FAQS
Do I have to apply for Medicare or do I get it automatically?
If you are already collecting Social Security, either retirement benefits or disability benefits, when you become eligible for Medicare you will be automatically enrolled in both Part A and Part B.
If you are not collecting Social Security when you become eligible for Medicare, you must enroll through Social Security. You can do this online at socialsecurity.gov, over the phone at 1-800-772-1213, or in person at your local Social Security Office. If I wait to enroll in Medicare Part B, will I face a penalty?
It’s important to sign up for Medicare coverage, including Part B, during your Initial Enrollment Period unless you have other coverage that’s similar in value to Medicare (like from an active employer). If you don’t, you may have to pay an extra amount, called a late enrollment penalty. Late enrollment penalties:
- Are added to your monthly premium.
- Are not a one-time late fee.
- Are usually charged for as long as you have that type of coverage (for most people, that’s a lifetime penalty).
If you have questions about whether you should wait to enroll in Part B contact Social Security at 1-800-772-1213 or the Medigap Helpline at 1-800-242-1060.
Does Medicare cover dental?
Medicare will not cover dental care that you need primarily for the health of your teeth. For example, Medicare will not cover routine checkups, cleanings, or fillings. Medicare does not pay for dentures even if Medicare has paid for you to have teeth pulled (extracted) as preparation for a medical procedure, you will be responsible for the cost of your dentures. However, some Medicare Advantage plans cover routine dental services. If you have a Medicare Advantage plan, check with your plan to see what dental services may be covered.
Medicare will cover some dental services if they are required to protect your general health, or if you need dental care in order for another health service that Medicare covers to be successful. For example:
- You receive an oral examination in the hospital because you will be having a kidney transplant or are in a rural or federally qualified health clinic before a heart valve replacement.
- You have a disease that involves the jaw (like oral cancer) and need dental services that are necessary for radiation treatment.
- You need surgery to treat fractures of the jaw or face.
While Medicare may pay for these initial dental services, Medicare will not pay for any more follow-up dental care after the underlying health condition has been treated.
Will Medicare cover Skilled Nursing Facility stays?
Medicare Part A (Hospital Insurance) covers skilled nursing facility care for a limited time (on a short-term basis) if you meet all of these conditions:
- You have Part A and have days left in your benefit period to use.
- You have a qualifying inpatient hospital stay.
- You enter the SNF within a short time (generally 30 days) of leaving the hospital.
- Your doctor or other health care provider has decided that you need daily skilled care (like intravenous fluids/medications or physical therapy). You must get the care from, or under the supervision of, skilled nursing or therapy staff.
- You get these skilled services in a Medicare-certified SNF.
- You need skilled services for one of these:
- An ongoing condition that was also treated during your qualifying inpatient hospital stay (even if it wasn't the reason you were admitted to the hospital).
- A new condition that started while you were getting SNF care for the ongoing condition.
- You need skilled nursing care or therapy to improve or maintain your current condition, or to prevent or delay it from getting worse.
A qualifying inpatient hospital stay means you’ve been a hospital inpatient for at least 3 days in a row (counting the day you were admitted as an inpatient, but not counting the day of your discharge). Medicare will only cover care you get in a SNF if you first have a “qualifying inpatient hospital stay.”
Wisconsin Medicare Supplement Policy 30-Day Nursing Home BenefitSince November 1979, Wisconsin State Law has required individual Medicare Supplements (Medigap) Policies issued in Wisconsin to cover 30 days of skilled nursing facility care [s.632.895 (3), Wis. Stat.]. To utilize this 30-day nursing home benefit the resident must be receiving skilled care, which is medically necessary services certified by the attending physician and recertified every 7 days. No prior hospital stay is required, and the nursing home does not need to be Medicare-certified but must be state-licensed.
The 30-day benefit can be utilized whether a nursing home stay is Medicare-covered or not Medicare-covered if all other requirements are met. (The 30-day benefit would be applied following the 100 Medicare-covered
days for a Medicare-covered stay).
You can also call Medicare at 1-800-633-4227 to speak with a representative directly. They are avaliable for questions 24 hours a day, 7 days a week.
Medicare didn't pay for my claim or Medicare denied my claim.
I lost my Medicare card.
Contact Medicare at 1-800-633-4227.
I don't qualify for Medicare yet, what kind of insurance is available?
If you are not eligible for Medicare, the two major non-employer-based coverage options are Wisconsin Medicaid and the Health Insurance Marketplace. Contact Covering Wisconsin at 877-942-6837 to work with an insurance navigator to assist in determining your most suitable coverage option.
I work for a small employer, do I need Medicare?
If you work for a small employer with fewer than 20 employees (fewer than 100 employees if you are under 65 and deemed disabled) and become eligible for Medicare, you should enroll in both Medicare A & B. This is because Medicare will be your primary insurance once you become eligible and your small employer coverage will be secondary.
I have retiree insurance. How does that work with Medicare?
Retiree insurance will typically be secondary to Medicare. This means that it only pays after Medicare pays, requiring enrollment in both Medicare Part A and B. Since each retiree plan is different, you should contact your plan's benefit administrator to find out about your plan's out-of-pocket costs and the services it covers.
Retiree insurance can act as supplemental insurance to Medicare. This means that it may pay out-of-pocket costs that Medicare does not pay for. It may also cover things that Medicare does not cover such as routine vision or dental care. Beneficiaries are responsible for paying their Medicare premiums as well as their retiree plan's premiums.
