List items for Frequently asked questions about Medicare
Click on a question below for more information.
Eligibility for Medicare for most people begins when they turn 65. However, some people may become eligible under age 65 due to disability, End Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). Find out more by visiting our Medicare eligibility page, or directly from Medicare.
If you are already receiving any Social Security benefits when you become eligible for Medicare, you will be automatically enrolled in Medicare by the Social Security Administration (SSA). You will typically receive your Medicare Card in the mail three months before your coverage starts.
If you are not already receiving Social Security benefits, then you will sign up for Medicare through the Social Security Administration (SSA). Siging up online is the fastest and easiest way.
Some resources to help you sign up online:
- SSA has a brief video that walks you through the steps of signing up for Medicare online
- You can download this checklist to know what information you should have ready when you are applying for Medicare.
- You will need to create a “my Social Security” account to sign up for Medicare or apply for benefits.
- You can download this checklist with tips on how to create a “my Social Security” account online.
- You will be required to verify your identity either through Login.gov or ID.me
You can also sign up for Medicare by calling Social Security at 1-800-772-1213 or 1-800-325-0078 for TTY users. You can use their field office locator to find the location and contact information for your local Social Security Office.
There are several factors that will impact when you sign up for Medicare, and which benefits you enroll in. You may even decide to postpone benefits if you are retired but covered by healthcare from a working spouse. Getting ready to retire and making the decision whether to enroll in Medicare doesn’t have to feel complicated. We have a variety of resources to help you understand your options. Our Getting Ready to Retire videos can help you plan ahead if you are:
- Under 65 and retiring;
- 65 and retiring; or
- Over 65 and retiring
Or, check out the Centers for Medicare and Medicaid Services’ (CMS) interactive tool to learn more about when you should sign up for Medicare.
Check out our "How Medicare Works" page to understand the structure of Medicare. If Medicare is your primary insurance, you will need to choose either:
- Medicare benefits through Original Medicare (Part A hospital insurance and Part B medical insurance), a Part D prescription drug plan and supplemental insurance (i.e. a “Medigap”, retiree coverage, Medicaid, etc.), or
- A Medicare Advantage Plan provided through a private company that manages your Medicare in a bundled package (most include prescription drug coverage).
Learn more about comparing Original Medicare or Medicare Advantage Plan options, below at What is the difference between Medicare Advantage and Original Medicare?
Once you have chosen which direction to go, you will need to identify which specific plans to sign up for to meet your health and prescription needs. For help comparing options, you can find a SHIIP-SMP counselor to meet with locally. You can also compare options yourself using the Plan Finder tool at Medicare.gov.
More information on how to compare plan options using the Plan Finder tool under How do I find the Prescription Drug Plan that best meets my needs?
As you start making choices, you can refer to our helpful “Checklist for New Beneficiaries” to help you ensure you have completed all the key steps.
When you enroll in Medicare Part A and Part B, you can choose to receive benefits through Original Medicare or a Medicare Advantage plan. It is important to understand how each option can work for you before deciding which path to take.
For detailed information about the differences between Medicare Advantage Plans and Original Medicare, watch our Understanding Medicare Advantage Plans video.
SHIIP-SMP also produces both a Iowa Medicare Supplement & Premium Comparison Guide and a Medicare Advantage and Other Health Plans in Iowa guide. These provide in-depth information about how Original Medicare Supplements and Medicare Advantage Plans work, along with details about current plans available to Medicare beneficiaries in Iowa.
The Centers for Medicare and Medicaid Services (CMS) also provides a comparison chart between Original and Medicare Advantage plans that can be helpful when making your decision.
Both Part D Prescription Plans and Medicare Advantage Plans can change their drug coverage and costs every year, which is why it is important to compare plans annually. You can choose which plan you want for the year ahead during the Open Enrollment Period (Oct. 15-Dec.7).
The Centers for Medicare and Medicaid Services (CMS) have created a Medicare Plan Finder tool that you can use to compare plans. It can show you:
- What Part D and Medicare Advantage Plans are available in your zip code.
- Whether the prescriptions you take are covered by a plan or not.
- Plan premiums and deductibles.
- An estimated cost of your prescriptions for the year or by month.
- A comparison of prescription costs by pharmacy.
- Whether or not a plan has any restrictions on your prescription (i.e. needing prior authorization, quantity limits or step therapy)
To get the most out of the Plan Finder tool, you will want to create a Medicare.gov account so that you can save your current prescriptions and preferred pharmacies.
This video from CMS will walk you through how to use the Plan Finder tool, if you have any questions.
You can also download our handout “Steer Your Own SHIIP” for a list of key steps and things to watch out for when selecting your own drug plan.
There are several programs available to help manage the costs associated with Medicare and prescription drugs, if you meet the income & resource guidelines.
- Low-Income Subsidy (also called Extra Help) is a program from the Social Security Administration that helps those with limited income and resources pay for prescription costs, including reduced (or no) premiums, deductibles and co-payments.
If you do not have internet access, you can also sign up by calling Social Security at 1-800-772-1213 or 1-800-325-0078 for TTY users.
- Medicare Savings Programs (also called MSPs) are state-run programs that can help people with limited income and resources pay for Medicare premiums, deductibles, and coinsurance. There are several different levels of assistance with Medicare Savings Programs. Visit our Medicare Savings Programs page for current income and resource limits. Applications for Medicare Savings Programs are submitted through the Iowa Medicaid portal.
If you do not have internet access, SHIIP-SMP can assist with application completion, by calling 1-800-351-4664. TTY users can call 1-800-735-2942.
Income and resource guidelines for both the Low-Income Subsidy and Medicare Savings Programs change each year, so be sure to check back each year for the updated qualifications.
CMS estimates that more than $100 Billion in Medicare claims are paid inappropriately every year due to fraud, errors and abuse. Stopping fraud, errors, and abuse can only be done if Medicare beneficiaries protect, detect, and report:
- Guard your card. Protect your Medicare number and personal information. Don’t give it out to anyone you don’t know or trust to make medical decisions for you (such as family members or your doctor). And especially don’t give out your Medicare number over the phone.
- Medicare and Social Security will never call you for personal information. If you are asked for your Medicare number over the phone, it could be a scam.
- Detect when something doesn’t seem to match your healthcare situation.
Review your benefits statements to make sure all services were ones you received and ordered by your doctor. Read our handy guide on How to Review your Medicare Summary Notice or Explanation of Benefits.
Track appointments and services received. You can download a digital My Health Care Tracker app to track what happens at medical appointments to help prevent and detect fraud, errors, or abuse.
Report any suspicious phone calls, healthcare packages, or items on your Medicare statements to SHIIP-SMP 1-800-351-4664 from 8:00 a.m. to 4:00 p.m., Monday to Friday (TTY users can call 1-800-735-2942).
You can learn more about common Medicare scams in the “Prevent Fraud” section of our website.
Below please find some basic actions that you can take to ensure your Medicare is healthy:
- Open and read all your mail about your health insurance and plans because that is how you are usually notified of any changes to your coverage. This includes mail from:
- Any health insurance or Medicare plans
- Center for Medicare and Medicaid Services
- Social Security Administration
- State Departments of Health and Human Services
- Review your Medicare plan each fall during the annual Open Enrollment Period (OEP) from October 15th to December 7th. This is when you can review and change Prescription Drug and Medicare Advantage plans, and since costs, benefits, and providers can change each year, evaluating your options each year is important to ensure the best coverage at the most affordable prices. Check out our OEP page for additional resources.
- Check your eligibility for assistance programs that help manage the costs associated with Medicare and prescription drugs. Income and resource limits for these programs change every year.
- Utilize free preventative benefits that apply to you. Medicare covers several free preventive benefits ranging from an annual wellness exam to several vaccinations.
The SHIIP-SMP program provides counseling, assistance, and education to Medicare beneficiaries, their families, and caregivers to help people navigate the complexities of Medicare and related insurances and prevent Medicare fraud. SHIIP and SMP are operated by the Iowa Insurance Division, and supported by federal funds.
If you need additional assistance, you can find a trained SHIIP-SMP Counselor at a site near you or call our toll free consumer line at 1-800-351-4664 from 8:00 a.m. to 4:00 p.m., Monday to Friday. TTY users can call 1-800-735-2942.
You can also reach out directly to Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users can use 1-877-486-2048.
The Social Security Administration has information at: ssa.gov,1-800-772-1213, or your local Social Security office.