Medicare Knowledge Base
Frequently Asked Questions
Medicare Basics
Medicare is a federal health insurance program for people 65 or older, certain younger people with disabilities (who have received Social Security Disability Insurance for at least 24 months), and individuals with End-Stage Renal Disease (ESRD) or ALS.
Planning for Medicare is crucial because some decisions you make can be permanent and may affect your costs and coverage. Proper planning helps you avoid penalties and ensures you get the most out of your benefits.
You’re eligible for Medicare if:
You are 65 or older.
You’re under 65 and have received SSDI for 24 months.
You have ESRD or ALS, regardless of age
You’ll get a lot of mail about Medicare, which can be confusing. We help simplify the process and guide you through each step, making sure you meet all deadlines.
If you’re already getting Social Security benefits, you’ll be automatically enrolled in Medicare Parts A & B.
If not, you’ll need to enroll yourself online at ssa.gov, by phone, or at your local Social Security office.
Enroll in Original Medicare (Parts A & B): Do this through the Social Security Administration—online, by phone, or in person.
Choose your supplemental coverage: Decide between a standard Medicare Supplement (Medigap) or a Medicare Advantage (Part C) plan.
Get prescription drug coverage: Decide how you’ll get Part D (medication) coverage.
Cancel your current health insurance: Only after you have your new Medicare coverage and ID numbers.
Transitioning to Medicare can feel overwhelming, but with the right guidance and clear steps, it’s a smooth and painless process. We are here to help you with this process.
Most of the information you’ll need is available right here on our website, and our team is ready to help you through every step to ensure you get the coverage you need.
Parts of Medicare
Medicare Part A helps cover:
Inpatient hospital stays (including acute care, critical access, rehabilitation, and psychiatric hospitals)
Skilled nursing facility care (after a qualifying hospital stay)
Hospice care
Some home health care services
Costs for 2025:
$1,676 deductible per benefit period
Days 1–60: $0 after deductible is met
Days 61–90: $419 per day
Days 91 and beyond: $838 per day (up to 60 lifetime reserve days)
New benefit period starts if you have not been re-admitted within 60 days
What’s not covered:
- Private rooms (unless medically necessary), private-duty nursing, personal items like razors or slippers
Medicare Part B covers:
Doctor visits and outpatient care
Preventive services (like screenings and vaccines)
Lab tests, X-rays, and durable medical equipment
Costs for 2025:
$257 annual deductible
After deductible: Medicare pays 80% of approved costs, you pay 20%
No cap on out-of-pocket costs; there is unlimited risk exposure
Medicare Advantage plans are offered by private insurance companies approved by Medicare.
These plans include all benefits of Parts A and B, often with extra coverage (like vision, dental, or hearing).
Most plans require you to use the plan’s network of doctors and hospitals.
You may pay a monthly premium (in addition to your Part B premium), plus deductibles, copayments, or coinsurance.
Costs, coverage, and rules vary by plan.
Part D helps cover prescription drug costs and is usually paired with Original Medicare or a Medicare Advantage plan.
Plans vary in cost, covered drugs (formularies), copays, medication tiers, and pharmacy networks.
All plans must cover nearly all medications in six protected classes: Anti-Psychotic, Anti-Convulsant, Anti-Depressants, Immuno-Suppressant, HIV/AIDS, and Antineoplastic drugs.
You can change your Part D plan each year during open enrollment.
Availability and options depend on your zip code or county.
Medicare.gov offers a helpful Part D plan search tool.
- Learn more about Part D in the "Part D Medicare" section of this page
A benefit period starts the day you are admitted as an inpatient to a hospital or skilled nursing facility and ends when you have been out for 60 days in a row.
You may have multiple benefit periods in a year, each with its own deductible
Medicare Eligibility
You are eligible to enroll in Medicare during a seven-month window that surrounds the month you turn 65. This window includes the three months before your birthday month, your birthday month itself, and the three months after.
If you are already drawing Social Security benefits when you turn 65, you will be automatically enrolled in Medicare Parts A and B—no action needed.
If you are not drawing Social Security, you must proactively sign up for Medicare. You can do this online at ssa.gov, by visiting a Social Security office, or by calling Social Security.
If you sign up during the three months before your 65th birthday, your Medicare coverage will begin on the first day of your birthday month.
If you enroll during your birthday month or in the three months after, your coverage could be delayed by up to three months.
Yes, if you are still working past age 65 and have employer health coverage, you can delay enrolling in Medicare. Most people elect Part A since it’s usually premium-free, but may delay Part B to avoid the monthly charge. The ability to delay Part B depends on the size of your employer.
When you retire or lose employer coverage, you have an eight-month window to enroll in Medicare without penalty. Note: COBRA does not count as continuing employer coverage, and supplement availability may be affected. Both employee and employer forms are required to elect Medicare in this scenario.
If you miss your Initial Enrollment Period, you can sign up during the General Enrollment Period (January 1–March 31 each year), but your coverage will start July 1 and you may face penalties.
Medicare Income Adjustments
Provided at no additional charge
(Worked 10 years or married 2 years)
Standard monthly charge of $185
If drawing social security, amount is automatically deducted
If not, SSA will bill quarterly or can setup auto-draft
- See the rules for Higher-Income Beneficiaries on ssa.gov website
- See the rules for Higher-Income Beneficiaries on ssa.gov website
Medicare Supplement Plan in Virginia
A Medicare Supplement, or Medigap plan, is additional insurance that helps cover costs not paid by Original Medicare (Parts A and B), such as copays, coinsurance, and deductibles. This helps reduce your out-of-pocket expenses and gives you more predictable healthcare costs.
Original Medicare covers many healthcare expenses, but it doesn’t pay for everything. A Medicare Supplement plan can fill those coverage gaps, offering you greater financial protection and flexibility to see any doctor or hospital in the U.S. that accepts Medicare patients.
Medigap plans help cover costs like deductibles, copays, and coinsurance, reducing your out-of-pocket expenses over time. This can make your healthcare more affordable and help you better manage your budget.
Yes. There are several standardized Medigap plans available in Virginia, each with different coverage levels and monthly premiums. You can choose the plan that best fits your needs and change your plan if your situation changes.
Plan A: Basic benefits with a lower premium, but you’ll pay deductibles when you go to the hospital.
Plan F: Broadest coverage for those eligible before January 1, 2020; covers almost all out-of-pocket costs.
Plan G: Broadest coverage for most people, except the Medicare Part B deductible.
Plan N: Lower premium with some copays and a small annual deductible.
You must be enrolled in Original Medicare (Parts A and B) to qualify for a Medigap plan. After enrolling, you’ll continue to pay your Part A (usually $0 for most) and Part B premiums in addition to your Medigap premium.
We take the time to understand your unique healthcare needs and budget. Then, we compare available plans in your area to find the best fit for you. We also help you enroll and keep track of your coverage, so you’re always supported.
Yes! We’ll help you review and select Medicare prescription drug plans (Part D) that work with your supplement plan, ensuring you have comprehensive coverage for both medical and medication needs.
Contact us today for a personalized consultation. We’ll guide you through your options, compare plans, and help you enroll in the coverage that best fits your needs.
Contact:
- Phone: 804-601-1501
- Email: hello@ameyacapital.com
Part D Medicare
Medicare Part D is prescription drug coverage for people with Medicare. It helps pay for medications that aren’t covered by Original Medicare (Parts A and B), making it a vital benefit for many seniors and those with disabilities.
Original Medicare does not cover most prescription drugs. Part D helps you afford the medications you need to maintain your health, reducing out-of-pocket costs and giving you access to a wide range of covered drugs.
Out-of-pocket prescription drug costs are now capped at $2,000 per year, providing major relief and predictability for beneficiaries.
The coverage gap (“donut hole”) has been eliminated, so you pay less throughout the year.
You can pay your out-of-pocket costs over time, thanks to the new Medicare prescription payment plan.
You can enroll in a stand-alone Part D plan to go with Original Medicare or a Medicare Supplement, or choose a Medicare Advantage plan that includes Part D drug coverage.
Enrollment periods include your Initial Enrollment Period (when you first become eligible for Medicare) and the annual Open Enrollment Period (October 15 to December 7).
In 2025, the standard deductible is $590 for brand-name medications, but some plans offer lower or no deductibles for a higher premium.
After you meet the deductible, you pay 25% of your prescription costs until you reach the $2,000 annual cap.
Once you hit the cap, you pay nothing for covered medications for the rest of the year.
Absolutely. A licensed agent can:
Explain what Part D covers and how it works
Help you compare plans and prices to find the best fit for your needs and budget
Guide you through enrollment and answer any questions along the way
If you go without creditable prescription drug coverage for 63 days or more after becoming eligible, you may pay a late enrollment penalty on your Part D premium if you sign up later.
Contact us today for personalized help. We’ll walk you through your options, compare plans, and ensure you get the prescription drug coverage you need at a price you can afford.
Contact:
- Phone: 804-6409-3357
- Email: hello@ameyacapital.com
