When Do I Get Started?
Refer to the Medicare and You 2019 handbook pages 20-28
To be eligible for Medicare, you must be at least 64 + 8 months or older, under 65 with certain disabilities, or of any age with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease). Additionally, you are entitled to Medicare Part A once you have worked for 10 years (40 quarters), or depending upon your disability, have been receiving disability benefits for 24 complete months.
If you are 64, your first eligibility to enroll in Medicare will actually begin three months before your 65th birthday, through the month of your 65th birthday, and three months after your 65th birthday--for a total of seven months. This is known as your IEP, Initial Enrollment Period. If you enroll three months before your birthday, your benefits will begin on the first day of the month of your 65th birthday. (if your birthday is on the first day of the month, your benefits will begin on the first day of the prior month).
Anyone who has been diagnosed with End-Stage Renal Disease (ESRD), should contact Social Security at www.ssa.gov or 1-800-772-1213 (TTY 1-800-325-0778) for more information about the amount of time required to be eligible for Medicare.
If you are already receiving Social Security benefits or Railroad Retirement Board (RRB) benefits, you do not have to enroll in Medicare Parts A and B. Your Part A and Part B benefits will automatically begin on the first day of the month you turn 65. If you’re disabled and under 65, your Part A and Part B benefits will automatically begin after you’ve been receiving disability benefits from Social Security or the RRB for 24 months. If you have ALS (Lou Gehrig’s disease), your benefits will automatically begin on the month that your Social Security disability benefits begin.
Even if you are receiving Medicare for any of the reasons above, when you turn 65, you will enter your IEP and will have new options:
- Make changes to your current plan, if you are enrolled
- You will enter your Open Enrollment Period and can select a Medicare Supplement without underwriting
- And if you were subjected to a Late Enrollment Penalty, it will be removed
What is Covered and What Do I Pay?
Refer to the Medicare and You 2019 handbook pages 29-33
Medicare Part A
Medicare Part A (Hospital Insurance) covers hospital care. Additional services that are covered by Part A include skilled nursing, home health care, inpatient rehabilitation care, and hospice. For most people, Part A is premium-free. However for those that do not qualify for premium-free Part A coverage, the 2017 premium could be as high as $413 each month. There are also co-insurance and subsequent costs for which a beneficiary may be responsible, depending upon the length of service, i.e. inpatient stays.
A Part A deductible has to be met for each benefit period before Medicare pays its portion of your hospital expenses. The Part A deductible, currently at $1,316, changes annually and there is no cap, meaning, if a beneficiary is admitted to the hospital for a specific issue, released then re-admitted for an unrelated issue, a new deductible will be due.
Medicare Part B
Medicare Part B (Medical Insurance) covers medically necessary as well as preventative services. Click here for (hyperlink - https://www.medicare.gov/coverage/preventive-and-screening-services.html ) the most current list of preventative screenings. Other services covered by Part B include ambulance, Durable Medical Equipment (DME), canes, oxygen, syringes for example, clinical research, limited prescription drugs and certain immunizations such as flu and pneumonia.
Part B has a monthly premium as well as an annual deductible. A beneficiary has the option to enroll in Part B comes when they elect Part A, but can elect to delay enrollment if they have other Creditable Coverage, e.g., you decide to continue working and are on a Group Health Plan. The Part B premium for 2017 is $134 while the Part B deductible is $183 for 2017. (These amounts can change on January 1st)
Once the deductible has been met, Medicare will pay 80% of approved medical services, and the beneficiary will be responsible for the remaining 20%. If you are part of a union group, have an HSA account, or are receiving a group benefits package, speak with your employer’s Human Resources representative first, as in most cases, once you opt to discontinue your employee plan benefits, you cannot recover them.
Have one of our licensed agents review your Medicare eligibility, assist you with enrollment, and help you select the correct Medicare plan for your health care needs.
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CALL 1 (855) 474-6234 TTY-711
Medicare Part C (Advantage Plans)
Medicare Part C (Medicare Advantage Plans) Medicare Part C plans (also known as “Medicare Advantage”) are provided by private insurance companies, and must cover all of the services as Original Medicare, except hospice care, and they typically surpass the basic benefits of Original Medicare (Medicare Part A and/or Part B) by including vision coverage, hearing services, dental care, and transportation, among other benefits. Note, this will depend on the service area. Most Medicare Advantage HMO and PPO plans include Medicare prescription drug coverage (Part D). Part C plans use a network of doctors and some plans will offer the option for Out-of-Network services. Medicare Advantage plans offer zero to low premiums, and the beneficiary will have a set co-pay for covered services. You must be enrolled in Medicare Part A and B, live in the plan’s service area and not have ESRD to qualify for a Medicare Part C plan.
Medicare Part D (Prescription Drug Coverage)
Medicare Part D (Prescription Drug Coverage) Medicare Part D covers prescription drugs, and is provided by private insurance companies that are approved by Medicare. When you receive your Medicare card (also known as your “red, white, and blue card”), it will not list Medicare Part D. If you require prescription drug coverage, you will need to apply for it separately, with a Medicare Prescription Drug Plan, PDP, provider of your preference, and you must have Medicare Part A or Part B to qualify. If you have what is called “creditable coverage” from your employer, you will not need to enroll in a Medicare Part D plan.
However, if at any time your employer’s coverage is considered “not creditable”, you will need to enroll in Part D as soon as possible. A delay in Part D enrollment can result in a lifelong penalty, assessed each month.
Medigap (Medicare Supplement Insurance Policies) Although Medigap policies are sold by private insurance companies, every policy must follow federal and state laws and are “standardized”. Meaning, policies are designated by a letter and any policy, regardless of carrier, with that letter designation will have identical benefits. These plans are designed to help pay for the health care costs that Medicare does not cover, such as copayments, coinsurance, and deductibles. The cost of a Medigap policy will vary by carrier and by offered benefits.
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How Do I Know Which Type of Insurance is a Good Fit for Me?
Refer to the Medicare and You 2019 handbook pages 57-60
Ask yourself this: Do I want to pay ahead and have services covered in advance, or pay as I go?
The cost of your premiums and applicable deductibles will depend on the company you enroll with. So the biggest question that you want to ask is; “What is my annual out-of-pocket limit?” All insurance companies have one and it will also vary. This means that if all your co-pays, deductibles, and co-insurance reach the limit, then the insurance company will be responsible for any further cost till the remainder of the year. The New Year begins a zero balance.
Check to see if your primary doctor, specialists, and preferred hospitals are in the network if you have to use a network. Do you have to get referrals? Are all the services you need covered in the plan you are interested in? What happens when I travel locally and abroad? Are all of my medicines covered by the plan and will they require me to use Step Therapy (trying generics before brands) or set Quantity Limits (restricting my refills until the next month)?
Use this handy- dandy Medicare Plan Questionnaire to see which Medicare Plan works best for your budget and your needs!