Medicare and Health Insurance Counseling - Frequently Asked Questions

A health insurance program serving:

• Adults aged 65 years and older;
• Those under age 65 considered disabled under Social Security provisions;
• All ages with End-Stage Renal Disease (ESRD);
• Those with ALS (Lou Gehrig's disease).

Medicare is provided by the Centers for Medicare and Medicaid (CMS). Enrollment in Medicare A and B is handled by Social Security Administration or Railroad Retirement Board.

If you are already getting benefits from Social Security or Railroad, you will automatically get Medicare the month you turn 65 or the month prior if your birthday is on the 1st. If you are under 65 and have a disability, you will automatically get part A and B after you get disability for 24 months. If you have ALS, you will get Medicare the follow month your Social Security begins.

If you are automatically enrolled, you will get your Medicare card in the mail. The Part B premium will be taken out of your Social Security check each month. Check with a SMAA Resource Specialist to see if you are eligible for any assistance paying for your Medicare costs.

Social Security administers the enrollment of Medicare Part A and B. You can call them directly or create an account online. This video will help show you how to create an account.

If you have End-Stage Renal Disease, you will need to contact Social Security Directly.

If you are turning 65 and not receiving Social Security or Railroad Retirement Board (RBR) benefits, you will need to reach out to Social Security directly. Railroad beneficences will need reach out to RRB. You can sign up 3 months priors to your birthday month, your birthday month, and 3 months after. However, when you sign up determines when your Medicare will start.

Learn more about when to enroll by watching this video - When do I enroll in Medicare?.

You may also use this helpful "Path to 65" (PDF) created by the National Council on Aging.

Welcome to Medicare! For those who are new, it is suggested you attend a SMAA Welcome to Medicare Seminar to learn more about Medicare. From there, we can schedule a one on one appointment to help review your needs.

Here is a helpful YouTube video that has an overview of the different parts of Medicare. Watch the video - Medicare & You: Understanding Your Choices.

Part A:

• Inpatient Hospital Care
• Skilled Nursing Care
• Hospice Care
• Home Health Care (short term)

Part B:

• Doctor Appointments
• Outpatient Care
• Home health Care
• Durable Medical Equipment
• Prevent Services

For more information on enrolling in Part A and Part B, please reference this fact sheet from the Centers for Medicare & Medicaid Services (PDF).

Part D:

• Prescription Drug Coverage

Supplemental Insurance:

• Has a monthly premium. Helps to cover the remaining 20% original Medicare doesn’t cover.

Advantage Plan: (Sometimes referred to as part C)

• Includes Part A and B and usually Part D. Has extra benefits (like dental, vision, hearing, etc.). Have out of pocket expenses.  

Learn more about what is not covered by Part and B at https://www.medicare.gov/what-medicare-covers/whats-not-covered-by-part-a-part-b.

Some people who are on employer or spouse employer insurance choose to stay on that plan and delay their Medicare. When that person retires, it will create a special enrollment period allowing Medicare enrollment. Some people chose to get Part A when they are first eligible since it is free (if you have paid into the system) and provides extra coverage. It is encouraged to reach out to your HR to determine if you can stay on the employer plan and how it works with Medicare as there are rules regarding creditable coverage and how many employees are at your company.

My employer has less than 20 employees:
You should sign up for Part A and Part B when you're first eligible. In this case, Medicare pays before your other coverage. If you don’t enroll when you’re first eligible, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later.

My employer has more than 20 employees:
Reach out to your HR to confirm that your group health plan coverage is creditable with Medicare. If your insurance is creditable, you may be able to delay Part A and Part B and won’t have to pay a lifetime late enrollment penalty if you enroll later. If you want to delay both Part A and Part B coverage, you don’t need to do anything when you turn 65. Learn more at https://www.medicare.gov/sign-up-change-plans/get-started-with-medicare/learn-based-on-my-situation.

If you’re eligible for premium-free Part A, you can enroll in Part A at any time after you’re first eligible for Medicare. Your Part A coverage will go back (retroactively) 6 months from when you sign up for Medicare or Social Security/RRB benefits (but no earlier than the first month you’re eligible for Medicare). To avoid a tax penalty, you should stop contributing to your Health Savings Account (HSA) at least 6 months before you apply for Medicare. If you aren't eligible for premium-free Part A, and you don't buy it when you're first eligible, you may have to pay a penalty. Learn more at https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods. You can use the money that is your HSA for premiums, co-pays, etc.

Learn more at https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/should-i-get-parts-a-b and by watching this helpful video Medicare & You: Deciding to Sign Up for Part B.

If you are eligible for Medicare, you are not able to stay on the Marketplace insurance and continue to get a tax credit unless you are not eligible for premium free part A. Remember, if you do not switch to Medicare when first eligible, you may receive a penalty for late enrollment or may need to wait for the general enrollment period. You will need to disenrollment from the Marketplace.

Marketplace to Medicare: Need to Know (PDF)

It is encouraged to have creditable prescription drug coverage. If you chose not to have any creditable drug coverage during your enrollment period, if you change your mind, you will need to wait until Open Enrollment to sign up for a drug plan. There will also be a penalty.

Learn more by watching this video - Medicare & You: How the Park D Penalty is Calculated.

Medicare has a plan finder that allows you to see your account and what plans will cover your prescriptions. Watch "Understand You Drug Cost" video

Learn more about how to use the plan finder with "2021 How to Use Medicare Plan Finder, step-by-step" video

The Maine Bureau of Insurance offers a Consumer’s Guide to Medicare Supplement Insurance (PDF) with a price comparison.

Yes! Your Medicare will be your primary insurer and MaineCare or QMB (Qualified Medicare Beneficiary) from the state will pay the remaining amount only if all providers except MaineCare and it is a Medicare Service. You can have a Medicare Advantage Plan but please remember you must be in network for MaineCare to cover those services. MaineCare will not help pay the co-pays for the extra benefits advantage plans offer. If you have full MaineCare, there may be services that are covered that Medicare does not provide. Call the state MaineCare Member services if you have specific questions about what is covered by your MaineCare, 1-800-977-6740. If you are not on MaineCare and think you may be eligible, you can apply online at https://apps1.web.maine.gov/benefits/account/login.html or call a SMAA resource specialist to learn more, (207) 396-6500.

Please note, if you have the Medicare Savings Program SLMB or QI, the state will not help you with the remaining costs of your Medicare and you will need a supplement or advantage plan.

In addition to creating a Mymedicare.gov account which allows you to monitor your Medicare claims and spot any errors or possible fraud, please watch this brief video with additional suggestions. If you find an error or have questions about your Medicare claims please contact the provider if known to follow up. If you suspect you are being charged for care you did not receive, please call 1-800-Medicare or if you’re in a Medicare Advantage Plan, call the Medicare Drug Integrity Contractor (MEDIC) at 1-877-7SAFERX (1-877-772-3379). To learn more, please contact your local Senior Medicare Patrol - in York and Cumberland County contact Southern Maine Agency on Aging.

Learn more by watching this video from the Senior Medicare Patrol - Protect Your Self Against Medicare Fraud