lower for a 65-year-old than they are for someone on Medicare disability under the age of 65. Get Medigap quotes by email.

Key Takeaways

• The Medicare supplements for someone under 65 are not available in every state, and rules vary widely.
• Premiums are often higher for those under 65 due to higher claims risk.
• Alternatives like Medicare Advantage or Medicaid may be worth exploring if costs are prohibitive.
• Turning 65 resets your Medigap open enrollment window and usually brings more affordable options.

Next Steps

If you’re under 65 and on Medicare due to disability, your best first step is to check your state’s Medigap rules and compare costs with Medicare Advantage. Any independent Medicare insurance agent can help you understand your options and find the most cost-effective coverage for your specific situation.

_____________________
65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

• Medicare’s Hidden Costs (2026): The Bill You Never Saw Coming
• Pennsylvania Medigap Plans: A Complete Guide to Medicare Supplement Coverage in PA
• Wisconsin Plan G: Why Doesn’t It Exist?
• The Issue-Age Medigap Myth: Why “Age Doesn’t Matter” Isn’t the Whole Story
• Medigap Premium Increase Letter: How to Understand It and What To Do Next

The post Medicare Supplement for Disabled Under 65: Where You Can Get Them and How Do They Work appeared first on 65Medicare.org.

In this guide, we’ll walk you through everything you need to know about how to appeal IRMAA, who qualifies, and the exact steps to take to file a successful appeal.

What Is IRMAA?

IRMAA is a surcharge that Medicare beneficiaries must pay if their income exceeds a certain threshold. The Social Security Administration (SSA) determines this amount based on your Modified Adjusted Gross Income (MAGI) from your tax return two years prior.

For example, if you’re enrolling in Medicare in 2025, the SSA reviews your 2023 tax return to assess whether you owe IRMAA.

2025 IRMAA Thresholds for Individual Filers

Thresholds are higher for married couples filing jointly.

When Can You Appeal IRMAA?

There are two main reasons the SSA will allow an appeal:

1. You Experienced a Life-Changing Event

Certain qualifying life events can cause your income to drop significantly, which may allow you to appeal IRMAA. These include:

• Retirement or reduced work hours
• Death of a spouse
• Divorce or annulment
• Marriage
• Loss of pension or income-producing property
• Settlement from an employer

If one of these events has occurred and your income is now below the IRMAA threshold, you may be able to request a lower premium.

2. SSA Used Incorrect Income Data

In cases where the IRS or SSA made an error or used outdated income information, you can appeal to have the correct data reviewed.

How to Appeal IRMAA: Step-by-Step Instructions

If you’re ready to learn how to appeal IRMAA, follow these four simple steps:

Step 1: Review the SSA Notice

You’ll receive an “Initial Determination” letter from the SSA if you’re being charged IRMAA. This letter explains your current premium amount and the income level it’s based on.

Step 2: Complete Form SSA-44

To appeal based on a life-changing event, use Form SSA-44, titled “Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event.”

You can download it directly from the SSA website:
Download SSA-44 Form (PDF)

On this form, you’ll:

• Select the qualifying event
• Provide the date of the event
• Estimate your current or future income
• Attach supporting documentation (e.g., retirement letters, tax documents, death certificates)

Step 3: Submit the Form to the SSA

Once you complete Form SSA-44, submit it along with documentation to your local Social Security office. You can deliver it:

• In person
• By mail
• By fax (call your office first to confirm)

Always keep copies of your submission and get a receipt when possible.

Step 4: Wait for a Response

The SSA typically takes a few weeks to a few months to process your appeal. If approved, your IRMAA adjustment will be reduced or removed, and any overpaid premiums may be refunded.

What to Do If Your Appeal Is Denied

If your appeal is denied, you have the right to request a further review:

1. Submit Form SSA-561-U2 – This is a Request for Reconsideration.
2. Request a Hearing – If reconsideration is unsuccessful, you can ask for a hearing before an Administrative Law Judge (ALJ).

It’s rare for IRMAA cases to go this far, but the option is available if needed.

Tips for a Successful IRMAA Appeal

Here are a few expert tips on how to appeal IRMAA effectively:

• Act Fast – You have 60 days from the date on the SSA letter to appeal.
• Be Precise – Carefully estimate your current or future income. SSA may request tax documents later to verify.
• Attach Proof – The more documentation you provide, the stronger your case.
• Seek Help If Needed – Medicare advisors, elder law attorneys, or financial professionals can guide you through the appeal process.

Real-World Example of Appealing IRMAA

Linda, age 67, retired in 2023. Her tax return from that year showed a MAGI of $155,000 due to a large severance package. In 2025, she received a notice from SSA indicating she owed over $170/month in IRMAA surcharges.

Since her 2024 income dropped to $42,000 after retiring, she filled out Form SSA-44 and submitted a retirement letter and recent tax documents. Within six weeks, her appeal was approved, and her IRMAA was removed.

What If You Don’t Qualify to Appeal IRMAA Right Now?

Even if you don’t meet the criteria for an IRMAA appeal at this moment, you’re not necessarily stuck paying higher premiums forever.

• IRMAA is reassessed annually. If your income drops in a future tax year, the surcharge may be removed automatically.
• Plan your income carefully. Consider financial planning strategies like Roth conversions or managing capital gains to stay under IRMAA thresholds.

Final Thoughts

If you’re wondering how to appeal IRMAA, the process is straightforward—but timing and documentation are key. Many Medicare beneficiaries don’t realize that IRMAA isn’t necessarily permanent and is re-evaluated annually. If your circumstances change, you may be eligible for a lower premium.

By filing Form SSA-44 and providing clear evidence of your income reduction, you can potentially save hundreds—if not thousands—of dollars annually.

Additional Resources

• SSA-44 Form: Medicare IRMAA Appeal
• Find Your Local SSA Office
• Medicare.gov – IRMAA Info

Need help appealing IRMAA or navigating Medicare enrollment? 65Medicare.org can help. We serve Medicare clients through all aspects of enrollment in Medicare and Medicare plans and ongoing, free support.

_____________________
65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post How to Appeal IRMAA: Step-by-Step Guide to Lowering Medicare Premiums appeared first on 65Medicare.org.

Who Needs to Sign Up for Medicare

First and foremost, you need to know whether you even need to sign up for Medicare. If you are already receiving Social Security benefits prior to turning 65, you should be enrolled into Medicare A & B automatically as of the 1st day of the month that you turn 65. If this is the case, you will receive your Medicare card in the mail about 3 months prior to your Medicare start date.

If you are planning to continue working or are covered under an employer/group plan that you plan to keep even after you are Medicare-eligible at age 65, you do need to sign up for Medicare. In this case, you are permitted to delay enrollment into Medicare and sign up at a later time, without penalty, when you drop or lose that employer/group coverage.

If neither of the above-mentioned circumstances apply to you, however, you will need to proactively sign up for Medicare.

How to Sign Up for Medicare

Signing up for Medicare can be done all online now. You can complete that process at this link on Social Security’s website: Sign up for Medicare | SSA. You will need some basic information about yourself in order to successfully sign up, including your Social Security number, where you were born (city, state, country), your date of birth and information about your current health insurance.

Alternatively, if you do not wish to sign up for Medicare online, you can also sign up by going to a local Social Security office.

When To Sign Up for Medicare

So, when should you sign up for Medicare? If you are planning to go on Medicare as your primary coverage when you turn 65, it is advisable to sign up for Medicare 2 or 3 months before your Medicare start date. Your Medicare start date would be the 1st day of the month that you turn 65, unless your birthday is on the 1st of a month, in which case your Medicare start date would be the first day of the preceding month.

If you are already over 65 and just need to add Medicare Part B, you can also do that online. And, you should do it at least a few weeks before you want your Part B to begin, when possible. Signing up for Medicare in advance ensures that you will have time to get your Medicare card in the mail prior to the start date of your Medicare coverage.

Signing Up for Other Medicare Plans

Around the same time that you sign up for Medicare itself, you should also consider any other Medicare-related plans that you need. Medicare Part D is the part of Medicare that covers prescription drugs so if you plan to stay with “original” Medicare (Medicare A & B vs Medicare Advantage), you will also need to add a Part D plan to have drug coverage.

Likewise, if you want to have coverage to fill in the gaps in Medicare A & B, the best time to sign up for that is during your initial open enrollment period when you turn 65. You can compare Medigap policies at this time to choose a Medigap plan that fits your specific needs and is available in your area.

_____________________
65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post How to Sign Up for Medicare When You Are Turning 65 appeared first on 65Medicare.org.

Medicare can be a welcome relief for many people who are turning 65, particularly if you have been paying the high premiums for your for own individual health insurance the last few years. But, here are three Medicare surprises that you may not know prior to researching and understanding Medicare.

1. MEDICARE SURPRISE #1: IT’S NOT FREE.

   Sure, you have been paying for Medicare your whole working life in the form of payroll deductions. Surely, the Federal Government has been safely storing your money in a bank somewhere to be used to “give” you Medicare when you turn 65, right?

   Well, not exactly. Medicare Part A (hospital) is premium-free currently, as long as you have worked 10 years and paid into the “system”. However, there is a premium for Medicare Part B. Currently, the standard Medicare Part B premium is $148.50/month (for 2021), although the exact premium you will pay is determined in some part by your income. If you fall into a higher income category, you could be responsible for IRMAA. And, if you fall into a lower-income category, you may be eligible for assistance in paying for Part B premiums.

2. MEDICARE SURPRISE #2: IT DOES NOT COVER EVERYTHING

   Medicare is certainly comprehensive coverage – in fact, over 75% of people who are on it are “very satisfied” with it according to a 2016 study by the Kaiser Family Foundation. That said, a number of those 75% have some sort of supplemental insurance or additional plan(s) to go with Medicare. Medicare, in and of itself, is not 100% full coverage.

   On the contrary, Medicare has deductibles and co-pays that are not covered by traditional Medicare. If you have “only” Medicare and no other types of supplemental or group coverage, you are responsible for a Part A  deductible ($1484/benefit period for 2021), Part B deductible ($203/year for 2021) and an uncapped 20% coinsurance. The “uncapped” is the key word in the previous sentence because it represents unlimited medical costs if you were to have hefty medical bills.

   This is also why such a large number of people (approximately 25%) purchase Medigap plans. Another quarter of the people, roughly speaking and based on 2019 figures, are enrolled in a Medicare Advantage plan. These number don’t include or account for another quarter of people who are dual-eligible for Medicare and Medicaid.

3. MEDICARE SURPRISE #3: IT IS NOT A ONE-TIME DECISION

   This Medicare surprise catches you off-guard. Most people spend hours on their Medicare-related decisions leading up to their 65th birthday. Then, they think they are finished for the rest of their lives. You certainly can do it that way; however, it is not prudent financially to do so.

   Some types of plans change over time – Part D prescription plans, in particular, which can have dramatic costs and formulary changes annually. Others, like Medigap, never change coverage but can change premiums over time. If you use a “set it and forget it” methodology when it comes to Medicare, you will almost certainly be paying too much by the time you are 70 years old.

   The best course of action is to periodically review your plan choices – annually or bi-annually usually works best – to make sure that you have the best available deals for your specific needs (Is Plan G a better deal than Plan F?). A good independent broker should proactively contact you or stay in touch with you in order to help with this.

Medicare surprises are not out of the ordinary – instead, they are pretty commonplace, as most people do not think about Medicare until it is time for them to receive it. These are three common, unexpected surprises that people receive when they do reach the golden age of 65.

____________
65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post Medicare Surprises: Three Medicare Surprises No One Told You appeared first on 65Medicare.org.

To understand the answer to this, we must first make the distinction between two terms used with Medicare Supplement (also called Medigap) plans – Guaranteed Issue and Open Enrollment. The terms have similar meanings and similar implications – for both situations, you cannot be turned down for a Medigap plan. There are no pre-existing conditions exclusions or limitations. However, there are some differences between open enrollment and guaranteed issue.

What is Medicare Supplement Open Enrollment?

Open enrollment, as it pertains to Medicare Supplement plans, is a 6 month period that begins the first day of the month that you are both 65 or older and enrolled in Medicare Part B (see page 14 of the “Choosing a Medigap” booklet).

Now, some states do have additional open enrollment periods for people on Medicare. This includes, in some cases, open enrollment periods for people under age 65. It also includes, in some states, continuous open enrollment periods or annual open enrollment periods. But in most instances and most states, the Medigap open enrollment period coincides with your enrollment into Medicare Part B and the contingency that you be 65 or older.

Additionally, most insurance companies allow you to enroll in a Medigap plan up to 6 months before your Medicare coverage starts. When you do that, the coverage does not start right away, though – it begins the same day that Medicare begins, which for most people, is the 1st day of the month that you turn 65.

If you continue working past age 65 and are covered by a group/employer plan, you can (and in many cases should) delay enrollment into Medicare Part B. In that instance, your open enrollment period is also delayed until such a time that you do enroll in Medicare Part B.

If you are in your open enrollment period, that means that you can get any Medigap plan that is sold in your state without any pre-existing conditions restrictions or exclusions. Insurance companies cannot refuse to sell you any Medigap policy that they offer, and they cannot charge you more based on your health. Because of that, it is crucial to compare and choose a plan within this initial 6-month open enrollment period (check out our Turning 65 Roadmap for guidance on starting with Medicare and Medigap).

When is a Medicare Supplement Guaranteed Issue?

A different type of eligibility for Medicare Supplement coverage is called Medicare Supplement guaranteed issue. Guaranteed issue periods have the same basic implications as the Medigap open enrollment period, in that you cannot be turned down for coverage or made to pay more based on your health. However, there are some additional considerations.

First of all, you must fall into one of the situation-specific guaranteed issue periods. These are mandated, under Federal law, and all insurance companies must abide by them in order to offer Medicare Supplement plans. The main ones are:

• You are losing a Medicare Advantage plan due to moving out of the plan’s service area or your plan pulling out of offering Medicare Advantage plans (What is the difference in Medigap and Medicare Advantage?)
• You are losing employer group health coverage that pays after Medicare pays.
• You have a Medicare SELECT plan and move out of the plan’s service area.
• You joined a Medicare Advantage plan when you first turned 65, and within the first year or joining, you decide you want to switch back to “original” Medicare and get a Medigap plan.
• You dropped a Medigap policy to switch to a Medicare Advantage plan for the first time, you’ve been in the Advantage plan for less than a year, and you want to switch back to the original Medigap plan.
• Your Medigap company goes bankrupt and you lose your coverage or your Medigap coverage ends through no fault of your own.

If you fall into one of those scenarios, you can get Medicare Supplement guaranteed issue into certain Medigap plans. One of the big differences between open enrollment and guaranteed issue is which plans are offered. Whereas in open enrollment, you can choose any Medigap plan that is offered in your state, during a guaranteed issue you can typically only choose Medigap Plans A, B, C, F, K or L that’s sold in your state by any insurance company. This does somewhat limit you on your plan selection and can be a problem if you wanted a different plan (i.e. Plan G, which is often a better deal than C or F in particular). NOTE: For people who are turning 65 after 1/1/2020, Plan F is not available (on a guaranteed issue basis or otherwise). For those people, Plan G is offered on a guaranteed issue basis if you meet those criteria.

How do you know if you’re in a Medicare Supplement guaranteed issue period? You can look at the situations above or check Medicare’s “choosing a Medigap” booklet. It is important to realize, too, that some of these provisions vary by insurance company and state. But the ones listed above are the ones that are Federally-mandated.

What If You’re Not in Open Enrollment or Guaranteed Issue?

If you are not in a Medicare Supplement guaranteed issue or open enrollment  period, it does not necessarily mean that you cannot get a plan. However, you will, in most cases, have to ‘qualify medically’ to get a plan outside of these periods. What this means, in practice, is that you have to answer medical questions on an application and be “approved” to get a plan. These questions vary by state and company, so the only way to see if you would qualify is to contact a broker for guidance or contact each insurance company in your state to find out if you are eligible.

Generally speaking, most insurance companies are asking about the last 2-3 years and asking about things like cancer, heart attacks, stroke, insulin-dependent diabetes, COPD, multiple hospitalizations, and known/upcoming medical tests/procedures. But again, each company is different, and the best way to get a read on whether you are eligible (if you are not in open enrollment or guaranteed issue) is to have an independent broker run options to see which companies, if any, may work for you.
_____________________
65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post When Is a Medicare Supplement Guaranteed Issue? appeared first on 65Medicare.org.

Although the Social Security offices are currently closed to walk-in visitors, there are, fortunately, still options for enrolling in Medicare online. These options have been expanded in recent months with a revamped and improved enrollment tool for signing up for Medicare Part B. 

If you are already getting Social Security benefits, or Railroad Retirement Benefits, you will automatically be enrolled in Original Medicare Part A and Part B.  The effective date will be the first of the month you turn 65.  If your birthday falls on the 1^st of the month, then your Medicare benefits will start on the first day of the previous month. If you are under 65 and disabled, you will automatically get Part A and Part B if you have gotten disability benefits from Social Security (or from the RRB) for at least 24 months.  If you have ALS, you’ll get Part A and Part B automatically the month your Social Security disability benefits begin.  Note: If you are a resident of Puerto Rico or reside abroad, you will not get Part B automatically and must apply for it.

You should sign up for Medicare online:

• If you are in your IEP (Initial Enrollment Period), you can sign up three months before your 65^th birthday
• During the “General Enrollment Period” – If you haven’t enrolled in Medicare Part B during your initial enrollment period, you can still sign up each year from January 1 through March 31. Your coverage will start July 1 of the year in which you enroll.
• If you are in a Special Enrollment Period (SEP) – you may enroll for Part B:
  • in any month you remain covered under the group health plan and your, or your spouse’s, employment continues (in other words, while you or your spouse are still working); or
  • in the 8-month period commencing with the month after your group health plan coverage or your or your spouse’s employment ends, whichever comes first.

What are the benefits of signing up for Medicare online?

• You do not have to make an appointment at your local Social Security office (during the COVID pandemic, Social Security offices are not seeing walk-in visitors). During busy times of the year, your wait to get in to see someone may be up to 3 or 4 weeks;
• The application online process can be started immediately;
• You can save your application and go back to it later, without losing any of your information;
• You can sign up in the comfort of your own home, using your own computer;
• You will save time and money by not having to travel to your local Social Security office.
• You can rest assured that the technology used to input your personal information is secure.

Here are some tips that will help you complete your online application:

• Prior to enrolling online, go to the “Checklist for Online Applications” at www.ssa.gov/hlp/isba/10/isba-checklist.pdf. This information will help you to prepare for the process
• Visit www.socialsecurity.gov/medicare/apply.html and choose “Apply for Medicare Only.”
• If you need further information, click on “Related Information”.
• The normal application process online usually takes from 10 to 30 minutes to complete.
• Click on “Submit Now” and your application will electronically go to Social Security.

Once you have submitted your application, a receipt will be generated which you can print for your records.  You will then be assigned an application number that will be necessary in case you want to check the status of your application.  During the review process, if clarification is needed, including additional documentation, Social Security will contact you.  A letter will be sent to you by mail with the decision (usually 7-10 days). Then, within 3-4 weeks, your Medicare card will arrive.

Although Social Security offices are not providing service to walk-in visitors, they are still available by phone.  You can call your local office by using the Field Office Locator, under “Social Security Office Information”.  Alternatively, you can call the toll-free national number at 1-800-772-1213.  If you are hard of hearing or deaf, the TTY number is 800-325-0778.  A staff member is available from 7:00 am to 7:00 pm, Monday through Friday.

At this time, Social Security is requesting that you should access their online services before reaching out by phone.  That said, it’s understandable that if you don’t have a computer or are not computer savvy, you can always call them!  Otherwise accessing their online services is the most practical way to contact them.  Some advantages of using the online system are:

• Applying for benefits
• Getting useful information
• Find publications
• Get the answers to FAQs

You can create a My Social Security account, which will give you additional options, i.e. review your Social Security statement, verify earnings, print a Benefit Verification Letter, or modify your direct deposit information.  If you need a replacement Medicare card or Social Security card (if there are no changes and your state participates), or a duplicate SSA-1099/1042S, you can request those as well.

Important note: If you are enrolling in Medicare Part B for the first time, that generates your initial open enrollment window for Medicare Supplement (Medigap) and Medicare Advantage plans as well. It is crucial to be aware of this and not miss any deadlines for enrolling.

_____________________
65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post COVID-19 and Medicare – How Do I Enroll in Medicare Online? appeared first on 65Medicare.org.

Signing up for Medicare is daunting enough, but what about all the years that follow? There are an unlimited number of Medicare questions that Medicare recipients come up with after they have made their decisions. Whether they chose Original Medicare, or a Medicare Advantage Plan (including a Prescription Drug Plan), or Original Medicare plus a Medicare Supplement (Medigap) plan, there may be unanswered questions from when they first enrolled, or questions that may have arisen afterwards. We have put together a list of the most frequently asked questions among this segment of the population, in hopes that clarity may be gotten from this information.

If I enrolled in a Medigap plan, do I need to renew it every year?

No, you do not have to renew it again. It is “guaranteed renewable”, which means you cannot be terminated from the plan for any reason, including any new health conditions you have developed.

Does a Medigap plan include prescription drugs?

No, it does not. You will have to get a stand-alone drug plan besides the Medigap plan.

When can I disenroll in or switch from one Medicare Advantage plan to another?

You can switch or drop your Medicare Advantage plan, but only during certain periods of the year:

• The annual open enrollment each year from Oct. 15 – Dec. 7. However, your new plan will not become effective until Jan. 1^st of the following year.
• The Medicare Advantage Disenrollment Period, Jan. 1 – March 31, each year.
• The Special Enrollment Period – there are certain circumstances which will allow you to change, i.e. moving out of the service area of your plan; you decide to switch during the first year you joined a Medicare Advantage plan (trial period).

I’m planning to retire, what will happen when my employer coverage ends?

When your employer coverage ends, you have 8 months within which to enroll in Part B (or choose COBRA). You will need to complete an Application for Enrollment in Part B (CMS-40B) and a Request for Employment Information (CMS-L564). Even if you choose COBRA, be aware that if you do not enroll in Part B during the 8-month period following your termination of coverage, the following may occur:

• You may incur a penalty for the duration that you have Part B.
• You will not be able to enroll until January 1–March 31. If that happens, you will then have to wait until July 1 of that year before your coverage starts.

Are pre-existing conditions immediately covered, or is there a waiting period?

Original Medicare and Medicare Advantage plans do not generally take into consideration pre-existing conditions or disabilities. However, if you have end-stage renal disease (ESRD) or want to enroll in a Medicare Supplement (Medigap) plan, there are some exceptions. It is the insurance company who determines what their guidelines are and which, if any, pre-existing conditions they want to include. Each company also decides on the length of the waiting period if any.

The exception to this is if you apply for a Medigap plan during the open enrollment period when you first turn 65 or start on Medicare. During this time period, there are no health questions, no pre-existing conditions, and you are automatically approved.

If I apply for a Medigap plan, will I be immediately approved?

Unless you are in “open enrollment” or are entitled to be a guaranteed issue, then no. Your application will have to go through medical underwriting and you will be obligated to answer medical questions. This is why it is important to choose a Medigap plan when you are first eligible for Medicare if you intend to get one at any point.

How often can I change my Part D, Prescription Drug Plan?

You can switch your PDP during the annual open enrollment period, Oct. 15 to Dec. 7, each year. Otherwise, there are certain circumstances which would allow you to change, i.e. you moved out of your plan’s service area; your plan was dropped from being offered in your service area. If you are eligible for Extra Help, you can change your PDP at any time during the year. You can also change at any time if switching to a 5-star rated prescription drug plan.

What is IRMAA and why do I have to pay it?

IRMAA stands for Income Related Monthly Adjustment Amount. It is an additional amount which is added to your premium. If your modified adjusted gross income is above a certain amount (according to your IRS tax return from 2 years ago), you will pay the standard premium amount ($135.50), plus an Income Related Monthly Adjustment Amount. To learn more, please go to https://www.medicare.gov/your-medicare-costs/part-b-costs.

What are the rating methods used to set the rates for Medigap plans?

Attained-age rates are determined by your age when you are on the policy. They go up as you get older. Issue-age policy rates are determined by your age at the time the policy is issued. Community-rated policies charge the same rates to everyone within the same geographic area.

What should I do if my Medigap premium goes up?

Medigap premiums, just like any other type of insurance, do go up over time. The premiums are typically determined by your age, so they will typically increase as you get older. Additionally, rates change as Medicare makes changes to the coverage offered by traditional Medicare, since Medigap plans automatically “expand” to cover Medicare gaps.

If and when your premium increases, it is a good idea to “shop” to ensure that you have the best available deal. If you are in good health, you can very easily change to equivalent coverage from a different company, potentially saving yourself money for equal coverage.

Other Medicare Questions?

You probably have Medicare questions that are not covered by this brief list. We have answers. If you have a question about Medicare itself, Medigap or Medicare Advantage or Part D, please feel free to contact us.

_____________________
65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post Frequently Asked Medicare Questions appeared first on 65Medicare.org.

Whether you use us or another broker, it is highly advisable to use a Medigap broker when you make your Medigap selection. There are a handful of reasons for this – we’ve listed the top 7 reasons to use a Medigap broker below:

1. You can compare all the Medigap options in a centralized place.

There are 30+ Medigap companies offering in most states. The alternative to using a broker, if you want to make any kind of educated decision, is to call each one of them. Even if you are retired with nothing but time on your hands, talking to insurance agents from 30+ insurance companies, each touting their own plans, may not sound like your idea of a good time.

A Medigap broker can provide a full list of the plans available in your area and help you compare them on the basis of price, company ratings and reputation and future outlook. This way, you can make an informed, no pressure choice.

2. Your Medigap agent/broker has a loyalty to you and your satisfaction, not to one specific insurance company.

Medigap brokers get paid when you sign up for a plan. They do not care whether it is Company X or Company Y paying them. Their loyalty is to the insured, to make sure that you are happy and satisfied with whatever plan you choose. If you are not, any decent Medigap broker will switch you to a company/plan that you ARE happy with. You are still their client, either way. This is, obviously, not the case if you are dealing directly with one insurance company.

3. You have a direct representative that you can call if you ever have problems or questions.

There are, frankly, very, very few “issues” with Medigap plans. The problems that are there are usually due to provider oversight or some other easily correctable issue. That said, when there are problems, your options are calling an 800 number to an overseas call room where the representative is not financially incentivized to handle your problem OR calling YOUR broker who knows who you are and IS financially incentivized to solve your problem.

4. Medigap brokers can do the majority of the enrollment work for you.

Have you seen the application for a Medigap plan? The applications for most companies are 10-15 pages long and written in 8 point font (not sure why Medigap insurance companies have not figured out who their market is). A Medigap broker will help you complete the application, and with most companies, it can even be done over the phone with minimal hassle and time spent by you.

5. Brokers can add other valuable services, such as annual Part D reviews.

Medigap brokers, again, are paid to keep you as their client. Most, including 65Medicare.org, offer additional services to clients. Some of these services that we (and many other brokers) offer include: an annual review of your Medigap plan, annual Part D reviews, quarterly email newsletters, important updates about changes to Medigap and Medicare and regular availability for problems or questions.

6. You are paying for it already, whether you use one or not.

Our favorite question is ‘how much does it cost to use you to sign me up for a plan?’ So glad you asked! The answer is $0 – yes, $0. Not much is free these days, but using a Medigap broker is. Well, not exactly – you see, the commissions that brokers are paid is built into your premiums already. In other words, you are paying for a broker, whether you use one or not. You get the same Medigap premium rate, whether you have a broker and his or her services or whether you do not have one.

7. Medigap brokers are financially incentivized to make sure you like your Medigap plan.

Last but not least, Medigap brokers get paid every time that you pay your premium to the insurance company. So, they are financially incentivized to ensure that you like your plan and are happy. Contrast this to a sales agent for insurance company X, who has a quota to meet and is paid a one-time bonus for “selling” you. Which one do you think has your interests more in mind?

THE BOTTOM LINE

Whether you use 65Medicare.org as your Medigap broker or someone else, it is a good idea to use one and have one. If you have not done so in the past, it’s not too late. If you are turning 65, it’s a good idea to establish a rapport with one broker so they can understand what your needs, resources and concerns are, thereby allowing them to make better recommendations.

If you want to work with us, let us know here: Work with 65Medicare.org to Compare and Choose a Medigap Plan.

The post Medigap Broker – 7 Reasons Why You Should Use a Broker to Sign Up for a Medigap Plan appeared first on 65Medicare.org.