Frequently Asked Questions

Where do I apply for Medicare?

You can apply for Medicare benefits through the Social Security Administration. Call 1-800-772-1213, TTY 1-800-325-0778 (Monday – Friday, 7:00 a.m. – 7:00 p.m.) or visit www.ssa.gov.

I am not currently collecting a Social Security check and I’m 65. Am I still eligible for Medicare and how do I pay for it?

In most cases, yes, you are eligible. Receiving Medicare benefits is not related to collecting a Social Security check. If you have not worked 10 years, you may be able to buy Part A. To pay for Part B, you will be billed quarterly. Call 1-800-772-1213, TTY 1-800-325-0778 (Monday – Friday, 7:00 a.m. – 7:00 p.m.) or visit www.ssa.gov for more information.

What happens if I’m still working at 65?

If you are still working when you become eligible for Medicare, and you have health care coverage through your employer or union, contact the benefits administrator to find out how your insurance works with Medicare and if you should enroll in Part B. It’s important to review your options to ensure you won’t have to pay penalties or higher premiums when you do retire.

What if I initially decline Part B, but want to pick it up later?

If you don’t sign up for Part B when you’re first eligible for Medicare, you may have to pay a late enrollment penalty every month for as long as you have Medicare. In addition, your monthly premium may go up as much as 10% for each 12-month period that you could have had Part B, but didn’t. If you have been actively working and covered by group insurance, this penalty may not apply to you. You should discuss this with your group’s benefits administrator prior to turning 65, so you have plenty of time to avoid penalties.

Does my income affect how much I have to pay for Medicare?

Yes. Your income determines how much you will pay for Parts B and D.

My husband plans on retiring and enrolling in a Medicare plan when eligible at age 65. I’m 62 and have always been covered by his health care benefits. What happens when he joins Medicare?

You will not be eligible for Medicare coverage until you turn 65, so you’ll need to find other health insurance coverage until then. Your husband’s company may have arrangements for retirees with younger spouses. Talk to his employer about your options.

Your husband’s job may offer COBRA coverage or you can look into group coverage if you belong to an alumni association or social or professional organization. Otherwise, you should review individual health insurance plans available in your area. Learn more about your plan options in New York State by visiting https://nystateofhealth.ny.gov

Do my spouse and I have to take the same Medicare plan?

No. You can choose whichever plan meets your individual needs.

I’ve heard that under Original Medicare, hospital stays can include a number of different copays. How does that work?

Part A of Original Medicare helps pay for hospital stays; however, the copays differ depending on how many days you stay in the hospital.

What happens if I’ve retired from the railroad?

In most cases, if you’re already getting benefits from the Railroad Retirement Board (RRB), you will automatically get Original Medicare (Parts A and B) when you turn 65. If you aren’t getting RRB benefits yet, you will need to contact the RRB to sign up. (1-877-772-5772, TTY 1-312-751-4701, Monday – Friday, 9:00 a.m. – 3:30 p.m. CST)

Which disabilities are covered by Medicare?

Most disabilities (for people aged 18 to 64) are covered by Medicare after a 25-month waiting period. Contact your local Social Security office or call 1-800-772-1213, TTY 1-800-325-0778 (Monday – Friday, 7:00 a.m. – 7:00 p.m.) to see if you’re eligible.

I am eligible for Medicare because of a disability. What are my coverage options?

Your coverage options are the same as someone who has turned 65. However, you will not be eligible for Elderly Pharmaceutical Insurance Coverage (EPIC) until you turn 65.

My 65th birthday falls on the 1st of the month. When does my Medicare coverage begin?

Usually, your coverage begins on the first day of your birthday month (for example, if your birthday is August 11, your coverage begins August 1). However, if your birthday is on the first day of the month (for example, April 1), your coverage begins the first day of the prior month (for example, March 1).

Is nursing home care covered by Medicare?

No. Most plans do not cover this type of long-term care, so you will need to look for long-term care insurance. More information can be found at www.medicare.gov or the NYS Department of Insurance website, www.ins.state.ny.us.

What are the eligibility requirements to join a Medicare Advantage plan?

  • You need to be enrolled in Parts A and B.
  • You must live in the plan’s service area.
  • You cannot have End-Stage Renal Disease (ESRD) – Exceptions may apply. For example, if you were already a member of Independent Health before having ESRD, you may stay in or join an Independent Health Medicare Advantage plan.
  • NOTE: You must enroll during the annual enrollment period or a special election period, if you qualify.

What do I need to bring to enroll in a Medicare Advantage plan?

The only thing you need is your red, white and blue Medicare card, which you should receive in the mail three months before your 65th birthday. If you don’t receive or can’t find your card, call the Social Security Administration at 1-800-772-1213, TTY 1-800-325-0778 (Monday – Friday, 7:00 a.m. – 7:00 p.m.) or visit www.ssa.gov. program. You must decide which benefits to use every time you see a doctor or get health care. If you want your Veteran’s benefits to cover a service, you must go to a Veterans’ Affairs (VA) facility or get the VA to authorize services in a non-VA facility. For more information and veteran’s benefits eligibility requirements, visit www.va.gov or call your local VA office or the national VA number at 1-800-827-1000, TTY users call 1-800-829-4833.

What if I’m a veteran? How am I covered?

If you are entitled to both Medicare and Veterans’ benefits, you can get coverage through either program. You must decide which benefits to use every time you see a doctor or get health care. If you want your Veteran’s benefits to cover a service, you must go to a Veterans’ Affairs (VA) facility or get the VA to authorize services in a non-VA facility. For more information and veteran’s benefits eligibility requirements, visit www.va.gov or call your local VA office or the national VA number at 1-800-827-1000, TTY users call 1-800-829-4833.

I currently have Original Medicare and a Medigap policy, but was thinking of moving to a Medicare Advantage plan. Can I have a Medicare Advantage plan and a Medigap policy at the same time? If not, can I drop the Medigap policy and pick it up again at a later time?

If you decide to join a Medicare Advantage plan, you must drop the Medigap policy, as you cannot use it to pay Medicare Advantage plan copays, deductibles (if applicable) or premiums. Medigap policies can only be used with Original Medicare (Parts A and B). If you want to cancel your Medigap policy, contact your insurance company. Once you drop your Medigap policy, you will not be able to re-enroll until the next annual enrollment period

What if I leave employer sponsored coverage for an individual plan? Can I go back on my employer’s plan?

It depends on whether your employer allows this. Talk to the benefits administrator at your company.

How do I know if I have creditable prescription coverage?

Once you become eligible for Medicare, your employer should notify you every year. Keep this statement for your records. Prescription coverage through Veterans’ Affairs is considered creditable.

I’m 62 and I have started receiving Social Security benefits. Can I also sign up for Medicare now?

In most cases, you are not eligible for Medicare until you turn 65. There are some individuals who qualify for Medicare because of disability. Please contact the Social Security Administration for questions about your Medicare effective date.

What are Accountable Care Organizations?

An Accountable Care Organization (ACO) is a group of doctors and other health care providers who are working together with Medicare to coordinate care and services. ACOs are designed to help doctors, facilities and providers communicate more closely about your care. Your doctor has to decide to participate in an ACO.

What are Dual Eligible Special Needs Plans?

If you are eligible for both Medicare and Medicaid, you could benefit from a Dual Eligible Special Needs Plan, or D-SNP. A
D-SNP plan combines the benefits of both programs to help raise the quality of care you receive, while reducing your costs.