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Medicare Frequently Asked Questions (FAQ)

Can I enroll in a Medicare Part D plan, Medigap plan, or Medicare Advantage plan if I am not enrolled in Medicare?

No. You must be enrolled in Medicare in order to be eligible to enroll in a Medicare Part D plan, Medigap plan, or Medicare Advantage plan. A Medicare Part D prescription drug plan only requires that you be enrolled in Medicare Part A. However, in order to enroll within a Medigap plan or a Medicare Advantage plan, you must first be enrolled in both Medicare Part A and Medicare Part B.

Do all Medicare Part D plans cover the same medications?

No, each plan may have a unique list of covered drugs. The list of covered drugs is known as a formulary. Medicare requires all Medicare Part D plans to cover at least two medications in each therapeutic category/class approved by Medicare. The drugs within the formulary are assigned to tiers. The tier determines the co-payment or out-of-pocket costs a person within the plan will pay for the drug. If you take a medication that is not covered on your Part D plan's formulary, you will pay full retail price.

Do I have to be enrolled in Medicare Part B before I enroll in a Medicare Advantage program?

Yes.

If I enroll in a Medicare Advantage plan or a Medigap plan, do I still have to pay my Medicare Part B premium?

Yes. You will have to pay your monthly Medicare Part B premium to Medicare alongside the monthly premium you pay to your Medicare Advantage plan or Medigap plan.

If I enroll in a Medigap plan, will it also cover my spouse?

No. You and your spouse must each enroll in a Medigap plan in order to obtain Medigap coverage.

Are Medicare and Medicaid the same thing?

No. Medicare is a federal health coverage program designed for the elderly as well as individuals with certain qualifying health conditions such as End Stage Renal Disease. Medicaid is a state-run health coverage program primarily targeting low-income individuals within the state.

What Clinical Costs Are Covered by Medicare?

Medicare covers most clinical services and supplies that are medically necessary to treat a beneficiary's condition or injury. Your benefits and costs will depend on which parts of Medicare you're enrolled in, whether you get your coverage through Original Medicare or a Medicare Advantage plan, and whether you have prescription drug or supplemental coverage.

What Happens if Your Medicare-Covered Prescription Drug Is Found Unsafe?

As a Medicare beneficiary, you could one day be in a situation where a drug covered by your Medicare Part D prescription drug plan or Medicare Advantage Prescription Drug (Medicare Part C) plan is found to be unsafe. Find out how to deal with this issue.

What Can You Do if Medicare Stops Covering Your Medication?

As a Medicare beneficiary, you could one day find that your Medicare Part D Prescription Drug Plan or Medicare Advantage Prescription Drug plan removes one or more of your prescription drugs from its list of approved medications. What can you do if your drug is no longer covered?

What do I need to know about my Medicare electronic health records?

An Electronic Health Record (EHR) is a digital, electronic version of a patient's medical history; that is, it's information entered on a computer. EHRs improve patient quality of care by making it easier to share medical information between patients, doctors, internal staff, and hospitals. Medicare uses EHRs to help Medicare beneficiaries more efficiently get the care they need.

What is the Medicare Coverage When you move to a different country?

Medicare generally doesn't cover health-care services if you moving to another country, even if you're still enrolled in Medicare. If you're a Medicare beneficiary moving outside the U.S., plan ahead and make sure you have health-care coverage (other than Medicare) in that country. But you might still want to retain your Medicare coverage in case you ever move back to the U.S.

Moving to Another State? Learn About Changing your Medicare Plan.

Are you a Medicare beneficiary who's moving to another state? This may be a good time to update your Medicare coverage to make sure you're getting your needs met. Here are some tips on what you'll to do when you move and steps for changing coverage after moving states.

What are Medicare Quality Improvement Organizations?

Quality improvement organizations (QIOs) are private, non-profit groups that work with Medicare to look into beneficiary complaints and make improvements as needed. Each organization is made up of practicing doctors and other health professionals who use their medical expertise to conduct case reviews during the appeals process and evaluate the appropriateness and effectiveness of health services for Medicare beneficiaries.

What Are Medicare Part D Straddle Claims?

There are three phases of the calendar year for your Medicare Part D coverage. Whether or not you receive your prescription drug coverage through a stand-alone plan that works alongside your Original Medicare, Part A and Part B, coverage or you belong to a Medicare Advantage Prescription Drug plan, the phases are the same.

What Does TrOOP Mean?

True out-of-pocket (TrOOP) costs refer to your Medicare Part D plan's maximum out-of-pocket amount. That is the total amount you are allowed to spend out of your own pocket each year on medications covered by your prescription drug plan. The TrOOP amount for 2015 is $4,700, meaning that once you have paid that much out-of-pocket, your drug plan's catastrophic coverage kicks in to cover you the rest of the year.

What if Your Pharmacy Can't Fill Your Medicare-Covered Prescription Drug?

As a Medicare beneficiary, you may one day be in a situation where your pharmacy can't fill your Medicare-covered prescription. If you're enrolled in either a Medicare Part D prescription drug plan or a Medicare Advantage (Medicare Part C) plan with drug coverage, there are a number of ways to deal with this issue.

What Is a Medicare Contractor and How Do They Help with Appeals?

Medicare relies on private contractors to support Original Medicare (Part A and Part B) administrative duties, such as claims processing and appeals. Both Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) are involved in the appeal process.

What Is a Medicare Drug Coverage Exception or Appeal?

Before joining a Medicare Part D drug plan, it is recommended that you compare all of the available options in your area. Each plan has a formulary, which is a list of medications covered by that particular plan. Every formulary can be different, so it is naturally important to try and find one that covers as many of your prescriptions as possible.

What is Telemedicine and its coverage under Medicare?

Telemedicine, also referred to as telehealth (and sometimes telecare), is an important and growing area in the field of health care. With technology and communications improving constantly, telehealth can offer convenience and comfort to patients. According to a study at the University of Massachusetts Medical School, telehealth saves health providers money (which could result in savings to Medicare and its beneficiaries).

Which pre-existing conditions are not covered by Medicare?

According to Medicare.gov, a pre-existing condition is any health condition or disability that you have prior to the coverage start date for a new insurance plan. If you have Original Medicare or Medicare Advantage, you are generally covered for all Medicare benefits even if you have a pre-existing condition or disability. However, if you're enrolled in a Medicare Supplement (Medigap) plan or have end-stage renal disease (ESRD), there are some exceptions.

When Can Your Insurance Company Drop Your Medicare Coverage?

There are several reasons why your insurance company may decide to drop your Medicare coverage. For Original Medicare, Part A and Part B, you can lose your coverage if you do not make your premium payments on time. In this situation, you will receive two warnings in the mail: a Second Notice (after your usual payment notice) and then a Delinquent Notice that will encourage you to make your payment.

What Is the Difference Between Medicare Coinsurance and Copayments?

It's easy to think coinsurance and copayments are the same when it comes to Medicare. Both terms refer to out-of-pocket spending, but it's important to understand the difference between the two. One of these costs refers to a flat fee that you pay when you receive a Medicare-covered service or treatment, while the other refers to a percentage amount you'll pay as a share for a Medicare-approved service or procedure. It's possible you'll pay both a copayment and coinsurance fee, so understanding the two is very important.



Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare and provide Medicare Part A and Part B coverage. Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the "gaps" in original Medicare coverage.

Medicare has neither reviewed nor endorsed this information.

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