Medicare is confusing. Approaching your 65th birthday requires action on most people’s part. Read below as Daniel Gomez, owner of Good Life Insurance Company answers questions from our readers.
When do I need to begin considering my options for Medicare? Can I start after I turn 65?
The best time to start considering your options for Medicare is between 3-6 months before turning 65. We encourage you to become familiar with Medicare as well as your options. Medicare will issue your Medicare card 3 months prior to turning 65 and they will allow you to choose a Medicare Supplement or Medicare Advantage Plan at this time if you choose to do so.
What is Medicare?
Original Medicare is a fee-for-service health plan for people that are 65 or older, certain people under 65 that have disabilities, or people who have end-stage renal disease (also known as permeant kidney failure needing dialysis or kidney transplant.) It is comprised of two parts: Part A (Hospital Insurance) and Part B (Medical Insurance).
Medicare Part A, which is your hospital insurance, usually has no monthly premium if you or your spouse paid Medicare taxes while working for a certain amount of time, usually 10 years.
Medicare Part B, which is your Medical Insurance, helps you cover services from doctors, outpatient care, Home health care, Durable medical equipment like wheelchairs and walkers, as well as preventative services. Medicare Part B does in fact have a standard monthly premium.
Medicare Part C, is an “all in one” alternative to Original Medicare that bundles Parts A, B, and usually Part D while including extra benefits that Original Medicare doesn’t cover— like vision, hearing, and dental services.
Medicare Part D, is prescription drug coverage run by private insurers while following rules that are set by Medicare. Your Part D is what you need to help cover the cost of prescription drugs. This will help lower your drug costs.
It is important to note that if you do not choose a Medicare Part D plan through a private insurer within 63 or more days in a row when you don’t have Medicare drug coverage or other creditable prescription drug coverage, you will incur a late enrollment penalty. This is an amount that’s permanently added to your Medicare drug coverage which means you’ll have to pay the penalty for as long as you have Medicare drug coverage.
Do I have to qualify for Medicare?
If you are 65 or older, you need to be a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years. You also need to be receiving Social Security or railroad retirement benefits or have worked long enough to be eligible for those benefits but are not yet collecting them. If you are currently receiving Social Security benefits, you don’t need to do anything. You will be automatically enrolled in Medicare Parts A and B effective the month you turn 65.
If you are under the age of 65, you can still receive medicare if you are entitled to Social Security disability benefits for at least 24 months. You can also receive Medicare if you receive a disability pension from the Railroad Retirement Board. Lastly you can receive Medicare if you have Lou Gehrig’s disease (known as ALS) or if you have permanent kidney failure requiring regular dialysis or a kidney transplant.
If you don’t qualify on your own or through your spouse’s work record but are a U.S. citizen or have been a legal resident for at least five years, you can get full Medicare benefits at age 65 or older. You just have to buy into them by paying a premium for your Parts A, B, and D.
Will Medicare save me money?
Medicare will definitely save you money, but it is good to remember that Original Medicare does not pay for all health care services and supplies. You will have to cover coinsurance, copayments, and deductibles that come along with Medicare.
Will Medicare cover all my medical expenses?
Short answer is, No.
You will still have to cover coinsurance, copayments, and deductibles. There are of course options available to help you cover these costs. You can choose a Medicare Supplement policy also known as Medigap which are sold by private companies and can help pay some of the remaining health care costs, like copayments, coinsurance, and deductibles. There is also another popular option in adding Medicare Part C Medicare Advantage which will further lower your out-of-pocket costs than Original Medicare. These options are also offered by private insurance companies and are offered as an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and will usually include your Part D. Unlike Medicare Supplement, most plans offer extra benefits that Original Medicare doesn’t cover— like vision, hearing, and dental services.
Do I still need medical insurance if I have Medicare?
You will not need additional medical insurance if you have Medicare. Medicare is in fact health insurance that is comprised of 2 parts, Part A and Part B. These combined will provide you with health insurance that covers hospital and medical services.
Medicare sounds confusing? Is there an “easy button”?
You have options when it comes to understanding Medicare better. You can contact an insurance agent that specializes in Medicare. You can also contact Medicare directly at 1-800-MEDICARE and ask any questions you may have. There are also plenty of online resources available at www.medicare.gov.
Does Medicare signup have a deadline?
You want to sign up for Medicare during your Initial Medicare Enrollment Period. This period starts 3 months before you turn 65 and ends 3 months after you turn 65. If you’re not already collecting Social Security benefits before your Initial Enrollment Period starts, you’ll need to sign up for Medicare online or contact Social Security. If you’re already receiving Social Security or Railroad Retirement Board benefits and you’re a U.S. resident, you won’t have to worry about your enrollment date, since the government automatically enrolls you in both Part A and Part B at age 65. Three months prior to your 65th birthday, your Medicare card will arrive in the mail.
If you choose to sign up for a Medicare Advantage, you want to do this when you first get Medicare, during the Initial Enrollment Period.
The best time to buy a Medicare Supplement plan is during your 6-month Medicare Open Enrollment Period which begins the first day of the month in which you are both 65 or older and enrolled in Medicare Part B. A good reason to enroll into Medicare Supplement Plan during the Medicare Supplement Open Enrollment Period is that companies that offer Medicare Supplement plans must sell you a policy at the best available rate regardless of your health status and can’t use medical underwriting during this time. Medical underwriting considers your health conditions and the costs to cover you and may reject you based on a health problem. During you Medicare Supplement open enrollment period, you could possibly have any health problem and still be accepted into a Medicare Supplement plan.
What if I miss the Medicare signup deadline?
If you miss your Initial Enrollment Period, you can sign up during Medicare’s General Enrollment Period which is from January 1 to March 31, and your coverage will start July 1.
If you decline Part B when you first become eligible, you might have to pay higher Part B premiums if you enroll later on. For each year that you don’t enroll, your premium will be 10% higher, unless the reason you declined Part B was that you were insured by an employer-sponsored health insurance plan offered by your, or your spouse’s, current employer.
If you miss your first chance at enrolling into a Medicare Advantage Plan, you have to wait until Medicare’s annual Open Enrollment Period which is from October 15–December 7 to join a plan unless you qualify for a special Enrollment Period (SEP). During this time each year, you can also drop or switch your plan coverage.
Will I have to give up my doctor if I switch to medicare?
Most American physicians participate in Medicare. You can go online to www.medicare.gov to search the medicare formulary and check if your physician accepts medicare. If your doctor is a non-participating provider you’ll have to pay the difference between the fees and the Medicare reimbursement.
Will I get second-rate care if I switch to Medicare?
No, you will receive the same care as with any other Health Insurance plan.
Information provided by Daniel Gomez, owner of Good Life Insurance, NC. He can be reached at 336-546-7956.