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FAQs

Frequently Asked Medicare Questions

 

 

Do you have Medicare questions? We've got answers.

Eligibility

Most people become eligible for Medicare benefits when they turn 65. However, if you have a qualifying disability, you may be eligible for Medicare benefits after receiving Social Security benefits for two years. There are two exceptions to the waiting period. If you are receiving Social Security disability benefits because you have amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) or end stage renal disease (ESRD), you are immediately eligible for Medicare.

Medicare is a federally funded health program, so you must be either a U.S. citizen or a legal resident of the United States for at least 5 years.

All U.S. citizens or legal residents can receive Medicare benefits, but in order to receive Part A benefits without paying a premium, you or your spouse need to have been employed and paying Social Security taxes for at least 10 years. For more information about buying Part A as well as Part B if you don't qualify for premium-free coverage, call Social Security at 1-800-772-1213 (TTY users 1-800-325-0778) between 7 a.m. and 7 p.m. Monday through Friday, or visit your local Social Security office.

Enrollment

If you're already getting Social Security checks or retirement benefits from the Railroad Retirement Board (RRB), Medicare enrollment is automatic. You'll get your Medicare card three months before your 65th birthday, and benefits will start on the first day of your birth month. However, if you're like most people, you'll need to enroll in Medicare through Social Security online, by visiting a local Social Security office, or by calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778) between 7 a.m. and 7 p.m. Monday through Friday.

It depends. If you or your spouse is still working and you're covered by an employer health plan, there's no need pay for duplicate coverage. When you retire or your employer coverage otherwise ends, you'll then be able to sign up for Part B (through a Part B Special Enrollment Period). You should enroll in Part A when eligible.
However, if you're still working and don't have other health coverage, then you should enroll in Part B (along with Part A) when you're first eligible. Otherwise, you'll have to pay a late-enrollment penalty and a higher premium when you do sign up.

Yes! Social Security allows another person to complete your enrollment for you, whether or not they have officially registered as your "authorized representative." If you are with the person when they are filing the application and can sign it yourself, then you both can proceed as if you were completing it yourself. If you are not present, the completed application will be mailed to you to verify and sign. For more information about enrolling, visit Social Security online, call 1-800-772-1213 (TTY users 1-800-325-0778) between 7 a.m. and 7 p.m. Monday through Friday, or visit your local Social Security office.

Highmark also allows an "authorized representative" to complete your enrollment application for our Medicare Advantage, prescription drug and supplemental coverage plans. We ask your representative to provide contact information and certify that s/he is authorized by you to act on your behalf.

Using Your Medicare benefits

If you get a monthly benefits check from Social Security, the Railroad Retirement Board (RRB) or the Civil Service, your Part B premium must be deducted automatically from the check. If you don't receive benefits from these programs, Medicare will bill you directly for your monthly premium.

If you are enrolled in Original Medicare only, then your coverage moves with you (you will need to provide a change of address). However, some Medicare Advantage and supplemental insurance plans are state-specific. So, make sure your insurance is transferable and will be accepted by doctors and hospitals in your new state of residence.

If you are enrolled in a Medicare Advantage plan, you have the option to leave your plan and return to Original Medicare between January 1 and February 14 of each year. After you switch back to Original Medicare, you will have until February 14 to enroll in a Part D plan.
You cannot switch to another Medicare Advantage plan unless your situation qualifies you for a Special Enrollment Period, or during Annual Open Enrollment from October 15 to December 7 each year.

Before deciding to switch out of your Medicare Advantage plan, be sure to assess all your costs including premiums, out-of-pocket costs, and prescription costs to ensure you get the best coverage at the best price for you. You can estimate your total costs right on this website.

You can order a replacement card online on the Replace a Medicare Card page of the Social Security web site. You can also call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) between 7 a.m. and 7 p.m. Monday through Friday. You may need to provide your Social Security number, date of birth, phone number, mother's maiden name, place of birth, and the amount of the last payment you received, or the month and year of your last payment.

Talk to a licensed Medicare advisor

To enroll in a Highmark plan or learn more call
1-844-614-0343 (TTY users call 711)
8 a.m. - 8 p.m. ET, Monday to Friday
9 a.m. - 5 p.m. ET, Saturday 
Or visit our Reservations site


Talk to a licensed Medicare advisor

To enroll in a Highmark plan or learn more call
1-844-614-0343 (TTY users call 711)
8 a.m. - 8 p.m. ET, Monday to Friday
9 a.m. - 5 p.m. ET, Saturday
Or visit our Reservations site