Frequently Asked Questions (FAQ)

Frequently Asked Questions (FAQ)

Read our frequently asked questions and answers on Medicare, insurance and working with Imagine Insurance Advisors. We make it easy for you to be in-the-know when it comes to product selections and working with us.

Working with Imagine Insurance Advisors

Q. How do I get started working with you?
A. The easiest way is to pick up the phone and call us or send an email. We are often involved in a task or a meeting, but if you leave a message, we will call you back. To evaluate your plan or provide quotes for insurance, there are certain information and forms that we need completed before we can meet or discuss plan details. Our industry is highly regulated by Medicare (CMS), so there are certain rules we must follow. The forms that are needed to engage our services are on our Contact Us page. You can download, print and mail or email them to us. If you cannot print, let us know and we can mail them to you.

Q. Do I have to have a Medicare.gov account? I'm not very technology savvy.
A. No, you do not have to have a Medicare.gov account, but we find that if you take more than a handful of medications, it makes it easier for us to help you. When you ask for a review of your plan, your medications are already entered, and we can quickly make edits and review drug costs as opposed to keying your drug list every time. We can assist you in creating an account.

Q. What do I owe you?
A. There is no fee for working with us. We are paid a commission from the insurance company. Medicare sets what those are for Part D and Part C plans, so we make the same so matter what you do. The greatest reciprocation you can give us is to refer us to your friends and family.

Signing Up for Medicare

Q. Am I automatically enrolled in Medicare at age 65?
A. If you are drawing Social Security, you are automatically enrolled in Medicare Part A & B effective the 1st of your birth month. If you are not drawing Social Security, then you must take action to sign up for Medicare Part A & B. You may not need to sign up for Medicare if you will continue to actively work, your employer has more than 20 employees, and your coverage is credible. We can help you determine if your employer coverage will be more suitable than selecting a Medicare option before retirement.

Q. I'm turning 65 and will continue to work. Do I need to enroll in Medicare?
A. If you are actively working and have credible insurance coverage through your employer (or your spouse's employer) and that employer has more than 20 employees, you do not have to sign up for Medicare. If you do, your employer insurance will be primary and Medicare would be secondary. You may choose to sign up for Medicare, but it may provide little value. Optionally, it may be beneficial to enroll in Medicare Part A which is free and enrolls you in the Medicare system. The rules for delaying Medicare are complicated, and comparing your Group coverage to Medicare can be hard without an industry professional. We encourage you to call us to discuss your situation and decide what you should do to avoid penalties and know what you need to do about your insurance over time. Perhaps leaving employer coverage and going onto Medicare would be more cost effective and we can compare the benefits and out-of-pocket costs to help you determine if it's an appropriate choice.

Q. I will continue working and I have an HSA. Should I pick up Part A since it's free?
A. Once you go on Medicare, you cannot contribute to a Health Savings Account (HSA). That means you cannot have any part of Medicare, either Part A or B if you want to contribute to an HSA. If you contribute to your HSA while on Medicare, there are tax consequences. If you sign up for Medicare after age 65, Medicare will backdate your Part A by 6 months, or to your 65th birthday whichever is later. You can use your HSA funds to pay for Medicare deductibles and copays, prescription copays, and other qualified expenses. You cannot pay your Medicare Supplement premium with Health Savings Account (HSA) funds.

Q. I am over age 65 and now plan to retire. How do I sign up for Medicare?
A. Congratulations on your retirement! Two months before you are going to retire, you should begin the process of signing up for Medicare Part A, if you don't have it, and Part B. There are two forms you need to send to Social Security. The first is the one you fill out requesting Part B, called the CMS Form 40-B. The other form your employer fills out stating your working and insurance status and is titled CMS Form L564. If you have not signed up for Part A, then you need to do that first on your Social Security account www.SSA.gov, or by calling Social Security at 1-800-772-1213 to schedule a phone interview. You will fax the CMS-L564 and 40B forms together to your local Social Security office. It is important that these forms are filled out correctly to avoid delays. If you would like, we can review them for completion and fax them for you.

General

Q. Should I create my www.medicare.gov account?
A. Yes! Your medicare.gov account gives insight into your Part A & B claims, what prescriptions will cost, and many other features like ordering a replacement Medicare card, paying your Part B premium, setting up EZ Pay if you are not drawing Social Security, and assigning Authorized Representatives (trusted family and friends that can help manage your Medicare account).

IMPORTANT! The government website is www.medicare.GOV, not .COM. The site medicare.com is a commercial/advertising site and if you provide your name and phone number, then you are consenting to random marketing representatives (like spam calls) to call you and discuss insurance products. Usually, call center agents are not local to your area and don't provide policy support, which makes them unfamiliar with your local market and act with less personal accountability.

We also find that when you have a medicare.gov account, reviewing your drug plan during the Annual Enrollment Period is a lot quicker since your prescription list is saved (versus manually keying each medicine for every conversation we have). You can also review what new medicines will cost you during the year. The website will not show what you have already paid or where you are in the Coverage Phases. To review your actual out-of-pocket costs, you will need to create an account for your drug plan company to read your monthly EOBs (Explanation of Benefits).

Creating a medicare.gov account is super easy! Simply go to www.medicare.gov and click "Log In" on the top right. "Create An Account" is found on the login page. The steps are very simple, as you simply add some personal identifiers, choose a username and password and then access is approved.

Part B Premium

Q. How do I pay the Part B premium?
A. If you are drawing Social Security, the government will automatically deduct the premium from your Social Security check before you get your deposit. There is nothing you need to do. If you are not drawing Social Security, the government will bill you quarterly by mail. You can set up EZ Pay through your www.medicare.gov account, which is an automatic monthly payment from your bank account or credit/debit card.

Q. Why am I being charged more for Part B?
A. People who earn more will pay higher Part B and Part D drug plan premiums. This is called the Income Related Monthly Adjustment Amount (IRMAA) and is based on your Modified Adjusted Gross Income (MAGI) on your tax return, using a two-year look back. So, if we are in 2025, Medicare is basing your premium off your 2023 tax return. If you have had a life event like death, divorce, marriage, work stoppage or work reduction, you can appeal to have the Income Related Monthly Adjustment Amount (IRMAA) reduced early. There is an appeal form (Form SSA-44) that you fill out and send to Social Security. We are knowledgeable about IRMAA. We can assist you in determining if you can have it reduced early and help with the form.

Special Considerations for People on Medicare for Disability

Q. I just received Medicare due to disability, what are my options?
A. The options for people on Medicare due to disability vary greatly by state. In Kentucky, as of Jan 1, 2024, you now have the option to get a Medicare Supplement when you first go on Medicare with no health questions. You only have a limited time to do that, so it is important to call us right away. Alternatively, you can choose to enroll in a Medicare Advantage plan. When you turn age 65, you will have a second opportunity to get a Medicare Supplement with no health questions. We specialize in Medicare for those on disability, so call us, we can help.

I'm Retired Do I Need Medicare?

Q. I have retiree insurance. I'm turning 65, do I need Medicare?
A. Yes. Will you be able to keep your retiree insurance when you turn 65 and go on Medicare or will it change over to the "Medicare" version of the retiree insurance? Some companies stop offering retiree insurance when you go on Medicare. It will become secondary insurance to Medicare. You must pick up Medicare Part A & B. That is because even if you have retiree insurance, Medicare will be primary, and the retiree insurance will be secondary. Failure to sign up for Medicare A & B will result in a penalty for Part B. See penalties below.

Penalties and Medicare

Q. I didn't sign up for a Part D drug plan when I turned 65 because I didn't take prescriptions. Now that I'm taking medications, I signed up for a Part D plan and I have a penalty. Why?
A. If you do not sign up for a Part D plan when you are first eligible for Medicare (your Part A effective date or when you turned 65) and you do not have other credible drug coverage, then there is a Late Enrollment Penalty (LEP) that is added to your monthly premium for each month you went without credible coverage. The penalty is 1% of the National Average Drug Plan Premium. This penalty stays with you for life – as long as you are enrolled in a Part D or Part C plan with drug coverage. The penalty is instituted and required by the government.

If you had other credible coverage, you can avoid the penalty by proving you had credible drug coverage. Credible coverage is considered for VA (Veterans Administration) coverage, Group/retiree insurance coverage through an employer based on current employment, or COBRA. We encourage everyone to have drug coverage as there is only one time per year you can enroll during the Annual Enrollment Period (AEP) October 15 to December 7. If something happens during the year and you need prescription drug coverage, you cannot get it until the Annual Enrollment Period (AEP) for a January 1st effective date, leaving you with no insurance coverage until then.

Q. I didn't know I needed to enroll in Medicare when I turned 65 because my full retirement age isn't until 67. I have retiree coverage from an employer. Why am I being charged more?
A. If you do not pick up Medicare Part B either when you turn 65 or stop working if later, there is a 10% penalty for every 12 months that you go without Part B coverage. Enrolling in Medicare at 65 is an independent event when you decide to if you will start drawing Social Security. If you do not sign up for Part B when you should, unless you have a Special Enrollment Period (SEP), you can only enroll in Part B from January 1 to March 31 of each year with coverage starting the first of the following month.

Medicaid and Extra Help

It's important to note that MediCARE and MediCAID are two different things and not everyone has both. Having both is called being Dual-Eligible. MediCARE is for people over 65 and those of any age on disability for at least 24 months. MediCAID is for those with limited income and assets. Medicaid is operated by the state and may have a different name and eligibility requirements in each state.

Q. I have a limited income and assets. Is there help for me from the government?
A. Extra Help and Medicaid eligibility depend on several factors. Your gross income and assets (money in checking, savings, stocks, bonds, CDs, IRA) are considered. If your income is below certain levels of the Federal Poverty Level (FPL) and your assets are below certain amounts, then you should be eligible for help from the government. See more of the definitions of Medicaid in our Glossary of Acronyms.

Extra Help is through Social Security and reduces your out-of-pocket costs only for prescription drugs and drug plan premiums, also known as a Low Income Subsidy (LIS). You can apply for Extra Help online at https://secure.ssa.gov/i1020/start or by calling Social Security (1-800-772-1213). We can also help you apply online.

Medicaid is managed through your state of residence and has different levels, each paying your Part B premium and/or medical bills that Medicare does not pay entirely. The lowest level of Medicaid (SLMB, QI1) will pay only your Part B premium. The highest level of Medicaid (QMB) pays your Part B premium and all the deductibles, copays and co-insurance of Medicare, meaning the state pays for all your healthcare. In Kentucky, the Department for Community Based Services (DCBS) handles enrollment and eligibility for Medicaid/MSP (Medicare Savings Program). To apply for Medicaid, you must contact DCBS (855-306-8959). You need to have all your income, bank account totals, and property information ready when you call. They may require proof documents that you send to them after the call.

If you are on Medicaid and go onto Medicare either by turning 65 or because of a disability, you must re-apply for the Medicare Savings Program (as the eligibility is different for non-Medicare Medicaid vs. Dual Eligible Medicare-Medicaid). Your current Medicaid coverage will not continue once you are eligible for Medicare until you re-apply and are approved.

Medicaid will only pay if you use doctors that accept Medicaid. It is very important to confirm this before you receive care, or you will have out-of-pocket costs.

All levels of Medicaid include Extra Help for drugs. All levels of Medicaid and Extra Help must be re-certified annually. If you fail to respond to renewal notices and provide documentation to Request For Information (RFI), your benefits may end and you will need to complete the application process again. This can result in a gap in coverage.

Q. I can't afford the Part B premium. Is there help for me?
A. See our answer above about Medicaid and contact your state's Medicaid office. There are multiple levels of Medicaid. The highest level (QMB) will pay the Part B premium AND the 20% Medicare does not (including deductibles and co-insurance). The other levels (SLMB) and (QI1) will only pay the Part B premium. They do not cover the 20% not covered by Medicare. This can be confusing. We can assist you in understanding what you might be eligible for and tell you where to go to apply. You must recertify annually for Medicaid and if you fail to respond, they will terminate your benefits.

I have VA, Tricare for Life or Champ VA. What do I need to do?

Q. I have coverage with the Veterans Administration (VA). Do I need Part B and any of the Medicare options?
A. Technically, if you only want to receive your services from the Veterans Administration (VA) facilities, then you do not need to enroll in Part B. We recommend enrolling in Part A because it is free. If you do not pick up Part B, then if you see doctors outside the VA system, you will have no coverage. Later, if you want to pick up Part B, you will have a penalty because the VA is not considered credible coverage for Part B. (See our Penalties FAQ for more information.) However, the VA is considered credible coverage for Part D drug, so if you find a drug is not covered by the VA, you can get a Part D drug plan with no penalty.

Q. I have Tricare for Life. Can I get a Medicare Advantage Plan?
A. You do not need it. You do not need anything else if you have Tricare For Life (TFL). Some clients like to pick up a Medicare Advantage-Only plan. A Medicare Advantage-Only plan does not include drug coverage to go with Tricare For Life (TFL). The Medicare Advantage plan gives you some extra benefits like dental, vision, hearing, a gym membership and more. The Medicare Advantage plan is primary and does have a network of doctors. The doctors need to know where to bill any copays either the MA plan or TFL. There is an extra step that must be taken when submitting claims.

Q. I have Champ VA. Do I need anything else?
A. No. Do not sign up for any of the Medicare options as you have all you need.

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