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. 

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

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


What does this cost? Medicare A and B? A Supplement? Drug coverage?

Medicare Part A is $0 for most people that have paid Medicare taxes for at least 40 quarters; in other words, it is 100% subsidized by the Medicare taxes you have paid during your working lifetime. Medicare Part B does have a premium. The standard premium for Medicare Part B for 2023 was $164.90 but for 2024, the premium went up to $174.70. Most individuals pay the Standard premium for Medicare; however, if you are a high-income earner, you could pay more.

More info here:

Why Am I paying more for Medicare?

Medicare Supplement prices vary by the following: Age, Male/Female, Smoker/Nonsmoker, Zip Code, which plan you select, ie. Plan F, Plan G or Plan N. Our office will provide quotes for the top 5 A-rated insurance carriers that offer Medicare Supplement coverage in the state of IL. At age 65, these plans can cost $120-$150/month per person.

State of IL has several dozen Medicare Part D RX* plans to choose from. They range from about $0/month to over $100/month. Most people can find a plan between $10-25/month, unless you have a lot of expensive medications. Our office has a website that allows us to shop with all Medicare RX plans in the state; by entering in your medications and your preferred pharmacy, we can help you find the BEST RX coverage for you based on annual cost of the card, the deductibles, and copayments for the pharmacy you use and the medications you are currently on.

*We are licensed with all IL insurance companies that sell Medicare Part D Drug Cards for 2024: Aetna, BCBS (HCSC), Cigna, Humana, MOO, UHC, WellCare/Centene.  


How do I get Drug Coverage?

You have one of two options for prescription drug coverage:

  1. Medicare Part D – stand-alone prescription drug coverage
  2. Medicare Part C – Medicare Advantage with Prescription Drug coverage (MAPD)

Our office will help you! We will get a list of your medications, dosages, frequency of fills, and your preferred pharmacy and shop all the available plans in IL (there are about 30!) We will run a report using either the tool on Medicare.gov (available to everyone) or our RX quoting site (soon to be on our website) to produce a report that shows you the lowest cost and BEST option for drug coverage based on your current medication list.

How Does Medicare RX work?


I don’t take medications; can I skip drug coverage?

You don’t want to ‘skip’ this coverage because:

  1. You will be PENALIZED later – 1% of the national average per month for every month delayed. ie you will pay 12% extra for 1 year delayed, 24% for 2 years, 60% for 5 years delayed!
  2. You will not be able to enroll at any time should you need to get the coverage later; you will have to
    wait until the annual open enrollment in the fall (October 15th – December 7th) and coverage will begin Jan 1st
    after you enroll.

How Do I Avoid Part D Penalty?


Do I need a Medicare Supplement?

Most people know that Medicare alone is not enough. A supplement is designed to pick up the hospital deductibles and coinsurance for Dr. visits, tests, therapy, etc, that is not covered by Medicare.

Without a Supplement, YOU are paying for the Medicare Part A hospital deductible for each and every hospitalization: for 2023 this is $1600 per admission. You will also pay 20% of all Medicare Part B charges after the annual deductible. This includes Dr. visits, outpatient tests, outpatients surgeries and procedures, including chemo and radiation. And the 20% is NOT Capped! You will pay 20% of all medical bills, whether they run
$10,000, $20,000 or $1 million dollars!

A supplement also allows you to see ANY DR. in the US that accepts Medicare (including providers at Mayo Clinic!) There is no network, per se; if the Dr. takes Medicare, they take the supplement too – any supplement.

And to confuse you further, the government alphabetized these supplements; they go by plans A, B, D, G, K, L, M, and N for new to Medicare recipients beginning Jan 1, 2020 and later. (NOTE: Plan C and F are only available to those individuals who were eligible for Medicare A or B BEFORE Jan 1, 2020.)

Medicare Supplement Explained

What is a MediGap policy? Or Medigap insurance? 

Medigap is another word for Medicare Supplement; they are interchangeable.

Medicare 101

Our site is filled with educational videos and articles to help you with your Medicare journey, get started by clicking any of the buttons below.

We also prepared more videos for you! Just visit our YouTube Channel by clicking the link below:

Here are videos we've curated for you to get started!

Medicare Basics Explained!

Enroll in Medicare at 65?

Medicare vs. Retiree Benefits

What Age Can I Get Medicare?

We created a YouTube channel where you can ...

  • Watch short, 5-10 minutes educational videos on different Medicare topics.
  • Learn the basics of Medicare and
  • Understand your choices and options
  • Become Educated so you can make the BEST decision for your situation!

Are you 7 months or more away from turning 65?

Fill out the form by clicking the button below and receive more information about Medicare via email! 

DISCLOSURE

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).