Your questions answered

Questions & answers

Here are some of the questions people have submitted. Check to see if your question is below. 

I will be turning 65 but am still working. How does Medicare work for me, do I need to sign up for Part B now even though I plan to keep working?

submitted by Sandy M. 

When you turn 65 you will likely want to sign up for Medicare Part A. Signing up for Part B is dependent on the size of the company you work for. If your employer has 20 or more employees, you do not need to sign up for Part B right away because your employer's group health plan will be the primary insurer. When you do decide to retire, you will sign up for Part B at that time and will have a special enrollment period of eight months to sign up for Part B, without penalty.

If your employer has fewer than 20 employees, then you will want to sign up for Part B. Medicare will become your primary insurer, which means they will pay first before your employer’s group plan. Before making a decision about Medicare Part B, you should always contact Social Security by:

I've heard people talk about the "donut hole" for prescription drug coverage. What is this and is it something I need to worry about?

​submitted by Patti S. 

The coverage gap, sometimes called the "donut hole," is a dollar amount limit when people with Medicare Part D drug coverage have to pay for a certain percentage of their drug costs instead of their plan's copayment of coinsurance. After you and your plan spend a certain amount on prescriptions, you're in the coverage gap. Not everyone will enter the coverage gap. If you do, you'll stay in the coverage gap until you've paid a predetermined amount (this amount can vary from year to year). If you reach that predetermined amount, you'll have catastrophic coverage and will pay a smaller share for your drugs.

How does Medicare work if I have a disability?

submitted by Charles R.

There are a couple of things to know about Medicare if you have a disability. If you're under 65 and are getting disability income from Social Security or the Railroad Retirement Board, or you have End-Stage Renal Disease (ESRD) or Lou Gehrig's Disease (ALS), you may be qualified for Medicare regardless of your age. Find out if your disability makes you eligible for Medicare by using the Eligibility and Premium Calculator on medicare.gov. In any case, if you are already receiving disability benefits through Social Security, you will automatically be enrolled in Medicare Parts A & B when you turn 65.

Normally, you'll be automatically enrolled in Medicare Part A and Part B after you get Social Security or Railroad Retirement benefits for 24 months. Your Medicare card will be mailed to you about 3 months before your 25th month of disability benefits.

Parts A & B make up Original Medicare. Then you decide if you would like to add additional supplemental coverage for the things that Original Medicare doesn't cover, like prescription drugs, by choosing a Medicare Advantage plan or a Medigap plan. You can begin researching plans at any time (see our plans here).

Read more about Medicare when you're disabled.

I'm enrolled in one of your plans now – do I need to re-enroll during the Annual Enrollment Period?

submitted by Mike S.

If you don't want to make any changes to your Priority Health plan selection during AEP (Oct. 15 through Dec. 7 each year) then you don't need to do anything. You'll automatically stay enrolled in your plan and we'll mail you an Annual Notice of Changes document telling you exactly what, if anything, is changing with your plan for the upcoming calendar year.

When can I enroll in Medicare?

submitted by Dana M.

The three months before your birthday, your birthday month and the three months after your 65th birthday are your initial enrollment period (IEP). During this time you can sign up for Original Medicare (Parts A and B), a Medicare Advantage plan (Part C) and/or a prescription drug plan (Part D). 

It may be best to enroll in Part B (medical and doctor visit coverage) during the three months before your 65th birthday. This will prevent any delays in Part B coverage.

Once you turn 65 and are signed up for Part B, you can choose to enroll in a Medigap plan.

If you're already receiving benefits from Social Security or the Railroad Retirement Board (RRB), you'll automatically be enrolled in Original Medicare (Part A, hospitalization coverage) on the first day of the month you turn 65. You don't need to do anything except watch for your red-white-and-blue Medicare card to come in the mail. If you're not getting Social Security or RRB benefits, you'll need to go to ssa.gov or call 1.800.772.1213 (TTY 1.800.325.0778). 

What's the penalty for not enrolling in Part B?

submitted by Steve V.

Enrolling in Part B is optional. Many people who are healthy at age 65 think, "I don't go to the doctor much, so I can just pay for my doctor visits myself." And they don't enroll in Medicare Part B.

But then, if their health changes and they want to enroll in Part B later, there's a penalty. And it's not just a one-time penalty. If you wait to enroll in Medicare Part B after your "Initial Enrollment Period" (when you are first eligible), you'll be paying a higher Part B premium every month for the rest of your life when you finally do sign up. And that penalty gets bigger for every month you waited to enroll.