Additional Information

What is Medicare? Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).  

Is there a penalty if I do not sign up on time? 

Medicare Part A penalty

            Most people eligible for Medicare    are entitled to Part A premium- free. This is because you or your spouse already paid the Medicare tax when you were working. (This is the  FICA deduction on your paycheck.) If you did not previously work or did not work long enough, you can still get Part A but you may have to pay a premium.

            If you did not get automatically enrolled or sign up during your Initial Enrollment Period,  you will have a late penalty premium for Part A when you do sign up later on. The penalty premium is 10% of the current Part A premium. You will continue to pay the penalty premium for twice the number of years you were eligible for Part A but did not enroll.

 Medicare Part B Penalty

              If you sign up late for Medicare Part B, you will have to pay a late penalty premium every  month for the rest of your life, along with your Part B premium. Your monthly  Part B  premium will go up 10% for each full 12-month period that you could have had Medicare Part B but did not take it. You will pay this higher premium as long as you have        

 Medicare Part B.

            You may not have to pay the penalty if you qualify for a Special Enrollment Period (SEP).  You might qualify for an SEP if you had health insurance through your job or your  spouse’s job when you were first eligible to sign up for Medicare Part B. You may not have to pay the penalty if you had health insurance through your job or  your spouse’s job when you were first eligible to sign up for Medicare Part B.

Medicare Part D penalty

             Generally, you are late if you did not join within 3 months after your

  Medicare Part A and Part B  becomes effective.  You do not have to pay the penalty if you  are eligible for the Extra Help with costs. You may not have to pay the penalty if you qualify for a Special Enrollment Period (SEP)  because you had other drug coverage that is as good as Medicare (creditable coverage) at the time you turned 65. Examples of creditable coverage include:

• Coverage through your job or your spouse’s job, OR
• Retiree coverage, OR
• Coverage through the Veterans Administration.

 The penalty premium is added onto the regular premium that you pay to your Medicare  drug plan. The fee is calculated as 1% of the average monthly prescription drug premium  (1% of $34.70 in 2024) times the number of months you were late, rounded to the nearest 10 cents. This penalty is permanent –you would have to pay it for as long as you have Medicare Prescription Drug Coverage.

What are Medicare plans and how do Medicare health plans work? A Medicare plan refers to any way other than Original Medicare that you can get your Medicare health or prescription drug coverage. This term includes all Medicare health plans and Medicare Prescription Drug Plans.  

Medicare Health plans are offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan. Medicare health plans include all Medicare Advantage Plans, Medicare Cost Plans, Demonstration/Pilot Programs and Programs of All-inclusive Care for the Elderly (PACE).  

How is Medicaid different from Medicare? Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services. If you qualify for Medicaid in your state, you automatically qualify for extra help paying your Medicare prescription drug coverage (Part D).

Is it important for my current prescription drug coverage to be creditable? Prescription drug coverage (for example, from an employer or union) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage is considered creditable. People who have this kind of coverage when they become eligible for Medicare can generally keep that coverage without paying a penalty if they decide to enroll in Medicare prescription drug coverage later.  

What is the Coverage gap or “donut hole” (Medicare prescription drug coverage)? A period of time in which you pay higher cost sharing for prescription drugs until you spend enough to qualify for catastrophic coverage. The coverage gap (also called the “donut hole”) starts when you and your plan have paid a set dollar amount for prescription drugs during that year.  

What is an Assignment? An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.  

Are doctors permitted to charge more than the Medicare approved-amount? If you have Original Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount, the difference is called the “excess charge”.  

What is custodial care? Non-skilled personal care, like help with activities of daily living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom. It may also include the kind of health-related care that most people do themselves, like using eye drops. In most cases, Medicare doesn’t pay for custodial care.