Guide to Understanding Medicare

Frequently Asked Questions About Medicare

Do I need to sign up for Medicare before I turn 65?

If you’re not currently collecting Social Security benefits, then yes, you do need to contact Social Security three months before turning 65.

Be ready when the time comes. Give us a call at 877-905-9216, TTY: 711 or visit us at HealthTeamAdvantage.com/contact and tell us when you expect to retire. We’ll get in touch with the information you need to choose the right Medicare plan for your needs when you’re ready.

If I’m still working and on my employer’s health plan when I turn 65, do I need to sign up for Part B during my Initial Enrollment Period?

No. You can wait until you’re ready to move off your (or your spouse’s) employer plan. When you do, you’ll qualify for a Special Enrollment Period and have an 8-month window to sign up for Part B. It begins when your employer or union coverage ends, or when employment ends, whichever is first. Be sure to elect Part B at that time to avoid the late enrollment penalty.

If I’m covered, is my spouse automatically covered?

No. Each person must sign up for Medicare individually.

When I go on Medicare, do I need to stay with the same insurance company I have through my employer?

Absolutely not. You can choose any type of plan you want, from any insurance company you want—possibly for the first time in your life. It’s best to look at available plans, speak with your employer group benefits administrator, compare your options, and choose the best value.

How do I enroll in Medicare?

Call or visit your local Social Security office or enroll online at ssa.gov.

When I enroll for Parts A and B with Social Security, do I also enroll for Part D?

No. Part D enrollment is different. If you want Medicare prescription drug benefits (Part D), you must enroll in a private insurance plan that contracts with Medicare. You can join either a Medicare Advantage plan that offers combined health and drug coverage in one plan or join a stand-alone plan that covers prescriptions only.

What are late enrollment penalties?

If you fail to sign up for Medicare coverage during your Initial Enrollment Period, you may be subject to the following penalties:

Medicare Part A: 10% late enrollment penalty applied to your monthly premium for twice the number of years you did not have Part A despite being eligible. If you or your spouse paid Medicare taxes while employed, there is typically no Part A monthly premium. Otherwise the monthly premium is $506.

Medicare Part B: 10% late enrollment penalty applied to your monthly premium for each full 12-month period that you did not have Part B despite being eligible. In most cases, this penalty will be added to your monthly premium for the remainder of your enrollment in Medicare. The Part B monthly premium is $164.90 (or higher depending on your income). There is a late enrollment fee as well.

Medicare Part D: The late enrollment penalty amount typically is 1% of the national base beneficiary premium for each full, uncovered month you didn’t have Part D or creditable coverage. The national base beneficiary premium for 2023 is $32.74. The monthly penalty is rounded to the nearest $0.10 and added to the monthly Part D premium. The base beneficiary premium changes each year. Medicare uses the current coverage year’s amount to calculate your new penalty amount. In general, once Medicare determines your penalty amount, you’ll continue to owe a penalty for as long as you are enrolled in a Medicare drug plan. This means that even if you join another Medicare drug plan, you’ll still have to pay the penalty once enrolled in a new plan. This also means that if you join a plan that has a $0 monthly premium, you’ll still owe a penalty.

Visit https://www.medicare.gov/basics/costs/medicare-costs for more information.

What if I miss an enrollment date?

It’s best to call Medicare directly at (800) 633-4227 (800-MEDICARE) 24 hours a day, 7 days a week. TTY/TDD users should call (877) 486-2048. Talk with a representative, explain your circumstances, and ask if you can still enroll or need to wait until the next enrollment period.

If I start receiving Social Security Benefits at 62, am I eligible for Medicare?

No. You must be 65 to be eligible for Medicare benefits. The exception is if you are under age 65 and have a qualified disability.

What if I wait until 66 or older to start my Medicare benefits?

You must contact Social Security to enroll and start your benefits. You could pay a higher premium for late enrollment. If you’re covered under a group health plan based on current employment, you will be eligible for a Special Enrollment Period to sign up for Part A and/or Part B any time as long as you or your spouse is working. You also have eight months starting the month after the employment ends to sign up for Part B without a penalty.

Will my Part A premiums automatically be deducted from my Social Security check?

No. Most people will not pay a monthly premium for Part A if you or your spouse paid Medicare taxes while working (10-year minimum). If you don’t meet the requirements and purchase Part A, you will receive a monthly bill from Medicare.

Do I have to sign up for Part B (medical services)?

If you are 65 and have credible coverage through an employer, you do not have to sign up for Part B. If you do not have credible employer coverage, you must sign up for Part B or may incur a late enrollment penalty.

What is the cost I pay for Part B coverage?

Most people pay approximately $165 per month, but if your income is above a certain amount, you could pay more. Medicare revises this amount periodically. Visit https://www.medicare.gov/basics/costs/medicare-costs for more information.

If I choose a Medicare Advantage Plan, will I still pay Part B?

Yes. You will continue to pay your Part B premium and the monthly premium from your health plan.

If I choose just Original Medicare (Part A and B), are there added costs?

Yes. You will pay deductibles, copays, coinsurance and Part B premiums.

Can I be refused for Medicare coverage?

No. All people age 65 and older are eligible to receive or purchase Medicare benefits.

Can I switch Medicare plans?

Yes. In fact, it’s smart to review your medical needs every year and decide whether your current Medicare plan is working for you. You have the option with Medicare Advantage plans to change once a year during the annual enrollment period (AEP), unless you qualify for a special enrollment period.

Resources

Medicare

Social Security is responsible for determining eligibility and handling enrollment for Medicare. If you are already getting Social Security checks, enrollment into Medicare is automatic. ssa.gov

Call Social Security Administration
800-633-4227
TTY and TDD 877-486-2048
Monday-Friday, 7 a.m.-7 p.m

The official Medicare handbook for Medicare programs is updated each year.
You can download a copy at the Medicare website, Medicare.gov, or call the Medicare Helpline to request a copy.
For online tools to find and compare Drug plans, Medicare Advantage Plans and Medigap Policies go to medicare.gov.

Medicare.gov

Social Security is responsible for determining eligibility and handling enrollment for Medicare. If you are already getting Social Security checks, enrollment into Medicare is automatic. ssa.gov

Call Social Security Administration
800-633-4227
TTY and TDD 877-486-2048
Monday-Friday, 7 a.m.-7 p.m

Seniors’ Health Insurance Information Program (SHIIP)

Get information about Medicare through your local SHIIP program. The organization offers counseling and assistance to people with Medicare and their families.

Call the NC Seniors’ Health Insurance Information Program
855-408-1212
Monday-Friday, 8 a.m.-5 p.m.

Visit the North Carolina Department of Insurance online NCDOI.gov/medicare-an-shiip

Elder Care Locator

This public service of the U.S. Administration on Aging, offers help in finding local, state, and community-based organizations that serve older adults and their caregivers in your area.

Call Elder Care Locator
800-677-1116
Monday-Friday, 7 a.m.-7 p.m

Visit Elder Care Locator online
eldercare.acl.gov

Your Current Health Plan

Your health plan’s customer service center can answer any questions you may have about your current coverage; call the number on your identification card.

Corporate

300 E. Wendover Ave., Suite 121, Greensboro, NC 27401

Local Benefit Center

Walk-Ins Welcome

5815 Samet Dr., Suite 107, High Point, NC 27265

HealthTeam Advantage, a product of Care N’ Care Insurance Company of North Carolina, Inc., is a PPO and HMO Medicare Advantage plan with a Medicare contract.  Enrollment in HealthTeam Advantage depends on contract renewal.

Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Every year, Medicare evaluates plans based on a 5-star rating system.