Frequently Asked Questions

 Medicare Annual Enrollment takes place from October 15th to December 7th each year.  

Choosing the right health insurance can be overwhelming. At Potje Team Health Insurance, we take the time to explain your options clearly, ensuring you understand each plan's benefits and limitations. Steve's background as a registered nurse allows him to assess your medical needs accurately and match them with the most appropriate insurance solutions.  

Supplemental coverage offered by a private insurance carrier will help cover costs that Medicare leaves behind.  

The price and benefits of your policy are exactly the same whether you enroll with an agent or directly through the carrier. Enrolling with a qualified agent with assist with rate comparisons and ensure you receive optimal coverage for your unique needs.  

Recipients of Medicare Advantage (Part C) may be eligible a FLEX CARD, which is a debit card used to pay for extra expenses. Flex card money could be used for groceries, assistive devices, utilities and more depending on your insurance plan. Each insurance plan has different rules on how much flex card money you can get and where you can spend it.

Unused benefits will expire by December 31st each year. If eligible, benefits will repost on January 1st of the following year. Typical benefits can range from $250 - $1,500

To be eligible for Original Medicare, you must be a permanent legal resident (green card holder) or an American citizen who has lived in the United States for at least five years AND one of the following:

• Age 65 or older

• Under age 65 and receiving Social Security Disability Income for 24 months

• Diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis

To enroll in Original Medicare, you may be required to reach out to your local Social Security office in some circumstances.

You will automatically be enrolled in Medicare at age 65 if you are receiving Social Security benefits or railroad retirement board benefits at least four months before you enroll in Medicare.

However, suppose you are not receiving Social Security benefits or railroad retirement board benefits. In that case, you will need to contact your local Social Security office to enroll in Medicare up to three months before your 65th birth month.

If you must contact your local Social Security office, you can sign up for Part A and Part B at the same time. Once you complete the application and provide the required documentation, you will begin receiving benefits on the first day of your 65th birth month.

To complete the application, you can do so online, in person, or over the phone.

While it is not mandatory, we recommend you enroll in Medicare Part A coverage as soon as you become eligible if you qualify for premium-free Part A coverage. However, if you delay Medicare Part A, you will be able to enroll later

during the General Enrollment Period or a Special Enrollment Period if you qualify. But, if you delay enrollment to the General Enrollment period, you will be required to pay late enrollment penalties.

IIf your employer offers creditable health coverage, you do not need to enroll in Medicare Part B if you are working past age 65. Creditable coverage is healthcare coverage that provides at least equal benefits to Original Medicare. Suppose you do not have creditable coverage and do not enroll in Medicare Part B when you first become eligible. In that case, you may have to pay the Medicare Part B late enrollment penalty as long as you have Medicare Part B.

Remember that even if you have creditable coverage, it is essential to compare your current plan to Original Medicare with a Medigap plan and Part D. Often, combining these Medicare plans will provide you with the most comprehensive coverage possible.

Medicare Supplement plans and Medicare Advantage plans are not the same things. While both Medicare Supplement and Medicare Advantage plans bring additional benefits to Original Medicare, they work very differently. Medicare Supplement plans, also known as Medigap plans, work as a secondary to Original Medicare (Medicare Part A and Part B). The plan will only pay after Original Medicare has paid its portion. These plans have no networks, no restrictions, and no referrals to see specialists.

Medicare Advantage plans, also known as Medicare Part C, on the other hand, become your primary coverage over Original Medicare. They often require you to follow a strict network of doctors and have higher out-of-pocket costs. However, they often provide additional benefits.

These additional benefits provided by Medicare Advantage plans often include dental, vision, hearing, and prescription drug coverage, as well as transportation assistance and gym memberships.

If you delayed Medicare coverage past age 65 with creditable coverage, you would need to contact Social Security to enroll in Original Medicare.

Since you have creditable coverage, you will receive a Special Enrollment Period to enroll in Medicare Part A and Medicare Part B benefits. From there, you can enroll in a Medicare Part D prescription drug plan and Medicare Part C or Medicare Supplement.

However, if you delayed Medicare coverage without creditable coverage, you would need to enroll in Original Medicare during the General Enrollment Period. This is an annual period that runs from January 1 to March 31 each year. Remember, coverage does not begin until July 1, when you enroll during the General Enrollment Period.

For most, the Medicare Part A premium is $0 per month. However, if you do not qualify for zero-premium Part A, the premium can be as high as $506 in 2023 or $505 in 2024. To qualify for zero premium, you must have worked at least 40 quarters or ten years paying Medicare taxes. If you did not meet this qualification, you would be required to pay the Medicare Part A premium.

The standard Medicare Part B premium is $174.70 in 2024. This can increase based on income. This difference in premium reflects your Income Related Monthly Adjustment Amount (IRMAA).

For example, if you and your spouse make $230,000 combined, you will each pay $244.60 per month in 2024. If you are subject to IRMAA, you will receive a determination letter with your new monthly premium.

It is illegal to enroll in both a Medicare Supplement plan and a Medicare Advantage plan. If you were to enroll in both plans, neither would become your primary coverage, leading to a denial of services. This could leave you paying out-of-pocket for all your healthcare services, regardless of having both coverages.

To avoid this, it is illegal for an agent to enroll you in one plan if you are already enrolled in the other and do not have a valid way out of the plan.

Original Medicare coverage is automatically renewable each year you are eligible. Thus, you do not need to renew your Medicare parts each year.

Medicare Supplement plans work the same way, once you are accepted, the plan is automatically renewable as long as you continue to pay the monthly premium.

Medicare Advantage plans work similarly. However, you have the option to change your plan each year if you do not like the benefits of your current plan.

Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with permanent kidney failure treated with dialysis or a transplant. Medicare has two parts - Part A which is hospital insurance, and Part B which is medical insurance. 

Generally, Original Medicare does not cover prescription drugs. However, Medicare does cover some drugs in certain cases such as immunosuppressive drugs (for transplant patients) and oral anti-cancer drugs. You should call your Durable Medical Equipment Regional Carrier for more information. Check the Important Phone Numbers section of this web site for the phone number. There are some Medicare Health Plans that cover prescription drugs. You can also check into getting a Medigap or supplemental insurance policy for prescription drug coverage. Medicaid may also help pay for prescription drugs for people who are eligible. 

Anyone who has refused, terminated, or withdrawn from Medicare Part B or Premium Free Part A coverage can enroll again. You can enroll during January, February, or March of each year. This is referred to as the General Enrollment Period. Your Medicare coverage will not begin until July 1st. You may or may not have to pay a premium surcharge. Call the Social Security Administration at 1-800-772-1213 for an appointment or visit your local Social Security Office to file an application. They will also tell you the amount of any premium surcharge you may have to pay 

Supplemental insurance policies are sometimes called Medigap plans. Medigap plans are private health insurance policies that cover some of the costs the Original Medicare Plan does not cover. Some Medigap policies will cover services not covered by Medicare such as prescription drugs. Medigap has 10 standard plans called Plan "A" through Plan "J". Each plan has a different set of benefits. The states of Minnesota, Wisconsin and Massachusetts have choices other than Plan "A" through Plan "J". Your State Insurance Department can answer questions about the Medigap policies sold in your area. Check the Important Phone Numbers section of this web site for the phone number of your State Insurance Department. 

Medicare covers the same supplies for both insulin and non-insulin dependent diabetics. They include: Glucose testing monitor, Blood glucose test strips, Lancets, Spring powered devices for lancets, and Glucose control solutions. Some frequency limitations may apply. Medicare does not cover insulin and syringes. Contact your Durable Medical Equipment Regional Carrier for more information. Check the Important Phone Numbers section of this web site for the phone number. 

Medicare Part B helps pay for doctors' services, outpatient hospital care, blood, medical equipment and some home health services. It also pays for other medical services such as lab tests and physical and occupational therapy. Some preventive services such as mammograms and flu shots are also covered. Medicare Part B does NOT cover routine physical exams; eye glasses; custodial care; dental care; dentures; routine foot care; hearing aids; orthopedic shoes; or cosmetic surgery. It also does not cover most prescription drugs or health care you get while traveling outside the United States (except under limited circumstances). 

A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill. There are deductibles for both the Part A (Hospital Insurance) and Part B (doctor services) portions of Medicare. Your deductible is taken out of your claims when Medicare receives them. Medicare will not start paying on your claims until you have met your annual deductible. If you have any questions on the status of your deductible please contact your Medicare carrier. 

For 2024, your Medicare Part A per occurrence deductible is $1,632 with your Part B annual deductible costing $240.

Original Medicare does not cover prescription drugs. If you wish to have coverage for prescription Medications, you will need to enroll in Medicare Part D. Medicare Part D helps cover the cost of prescription medications. Additionally, some Medicare Advantage plans provide prescription drug coverage as well.

If you do not enroll in Medicare Part D, you may be subject to the Medicare Part D late enrollment penalty. This penalty is for those who delay Part D benefits without creditable coverage. You will

Original Medicare does not offer coverage for hearing aids.

However, some Medicare Advantage plans may provide this benefit. CMS does not deem hearing aids medically necessary, so they are not covered by the federal healthcare program.

If you need hearing coverage but do not want to enroll in a Medicare Advantage plan, there are several options. You can enroll in a stand-alone benefits plan that allows hearing coverage to work alongside your Medicare plan.

It is not required for you to enroll in Medicare if you have VA benefits. However, if you ever receive coverage outside of the VA system, you will need medical coverage to cover these costs.

Remember, if you have VA coverage and delay Medicare Part B enrollment, you will have to pay the Medicare Part B penalty if you decide to enroll in Medicare coverage later in life. Once you enroll in Medicare, it pays primary, and the VA pays secondary.

Medicare HMO and PPO plans are Medicare Advantage plans.

HMO plans are the most restrictive with tight networks and require referrals to see specialists. PPO plans are more lenient and have a more comprehensive network of doctors and hospitals you can utilize. HMO plans typically cost less than PPO plans.

However, both types of plans have restrictions and guidelines you must follow to receive care.

Original Medicare does not have a typical network of doctors and hospitals. Instead, doctors and hospitals can opt in or opt out of accepting Medicare. In 2024, nearly 93% of doctors and hospitals nationwide will accept Medicare.

When you enroll in a Medicare Advantage plan, you will have to follow the network of doctors who accept your plan. This is one of the downsides of enrolling in an Advantage plan. You lose the freedom to choose your care team thoroughly.

However, with a Medicare Supplement plan, you will be able to see any doctor nationwide. This is a bonus if you often travel or have dual residency.