Medicare FAQs

Your Initial Enrollment Period begins three months before your 65th birthday and lasts until the three months after your birthday. If you started receiving Social Security benefits at least four months before the age of 65, you will automatically be enrolled in both Medicare Part A and Medicare Part B. If you sign up during the first three months of your Initial Enrollment Period, your coverage will start the first day of your birthday month. If you do not sign up during the Initial Enrollment Period, you will have another opportunity from January 1 to March 31 of each year; however, if you enroll during that window, your coverage won’t begin until July. This could cause a lapse in coverage that could leave you owing lifelong late enrollment penalties.

If you have “creditable coverage” (a plan that meets certain requirements) from a group health plan through either your or your spouse’s employer, you may qualify for a Special Enrollment Period during which you can sign up for Medicare. This period lasts for eight months and begins either the month after the employment ends or the month after the group health insurance plan based on current employment ends.

The Open Enrollment Period occurs from October 15 to December 7. If you’re already enrolled in Medicare, you may review your coverage and decide whether to make any changes during this time. For more information or to enroll in Medicare Part A, visit the Social Security Administration’s Medicare page.

If you’re 65 or older, you qualify for Medicare benefits if:

• You are a U.S. citizen or permanent legal resident.
• You receive Social Security or railroad retirement benefits or have worked long enough to collect those benefits.
• You or your spouse work(ed) for the government and paid Medicare payroll taxes.

If you’re under 65, you may quality if:

• You’ve received Social Security disability for at least 24 months.
• You receive a disability pension from the Railroad Retirement Board.
• You have Lou Gehrig’s disease.
• You have permanent kidney failure.

Participation in Medicare is voluntary, though you should consider the late fees before opting to skip enrollment. Individuals who pay a Part A monthly premium will incur a 10% increase to their monthly payment for signing up late. Also keep in mind that you must be enrolled in either Medicare Part A or Part B to qualify for Medicare Part D (Medicare prescription drug coverage).

Most individuals don’t pay a monthly premium for Medicare Part A coverage. Premium-free Part A is offered to those who already get retirement benefits from Social Security or the Railroad Retirement Board, individuals who are eligible for those benefits but haven’t filed for them yet, or individuals who had (or their spouse had) Medicare-covered government employment. For those under 65, you may qualify for premium- free Part A if you’ve received Social Security disability for at least 24 months or have end-stage renal disease.

If you don’t qualify for premium-free Part A, you can buy into a plan. People who buy into Part A pay a premium that’s based on how long they or their spouse paid Medicare taxes. In most cases, if you choose to buy Part A, you must also have Medicare Part B.

For a more detailed cost breakdown, check out the Medicare costs at a glance.

Almost all hospitals and doctors accept Medicare. In fact, ninety-three percent of non-pediatric care physicians accept Medicare. The hospitals that do not accept Medicare include Veterans Affairs and active military hospitals. Use the Physician Compare resource to search for doctors and facilities that accept Medicare near you.

Your Initial Enrollment Period begins three months before your 65th birthday and continues the three months after your birthday. If you started receiving Social Security benefits at least four months before turning 65, you will automatically be enrolled in both Medicare Part A and Medicare Part B. If you sign up during the first three months of your Initial Enrollment Period, your coverage will start the first day of your birthday month. If you do not sign up during the Initial Enrollment Period, you will get another opportunity from January 1 to March 31 of each year; however, if you enroll during that window, your coverage won’t begin until July of that year.

The cost of Part B includes monthly premiums, a deductible and coinsurance or copay. If you didn't enroll in Part B when you were first eligible, your monthly premium may go up 10% for each 12-month period you could've had Part B, but didn't sign up. If you have “creditable coverage” (a plan that meets certain requirements) from a group health plan through either your or your spouse’s employer, you may qualify for a Special Enrollment Period during which you can sign up for Medicare. This period lasts for eight months and begins either the month after the employment ends or the month after the group health insurance plan based on current employment ends.

The Annual Enrollment Period occurs from October 15 to December 7. If you’re already enrolled in Medicare, you may review your coverage and decide whether to make any changes during this time. For more information or to enroll in Medicare Part B, visit the Social Security Administration’s Medicare page.

If you’re 65 or older, you qualify for Medicare benefits if:

• You are a U.S. citizen or permanent legal resident.
• You receive Social Security or railroad retirement benefits or have worked long enough to collect those benefits.
• You or your spouse work(ed) for the government and paid Medicare payroll taxes.

If you’re under 65, you may quality if:

• You’ve received Social Security disability for at least 24 months.
• You receive a disability pension from the Railroad Retirement Board.
• You have Lou Gehrig’s disease.
• You have permanent kidney failure.

Participation in Medicare is voluntary, though one should consider possible late fees before opting to skip their Initial Enrollment Period. Your monthly premium may go up 10% for each 12-month period you could've had Part B but delayed enrollment. For example, your premium could increase by 10% if you delay enrollment by 12 months, and could increase by 20% if you delay enrollment by 24 months, and so on. You will pay this penalty for the entire time you have Medicare.

Another thing to consider is that in order to qualify for Medicare Part D (Medicare prescription drug coverage), you must be enrolled in either Medicare Part A or Part B.

Some people are automatically enrolled in both Medicare Part A and Medicare Part B, but others may have to sign up for it. Whether you’re automatically signed up typically depends on if you’re receiving benefits from Social Security or the Railroad Retirement Board. If you do need to sign up, it’s important to do so when you’re first eligible, as your monthly premium may go up 10% for every 12-month period you could have had Part B but didn’t enroll. The penalty increases the longer you go without coverage. If you meet certain conditions that allow you to sign up during a Special Enrollment Period, you may not have to pay the late fee.

Most individuals pay the standard premium amount. If your modified adjusted gross income as reported on your IRS tax return for 2 years ago is above a certain bracket, you may pay an Income Related Monthly Adjusted Amount (IRMAA). This is an extra charge added to your premium. For an income breakdown, check out the Medicare Part B costs.

Almost all hospitals and doctors accept Medicare. In fact, ninety-three percent of non-pediatric care physicians accept Medicare. Use the Physician Compare resource to search for doctors and facilities that accept Medicare near you.

To qualify for Medicare Part C, you must already have Medicare Part A and Part B. You can join during the Initial Enrollment Period (when you first become eligible for Medicare) or during the Annual Enrollment Period (October 15 – December 7). Once enrolled, your plan will automatically renew every year, as long as the plan is still being provided and you are paying your plan premiums. You can make changes to your plan during both the Annual Enrollment Period (October 15 – December 7) and Medicare Advantage Open Enrollment Period (January 1 – March 31). To shop for plans, visit the Medicare plan finder tool or contact a private insurance company of your choice.

Individuals are eligible for Medicare Part C if they:

• Are enrolled in Medicare Part A and Part B.
• Live in an area serviced by providers who offer Medicare Advantage and are available during the Enrollment Period.

Medicare Part C is completely optional but may be beneficial to those who need more than the basic hospital and medical insurance offered by Part A and Part B.

Medicare Part C’s costs and premiums vary by plan. Some plans will have their own premium and deductible, while others cover a portion of your Medicare Part B premium. In addition, you may also owe a copayment for certain medical services. It’s important to compare Medicare Advantage costs and coverage to find what works best for you.

In order to enroll in Medicare Part C, you must already be enrolled in Medicare Part A and Part B. These “bundled” plans include Part A, Part B, and usually Part D. If your plan includes drug coverage, you won’t need to enroll in Medicare Part D in tandem with Part C. If not, you'll need to sign up for a standalone Part D plan. To find out which prescription drugs are covered under your plan, contact your insurance provider.

You have several opportunities throughout the year to switch your Medicare Part C coverage. You can make changes to your plan during Annual Enrollment (October 15 – December 7) and Medicare Advantage Open Enrollment (January 1 – March 31) Periods, or during a Special Enrollment Period triggered by a major life event. At these times, you can either change your plan or switch back to Original Medicare.

Though Original Medicare includes Part A and Part B, Medicare Part C offers an “all in one” insurance bundle including Medicare Part A, Part B and often Part D. These plans may have lower out-of-pocket costs and offer additional benefits that Original Medicare doesn’t cover, such as vision, hearing, dental and more. If you are interested in joining a Medicare Advantage plan, speak to a plan representative for more information.

Our pharmacy is a preferred pharmacy for Medicare Advantage plans offered by a broad network of insurance companies.

Preferred pharmacies offer lower copays on certain drugs than a standard pharmacy does. Any pharmacy in your plan’s network will be able to fill your prescription. The Kroger Family of Pharmacies is included in the preferred pharmacy network for Medicare plans and many private insurance companies. In some cases, we may also be able to fill prescriptions with Part C coverage even if we aren’t listed as a preferred pharmacy. Remember that not all Medicare Part C plans provide drug coverage. To make sure you have the coverage you need, contact your plan’s representative.

Most Medicare drug plans have a coverage gap. This gap, also known as the “donut hole,” temporarily limits what your drug plan will cover. This hole begins when your total prescription drug costs are more than the initial coverage limit for the year. While in this coverage gap, you are typically required to pay a percentage (at most 25%) of the cost of your prescription drugs, the same amount you paid before entering the coverage gap. Here are some charges that count toward the donut hole:

• Deductible
• Co-insurance and co-payments
• Discounts on brand-name drugs

To enroll in Medicare Part D, you must already have Medicare Part A and/or Part B. You can join during the Initial Enrollment Period (when you first become eligible for Medicare) or Annual Enrollment Period (October 15 – December 7). Once enrolled, your plan will automatically renew every year, as long as the plan is still being provided and you are paying your plan premiums. You can also make changes to your plan during the Medicare Advantage Open Enrollment Period, but only if the changes you make to your Advantage plan result in you losing your prescription drug coverage.

Even if you’re not currently taking prescription drugs, you should consider enrolling in Medicare Part D to avoid having a late enrollment penalty added to your premium. To shop for plans, visit Medicare’s plan finder tool or contact a private insurance company of your choice.

If you’re eligible for Original Medicare, you’re eligible for Medicare Part D.

If you’re 65 or older, you qualify for Medicare benefits if:

• You are a U.S. citizen or permanent legal resident.
• You receive Social Security or railroad retirement benefits or have worked long enough to collect those benefits.
• You or your spouse work(ed) for the government and paid Medicare payroll taxes.

If you’re under 65, you may quality if:

• You’ve received Social Security disability for at least 24 months.
• You receive a disability pension from the Railroad Retirement Board.
• You have Lou Gehrig’s disease.
• You have permanent kidney failure.

Medicare Part D is a voluntary prescription drug plan for individuals with Medicare. If you have drug coverage from somewhere that’s “creditable,” such as your employer, you may not need additional prescription coverage. However, if you do not have prescription coverage, it’s important to consider signing up for Medicare Part D as soon as you’re eligible. If you delay enrollment, you will only be able to sign up during Annual Enrollment (October 15 – December 7), and may be required to pay permanent financial penalties on your premium based on the number of months you have been without Part D or other creditable drug coverage since turning 65.

Your drug coverage costs will vary depending on your prescriptions, what formulary “tier” they’re in, which benefit phase you’re in, which pharmacy you use, and if you’re receiving any Extra Help paying monthly premiums, annual deductibles, and copayments. View the Medicare drug plan costs, then contact the plan provider for additional questions on specific plans.

You must be enrolled in Medicare Part A and/or Part B to enroll in Medicare Part D. You do not have to have Medicare Part C to enroll in Medicare Part D.

You can join or make changes to your plan during the Annual Enrollment Period, from October 15 – December 7. If you make a change at this time, your new coverage will begin January 1. You may also change Part D plans if you experience a life event that qualifies you for a Special Enrollment Period.

The right plan depends on availability, budget, medication costs, and more. Use the Medicare plan comparison tool to help you choose a plan that fits your overall health and medication needs. When choosing plans, consider out-of-pocket costs for premiums, deductibles, and co-pays; if you travel often; and if your doctor is listed in the plan’s network. The Kroger Family of Pharmacies is a preferred pharmacy for Medicare Part D plans offered by a broad network of insurance companies.

Preferred pharmacies offer lower copays on certain drugs than a standard pharmacy does. Any pharmacy in your plan’s network will be able to fill your prescription. The Kroger Family of Pharmacies is included in the preferred pharmacy network for Medicare plans and many private insurance companies. In some cases, we may also be able to fill prescriptions with Part D coverage, even if we aren’t listed as a preferred pharmacy.

Most Medicare drug plans have a coverage gap. This gap, also known as the “donut hole,” temporarily limits what your drug plan will cover. This hole begins when your total prescription drug costs are more than the initial coverage limit for the year. While in this coverage gap, you are typically required to pay a percentage (at most 25%) of the cost of your prescription drugs, the same amount you paid before entering the coverage gap. Here are some charges that count toward the donut hole:

• Deductible
• Coinsurance and copayments
• Discounts on brand-name drugs