Frequently Asked Questions
What is Medicare and who is eligible?
Medicare is a health insurance program for US citizens age 65 or older and those under 65 who have been receiving SS disability payments for 24 months. People with permanent kidney failure and amyotrophic lateral sclerosis (Lou Gehrig’s disease or ALS) may also be eligible for Medicare.
A non-US citizen may be eligible if they are an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare may be eligible. NOTE: They may not be eligible for FREE part A and may have to pay to get Medicare A and B.
Citizens and non-citizens who have worked in the United States and paid Medicare taxes for at least 40 quarters (10 years), can qualify for Medicare Part A with no premium, otherwise known as FREE Part A. Those not meeting these requirements could be required to pay for Part A.
Initial Enrollment: When is the best time to enroll in Medicare?
The initial enrollment period is a seven month window. Which is the month you turned 65, three months prior and three months after. NOTE: The only exception is if your birthday falls on the 1st of the month; then you are eligible a month prior to your birthday and your 7 month window begins 4 months prior to your birthday month.
If you need coverage to start when you are first eligible ie "The first of the month in which you turn 65", enroll at the start of your Initial Enrollment or at least 6-8 weeks prior to needing coverage. Normal processing times can run 2-3 weeks, but if it is the 'busy season' for the SS office (typically end of the year), or if you have any issues that cause the application to be delayed.
What does Medicare cover?
Medicare Part A covers inpatient hospital stays; Medicare Part B covers all outpatient medical services except prescriptions filled at the pharmacy. You can get outpatient prescription coverage either through Medicare C (otherwise known as MAPD - Medicare Advantage with Prescription Drug coverage) or Medicare D - a stand-alone Medicare drug card. NOTE: Medicare does NOT cover all your health care costs - there are deductibles for Medicare A and B, 20% coinsurance, and deductibles, copayments and coinsurance for outpatient prescription drugs.
For more info, check out these videos:
Why Medicare ALONE is not enough
11 Things NOT covered by Medicare
How do I enroll in Medicare?
You can enroll online by clicking this link: https://www.ssa.gov/benefits/medicare/#anchor4
You can also call Social Security to make a phone appointment to enroll: 1-800-772-1213
NOTE: If you are OVER 65, and enrolling in Medicare A and B for the first time or enrolling in Medicare B for the first time, there are 2 forms you need: 1) the application for Medicare (A and B or B only) and 2) The Employer Verification of credible coverage ... so you won't be charged a LATE Penalty!
Get ER Verification form here: https://www.cms.gov/cms-l564-request-employment-information
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Our first priority is helping you find the BEST Medicare plans that suits your needs and budget. While our office is licensed with most of the Major A-rating insurance carriers in IL, we do not offer every plan in the state of Illinois. See list below. To see the entire list of carriers in IL, you can visit www.Medicare.gov or call 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all your options.
In most areas of Illinois, there are 19 PDP plans; our office is licensed to sell 18 out of 19 PDP RX plans. There is only one company (Clear Spring Health has a new PDP for 2024) that we do not represent.
For MAPD plans, there are around 51 plans depending on what county you live in. Our office is certified to sell 43 out of 51 MAPD plans; CB Health Insurance represents Aetna, BCBS of IL (HCSC), Cigna, Humana, UnitedHealthcare/AARP, and WellCare/Centene. We do not currently represent Molina Health (1 HMO only in certain counties), Zing (2 HMO plans), Devoted (2 HMO and 1 PPO). Clear Spring Health (2 HMO plans).