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LIsa Caulkins - Trusted Advisor
LIsa Caulkins - Trusted Advisor
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F.A.Q.'s

Do I need to call S.S. office to order my card before turning 65?

Yes and no. If you are already collecting social security, they will send you your Medicare Part A & Part B card automatically, usually about 3 months prior to your birthday month. If you are NOT collecting S.S. yet, then yes, you will need to call the S.S. office 3 months prior to your birthday month and request your card.

How do I know what plan is right for me?

This is where you sit down with an agent and discuss what is important to you in a plan. Not everyone is the same. Understanding what your options are is vital. Understanding what doctors are available and what the costs of your prescription drug costs are can help determine what plan you select. 

I travel a lot. Will an advantage plan cover me when I am away?

Yes, when you are traveling you always have access to urgent cares and emergency rooms and emergent hospitalization.   It will be  covered as an in-network service.  If you need to use the E.R. or urgent care while away, get treated and then follow up with your PCP when you return home.

 Additionally, some advantage plans have travel benefits that include in-network copays and coinsurance while you are in another state for up to 9 months or longer. Again, let your agent know what is important to you and what your options are so that you select the best plan that will fit all of your needs. 

I have pre-existing conditions. Can I still sign up for Medicare?

Absolutely! Advantage plans are a guaranteed acceptance if you have Medicare A & B and reside in their service area.  When applying for a Medicare Supplement or "Medigap" plan before turning age 67, it does not matter what conditions you have, you have a guaranteed acceptance. The only time where pre-existing conditions would apply is if you wanted to sign up for a Supplement plan after turning 67. During this time, you will be subject to medical underwriting and, if you have medical conditions, you could be rated at a higher premium, or, in certain circumstances, denied for a supplement plan.   Speak to your agent to see what you qualify for.

How much does an agent cost to advise me?

ZERO! Think of us as Sherpas helping you climb the Medicare mountain. We get compensated from the carriers when you enroll into a plan. Which means this costs you nothing when you are getting advice from a licensed and qualified agent or broker. It's like having a free professional coach to help you understand Medicare and select the right plan.

Do I have to take Medicare at age 65?

No. If you are still employed and want to work past age 65 and still use your employer's insurance, you can do that. This is called delaying your part B. When it comes time for you to leave your employer's insurance, you will have to show that you had creditable coverage. You have your employer fill out form CMS-L564 and you fill out form CMS 40B.  L564 shows that you had creditable coverage and form 40B is your application for part B to start. You can find CMS 40B on the Medicare.gov website.

I heard of the 80/20 rule, how does that work?

When you first have Medicare you start off with part A & part B. This is called original or traditional Medicare. It is issued by the federal government. If you just kept part A & part B, you would be billed using deductibles and the 80%/20% rule. After paying the deductibles, the government pays 80% of your bill and you pay the remaining 20%. This can get expensive. However, if you joined an advantage plan, the 80/20 rule does NOT apply. And there are usually no deductibles. But if you kept the part A and part B and added a part D (PDP plan), and also added a supplement plan, then the supplement plan would pay  20up that whole 20% co-insurance.  That is why the supplement plan is also called a Medigap plan. Because it fills in the gaps (20%) that you normally would have to pay.

Can I still get a plan F on a supplement plan?

It depends. If your 65th birthday was before January 1st, 2020 then the answer is yes. If your 65th birthday is after January 1st, 2020, then the answer is no. After January 1, 2020 you now can get a plan G. The only difference between a plan F and a plan G is the part B deductible. On plan G, you are responsible for the deductible of part B which in 2022 is $233. On a plan F, the deductible was covered.  There are other supplement plans with different levels of coverage. 

When should I talk to an agent?

I always tell people to learn as much as you can well ahead of your time to sign up. You get your card 3 months prior to your birthday month and is the time to sign up. I advise folks to get with an agent at least 3 to 4 months prior to your birthday so that you completely understand what your options are in your area. 

Call Lisa Caulkins - Medicare & Small Group Health

1(520)977-5911

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