The New York Statewide Senior Action Council can assist you with initially signing up for Medicare, evaluating your existing Medicare coverage to make sure it is still right for you, evaluating your options for saving on your premiums and drug costs and dealing with any concerns you have regarding fraud and abuse. If you have questions or would like more information, contact our trained personnel for free assistance 1.800.333.4374.

Medicare 101:

When am I eligible for Medicare?

Generally, if you are 65 or older or if you are under 65 and have been on disability for 2 years or more or if you have End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant) or have ALS.

How do I apply for Medicare A and B? 

• You apply for Medicare Part A (hospital) and Medicare Part B (medical) also Social Security benefits,  through the Social Security Administration. https://www.ssa.gov/benefits/medicare/
• Medicare Part A is hospital coverage and is usually free provided you have worked a minimum of 10 years prior to applying. You are often automatically enrolled in part A but you can check with the Social Security Administration if you are not sure. 
• Medicare Part B is medical coverage and you must pay a monthly premium for it. The monthly premium in 2021 is currently $148.50. 

If you have retirement benefits either through yourself or your spouse, please contact your benefits administrator before making any changes to your coverage to avoid any conflicts that could result in loss of your retiree benefits. 

How do I get Part D (prescription drug coverage)?

You must have Medicare Part A (hospital), Medicare Part B (medical) or both before you can sign up for Medicare Part D (prescription). We can assist you with plan comparisons to find a plan that best suits your needs. Contact us at 1.800.333.4374 to speak with our trained personnel. 

What is the Linet program?

Medicare’s Limited Income NET Program, effective January 1, 2010, provides temporary Part D prescription drug coverage for low income Medicare beneficiaries not already in a Medicare drug plan including: 

• Full Benefit Dual Eligible and SSI-Only beneficiaries on a retroactive basis, up to 36 months in the past; and
• Low-Income Subsidy (LIS) Eligible beneficiaries at the pharmacy counter and up to 30 days in the past.

What is a supplemental or Medigap policy? 

If you have Medicare A and Medicare Part B you may be eligible for a supplemental policy, also known as a Medigap policy, to assist with the costs of copays, coinsurance and deductibles. You CANNOT have a Medigap policy if you already have Medicaid. For more information on what Medigap plans cover and the rates for plans, you can visit:

https://www.dfs.ny.gov/consumers/health_insurance/supplement_plans_rates

What is a Medicare Advantage Plan?

A Medicare Advantage Plan is coverage offered by private companies that contract with the federal government. Medicare Advantage Plans generally include Medicare A, B and D coverage rolled into one plan and they can offer additional services Medicare does not cover such as vision and dental. You must have BOTH Medicare A and B to sign up for a Medicare Advantage Plan. You would still need to pay for your Medicare Part B premium in addition to any costs associated with a Medicare Advantage Plan. We can assist you with plan comparisons to find a plan that best suits your needs. Contact us at 1.800.333.4374 to speak with our trained personnel. 

How can I save money on my Medicare coverage?

There are a variety of programs available to assist with paying for parts of your Medicare coverage. Most savings programs are income based. For assistance finding out if you would qualify for any of these programs, please contact us at 1.800.333.4374 to speak with our trained personnel or check our information on Cost Savings Programs here (link to saving section?)

Penalties:

Part B (Medical Coverage):

If you do not apply for Part B when you are eligible, if you do not have medical coverage that is as good or better than what Medicare offers, you will be penalized. The penalty is up 10% for each 12-month period you could’ve had Part B, but didn’t sign up. In most cases, you’ll have to pay this penalty each time you pay your premiums, for as long as you have Part B. And, the penalty increases the longer you go without Part B coverage.

Part D (Prescription Drug Coverage):

The late enrollment penalty is an amount that’s permanently added to your Medicare drug coverage (Part D) premium. You begin to be penalized if you have gone 63 or more days in row without prescription coverage. 

Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($33.06 in 2021) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

The national base beneficiary premium may change each year, so your penalty amount may also change each year.

Have questions about penalties and how they may impact you? Call us toll free at 1.800.333.4374 to speak with a trained staff member.