The experienced agents at South Dakota Senior Insurance Agency (SDSIA) are here to provide the Medicare information you need in order to make an informed decision regarding your insurance coverage options.
Browse our Medicare FAQs below for answers to common questions, such as Medicare costs and how to enroll in Medicare’s prescription drug plans. Please feel free to contact us [Link to: Contact] if you have additional questions.
For more information on specific Medicare plans, select an option below.
What Is Medicare?
Medicare is a health insurance program provided by the U.S. government for people ages 65 and over, as well as younger people with certain disabilities.
However, Medicare does not cover all health care costs, and you can enroll in a Medicare Supplement Insurance or Medicare Advantage plan to receive fuller coverage.
Medicare is split into four parts: A, B, C and D.
Part A helps pay for hospital expenses. Most people pay no premium for Part A, but there are costs for you. Medicare Supplement Insurance and Medicare Advantage plans can help with these costs.
Part B helps pay for physician expenses. There is a premium, a deductible and other costs for Part B. Medicare Supplement Insurance and Medicare Advantage plans can help with these costs.
Medicare Parts A and B are sometimes referred to as Traditional Medicare or Fee for Service Medicare. If you would like more coverage than Medicare Part A and Part B provide, you might be interested in a Medicare Supplement Insurance policy from SDSIA.
Part C is also known as Medicare Advantage. You can sign up for a Medicare Advantage plan through an insurance agency such as SDSIA. Medicare Advantage plans generally have low or no premium but do have copays and network restrictions. You must also continue to pay your Part B premium. You do not need both a Medicare Advantage and a Medicare Supplement Insurance plan. You only ever need one or the other.
Part D is the portion of Medicare that handles prescription drug coverage. You can sign up for a Part D plan through an insurance agency such as SDSIA. There will be a premium and some copays.
How do I sign up for Medicare?
If you already get Social Security benefits, you will be automatically enrolled in Medicare Hospital Insurance (Part A) and Medical Insurance (Part B).
If you don’t get Social Security benefits and are not ready to apply for them yet, you should sign up for Medicare three months before your 65th birthday.
The easiest way to apply for Medicare is by applying online at www.socialsecurity.gov.
How is Medicare different from Medicaid?
While they sound alike, Medicare and Medicaid are different. Medicare is a health insurance program provided by the U.S. government for people ages 65 plus, as well as younger people with certain disabilities. Medicaid is a government health program designed specifically to help low-income people afford health care.
How do I get a replacement Medicare card?
If your Medicare card was lost, stolen or destroyed, you can ask for a replacement by using your online my Social Security account.
If you can’t or prefer not to use the online service, you can call 1-800-MEDICARE (1-800-633-4227)
Can I get vision, dental and hearing insurance?
Medicare doesn’t pay vision, dental or hearing benefits unless they are related to a larger medical occurrence. Generally, Medicare Supplement Insurance plans do not offer these benefits, either. Medicare Advantage plans might contain vision, dental, or hearing benefits.
Learn more about vision, dental and hearing insurance here.
Medicare is split into different Parts. Part A is generally free, and Part B has a monthly premium. In addition to Part A and Part B, you may elect to purchase a Medicare Supplement Insurance plan, which will have a monthly premium.
Alternatively, you may elect to enroll in a Medicare Advantage plan. You will still need to pay the Part B premium, and there may or may not be an additional monthly premium for your Medicare Advantage plan.
Here are the specific rules for Part A and Part B of Medicare:
- Part A (Hospital Insurance) – Free to anyone who has paid Federal Insurance Contribution Act (FICA) tax for 10 years or 40 quarters. That’s the federal employment tax you and your employer paid while working. It funds Social Security and Medicare. The rules are slightly different for railroad employees.
You can still get Part A if you haven’t met these requirements but you will pay a premium. There is a 10 percent late penalty if you don’t enroll when you’re first eligible. You have to pay that premium for twice the number of years you could have had Part A, but didn’t sign up
- Part B (Medical Insurance) - Everyone is required to pay a premium for this coverage. The federal government sets the amount each year. You can have it deducted from your Social Security benefits
Generally, Medicare Part B and Medicare Supplement Insurance plan premiums increase each year. Medicare Advantage plans may change premiums and cost sharing each year.
Medicare generally doesn't pay any coverage for care received outside the U.S. Many Medicare Supplement Insurance plans pay 80 percent of Medicare approved costs after a $250 deductible and up to a lifetime $50,000 limit for emergency care that begins during the first 60 days of each trip. Medicare Advantage plans are based on networks and generally don't pay for any care received outside the US.
With a Medicare Supplement Insurance plan, your premium can increase over time. Your insurance company will notify you in advance of any premium changes.
With a Medicare Advantage plan, changes cannot occur in the middle of a year but can change each calendar year.
With a Medicare Supplement Insurance plan, your benefits will not change over time. Your premium may increase, and if your plan does not cover deductibles, the amount of those deductibles will change annually.
Medicare Advantage plans can be changed each calendar year. You can always switch Medicare Advantage plans during the Annual Enrollment Period from October 15 to December 7 each year.
You may be surprised to learn that government-provided Medicare doesn’t cover 100 percent of health care costs. However, there are coverage options available to you. You can enroll in Medicare and purchase a Medicare Supplement plan. Alternatively, you can enroll in a Medicare Advantage plan.
The personalized recommendation on this site can help you choose between Medicare Supplement Insurance and Medicare Advantage.
In addition, Part D is the portion of Medicare that provides prescription drug coverage. You can purchase a Part D plan in addition to a Medicare Supplement Insurance plan, while many Medicare Advantage plans include prescription drug coverage.
Can’t find the answer you need? Contact us for assistance!