Turning 65 can be an exciting time if you are making your retirement and travel plans. After years of hard work, you finally you get to enjoy the fruits of your labor! It also means it’s time to start thinking about Medicare, which can bring anxiety and confusion. Whether you’re hanging up the nine-to-five hat for good or simply transitioning off another medical insurance plan, here’s an overview of the What, When and How of Medicare to bring some peace and confidence in the next stage of healthcare. And a big thank you to Angel Barna at Troth & Company, a local health insurance expert, for collaborating with us on this article!
What is Medicare?
Medicare is a federal health insurance plan for those 65 and older and is divided into four parts.
- Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care and is available at no cost for most people.
- Medicare Part B (Medical Insurance) covers certain doctors’ services, outpatient care, medical supplies, and preventive services and has an income-based cost. Parts A and B together are also called “Original Medicare” and is an 80/20 plan, meaning the government pays 80% of covered expenses and you pay the remaining 20%. It should be noted that this 20% is uncapped.
- Medicare Part D (Prescription Drug Coverage) adds prescription drug coverage to Original Medicare through plans offered by Medicare-approved insurance companies. Many Medicare Advantage Plans also include similar prescription drug coverage.
- Medicare Supplement plans (Medigap) are offered by private insurance carriers to help Original Medicare participants cover copayments, coinsurance, and deductibles. Though these supplemental policies are federally standardized, costs can vary from carrier to carrier.
- Medicare Advantage plans (also called Medicare Part C) are bundled alternatives to Original Medicare offered by private companies that contract with Medicare. They usually include parts A, B and D. If you have a Medicare Advantage plan, it is illegal for anyone to sell you a Medigap plan unless you will be switching to Original Medicare.
So, how do you choose between Original Medicare and Medicare Advantage? It’s highly dependent on your specific situation and should be discussed with a qualified Medicare insurance professional.
When does Medicare start?
Medicare begins when you turn 65 with your first enrollment window starting three months before you turn 65 and ending three months after your turn 65.
Start forming your plan at least three months before you turn 65. This gives you plenty of time to learn about options and decide if you plan to enroll directly in parts A and B, if you’ll need part D prescription drug coverage, or if you’ll bundle with a Medicare Advantage plan instead.
Consulting a Medicare-specialized insurance professional can be very helpful as you navigate these waters. We’re always happy to provide a recommendation!
Avoid the late enrollment penalty!
If you miss your initial enrollment period and don’t have coverage similar to Medicare from an employer or otherwise, you could be subject to a late enrollment penalty. For many, these penalties apply for life, so don’t be caught off guard…plan ahead! Medicare provides a guide to avoid late penalties.
How do I enroll in Medicare?
There are several ways to tackle this, depending on your plan. We suggest working with a local Medicare insurance professional. They can guide you through your options for plans, networks, drug coverage, travel coverage and answer your questions around Medicare. They can also help with enrollment at no cost to you. According to Angel at Troth & Co, “Once you get through your first Medicare enrollment, the rest is easy. It’s worth the time energy to reach out to a Medicare professional to get guidance.” If you’d like her help, you can contact her here!
If you prefer to tackle it on your own, you can:
- Visit the Medicare website
- Call 800-772-1213
- Make an appointment to go into your local Social Security office
Medicare Parts A and B should be considered when you are retiring or otherwise leaving a group or individual health insurance plan. Some people are enrolled automatically while others must sign up, usually depending on if you’re receiving Social Security benefits.
Medicare Part D, Medicare Supplements, and Medicare Advantage options can be reviewed and enrolled with the help of a local insurance professional. Or, if you prefer, you can review and enroll in your local plans directly on Medicare’s Website.
Medicare can be daunting and the marketing in your mailbox alone can be overwhelming. In case we haven’t made it clear enough, working with the right Medicare insurance professional can help avoid common mistakes and arrive at a plan tailored to your needs. Don’t hesitate to ask for help along the way because, with the right education and professional team, you’ll make it through enrollment and sail smoothly into this next phase of life!
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