Jim retired from his job as a supervisor at a manufacturing plant in the Midwest at the end of last year. As he approached his 65th birthday in early 2018, Jim realized that he would become eligible for Medicare. That realization marked almost the entire extent of his knowledge of this crucial health insurance for seniors aged 65 and older. While wading through Medicare and its various components can be confusing at times, this enrollment guide is designed to help smooth your way.
What is Medicare?
According to a publication from the United States government office that oversees the plan, Medicare can best be described as health insurance for those people who seniors that are 65 years of age or older. While other segments of the population can access Medicare — such as people of any age with certain disabilities or those who have End-Stage Renal Disease (ESRD) — its largest audience is those that fall within the 65 and older bracket.
What are the Different Parts of Medicare?
If you are like many seniors, you frequently hear commercials that mention terms like Medicare Part A and B, but you aren’t really sure what they mean. In actuality, there are four distinct parts of Medicare — Parts A, B, C and D — with each part having its own focus and advantages. A brief overview of these differences follows:
- Medicare Part A
Medicare Part A is the portion of this health insurance that nearly everyone can take advantage of. Typically free, Medicare Part A is hospital insurance that includes skilled nursing facility care, home health care, inpatient care in a hospital and hospice care. As long as you or your spouse has paid Medicare taxes and worked for at least 10 years — or 40 quarters –Medicare Part A is free. If you don’t meet this requirement, you’ll have to pay a premium for Part A coverage.
- Medicare Part B
As the medical insurance portion of Medicare, Part B offers you an expanded list of options that can improve your health and quality of life. If you choose to buy Medicare Part B coverage, you’ll have help with items such as durable medical equipment, outpatient care, services provided by doctors and other medical professionals, home health care and a number of preventative services. It’s important to note here that if you don’t sign up for Medicare Part B when you are first able to do so, you’ll probably have to pay a penalty for late enrollment for as long as you have this coverage.
- Medicare Part C
Overseen by private insurance companies that have the approval of Medicare, and that agree to abide the agency’s regulations, Part C comprises all the benefits of Part A and Part B as listed above. In addition, you’ll also typically have access to prescription drug coverage from Medicare — also known as Part D.
- Medicare Part D
Medicare Part D is known as the prescription drug portion of Medicare. Opting for this coverage can help you pay for the costs of any prescription drugs your doctor gives you. Run by those insurance companies that are approved by Medicare and that follow their rules, Part D can help reduce your costs for the prescription drugs you take and could protect you against rising prices in the future.
How to Sign Up for Medicare
Most people will need to sign up for Medicare as they near the age of 65. Some exceptions to this include those people who are already getting benefits from either the Railroad Retirement Board (RRB) or Social Security. In this case, you’ll automatically start getting Medicare on the first day of your birth month unless your birthday happens to fall on the first. If it does, then your Medicare benefits will begin on the first day of the previous month.
Start Your Research Early
While the Medicare website suggests applying for Medicare three months before you turn 65, it’s a good idea to allow yourself a few extra months to become acclimated to the process and gather the documents you need. There are a number of deadlines and conditions that you need to familiarize yourself with so that you are able to take full advantage of the benefits you deserve.
You’ll need to contact Social Security about three months before your 65th birthday. Depending on your preference, you can call the Social Security Administration and apply over the phone. Another way to apply for Medicare is by visiting the “Retirement” section of the official Social Security website. You can also apply in person at your local Social Security office though you will want call first to make an appointment and confirm what kinds of documentation are needed.
Familiarize Yourself With Your Choices
Before you apply for Medicare, you need to know the type of coverage you want. Here is where taking a few weeks — or even months — provides you with the time to thoroughly research your options can come in handy. As noted above in the details about Medicare Part B, if you make the wrong choice when you initially apply for Medicare, you could wind up paying a penalty for the duration of your coverage or, worse still, not have an adequate amount of coverage to meet your needs.
First Step: Choose Either Original Medicare (Part A and/or Part B) or Medicare Advantage (Part C)
The first step in your research is deciding if you want the coverage that is offered by Medicare or if the Medicare coverage provided by private insurance companies is better suited for your needs. Here’s an overview of the two options.
- Original Medicare
Original Medicare includes Part A — which is typically free as long as you and your spouse worked for at least 10 years — and offers you the option of purchasing Part B. If you choose this option, then you’ll be dealing with Medicare directly. Through Medicare, you can choose the hospitals, doctors and other medical providers that you want as long as they accept Medicare. In most cases, you have to pay any deductibles or you can purchase supplemental insurance that covers those fees. In nearly all cases, you’ll be responsible for paying a monthly premium if you want Medicare Part B.
- Medicare Advantage
Medicare Advantage might be better known to you as Medicare Part C. Offered to seniors over the age of 65 by private insurance companies who have been approved by Medicare and who follow the agency’s regulations, Medicare Advantage (Part C) includes both Part A (hospital insurance) and Part B (medical insurance).
Much like private health insurance you may have purchased on your own or group health insurance you obtained through an employer, most Medicare Advantage plans require that you use the medical providers, doctors and hospitals that are approved or you could be responsible for some or all of the costs.
In addition to paying the premium for Part B coverage, you might also be responsible for paying for Medicare Advantage coverage, as well as copayments, deductibles or coinsurance, if applicable. Depending on the plan and insurance company you choose, your costs, rules and additional coverage details could vary widely.
Second Step: Do You Want Prescription Drug Coverage (Part D)?
While prescription drugs are often vital in maintaining your good health as you age, their coverage by Medicare is not automatic. Whether you choose Original Medicare or Medicare Advantage, if you want prescription drug coverage, you’ll probably need to pay an additional premium for it.
Did decide that Original Medicare is the best option for your needs? If so, and you want Part D, prescription drug coverage, you will need to join a Medicare Prescription Drug Plan. These plans are overseen by private companies that have the approval of Medicare and who have agreed to abide by the agency’s rules. In nearly all cases, you’ll have to pay a premium every month in order to access Medicare Part D.
Those seniors who elected to purchase Medicare Advantage and who also want Part D (drug coverage) will probably have to purchase it through your Medicare Advantage Plan. In most instances, the only exception to this is if the plan you’ve chosen doesn’t offer the option of drug coverage. If this is the case, you’ll have the option of joining a Medicare Prescription Drug Plan.
Third Step: Is Supplemental Coverage Right for You?
Whether you choose to enroll in the Original Medicare Plan that is offered by Medicare or you enroll in a Medicare Advantage Plan that is provided by a private insurance company, you’ll need to be prepared to pay for more than any monthly premiums that you’re responsible for. Copayments, coinsurance and deductibles are all additional fees that you need might need to pay out of pocket each time you visit a doctor, hospital or medical providers or get a prescription filled — if you have Medicare Part D.
If you want supplemental coverage — also known as Medigap — to help offset those out-of-pocket costs, there are a few things you should know first.
- You must be enrolled in Original Medicare in order to purchase a supplemental coverage policy.
- If you have a Medicare Advantage Plan, you are not eligible to use a Medicare Supplement Insurance plan to pay for those costs that you incur out of pocket.
- In most cases, you must drop your Medicare Advantage Plan and enroll in Original Medicare before you can purchase Medicare Supplement Insurance.
- Private insurance companies that have prior approval from Medicare offer policies for supplemental coverage.
- Depending on the coverage, insurance company and other factors, the costs of such insurance can vary widely.
- In some cases, your employer or a union that you belong to might offer coverage that is similar in nature.
How to Choose the Right Plan for Your Needs
When you are deciding if you should choose Original Medicare or Medicare Advantage, there are a number of factors that you should consider. Chances are you already have an established relationship with medical professionals in your area. Ensuring that the Medicare plan you are considering is accepted by your preferred doctors, hospitals and other medical professionals can help smooth the way for your health care. Other things to consider that you might not have thought of include:
While cost is a crucial factor in deciding which Medicare plan to choose, it should be weighed against other components as well. For example, don’t make the mistake of choosing a low-cost plan that is so affordable because it offers you little choice in terms of your care. Chances are that you’ll be dissatisfied with the plan when you need to use it.
Don’t discount the convenience factor that your Medicare plan can offer you. Are the doctors within the plan that you’re considering located nearby? Do they offer convenient hours? Is your favorite pharmacy that is close to your home included within that plan?
One of the benefits of being retired is the unfettered ability to travel as you like — unless your Medicare plan stipulates that your coverage is limited only to your home state. If you travel frequently abroad or within the United States, does your Medicare plan provide the option to obtain care there?
The quality of the health care you receive from both your medical providers and your insurance company can make a significant difference in the quality of your life. This quality of care — coupled with the services they offer — is an important consideration for when you choose your Medicare plan. If you feel that something is lacking in the care you’ve received, search for a plan that offers what you need.
- Other Coverage
Do you already have other types of prescription drug coverage that is offered by your employer or union? Is health care provided? If the answer is yes, you’ll want to know exactly which types of coverage you are eligible for so you don’t pay for something that you already have. Contact the benefits advisor for your coverage for full details before you make a decision like dropping it. In many cases, if you disenroll in insurance of that type, you are not able to reenroll at a later date.
Medicare is there to help you stay happy and healthy as you enjoy your senior years. Demystifying the process helps you make the right choices for your current and future needs. The key is to give yourself lots of time to compare plans and options so you don’t have to hurry to make a decision under pressure.