More individuals than ever before are turning 65 and becoming eligible for Medicare. By 2030, 80 million people in the United States will turn 65 years old. If you are approaching 65, you are probably being inundated with calls and mail, which can make it difficult to figure out which path to take. Finding an agent who can help you navigate the Medicare maze should be a priority.
I am about to provide you with some valuable advice. You may even want to save it for future reference.
If you are coming off a group plan and transitioning to Original Medicare, there is a possibility you will be eligible for Guaranteed Issue Medicare Rights (Medigap protections). If you would like more information, please click here.
Navigating the Medicare maze
Discussing Part A, B, C or D, Medigap, Medicare Supplements, initial enrollment period, or Original Medicare can be confusing. At MWG Senior Services, helping seniors navigate the Medicare maze is our specialty. So, let’s get started.
Original Medicare is health insurance coverage managed by the federal government. The two main parts are Part A (Hospital Insurance) and Part B (Medical Insurance). Part A covers care in a skilled nursing facility, inpatient hospital stays, hospice care, and some home health care. A rather large number of US citizens will not be required to pay for their Part A monthly premium.
Premium-free qualifications for Part A at 65 years of age:
- If you or your spouse has worked 40 or more quarters paying Medicare taxes.
- If you receive retirement benefits from Social Security or the Railroad Retirement Board.
- If you are eligible to get Social Security or Railroad benefits, but haven’t filed for them yet.
If you OR your spouse had Medicare-covered government employment.
Premium-free qualifications for Part A if you are UNDER 65 years of age:
- If you received Social Security or Railroad Retirement Board disability benefits for 24 months.
- If you have End-Stage Renal Disease (ESRD) and meet certain requirements.
Part A Premiums
According to Medicare.gov, if you paid Medicare taxes for less than 30 quarters (7 ½ years), the standard Part A premium is $413 in 2017. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $227. But in most cases, if you choose to buy Part A, you must also purchase Medicare Part B (Medicare Insurance). You will be required to pay monthly premiums for both.
Part B Premiums
Historically, Part B premiums have increased every year. In 2017, the Part B premium is $134 (or higher depending on your income). If you are currently receiving Social Security benefits, you could have a decreased Part B premium.
In Original Medicare, Part B will cover certain doctor services, outpatient care, medical supplies, and preventive services.
Two types of services Part B can cover:
- Medically necessary: Services or supplies needed to diagnose or treat your medical condition which meet accepted standards of medical practice.
- Preventive: Services which provide healthcare to prevent illness (like the flu), or detect it at an early stage when treatment is most likely to work best. You pay nothing for most preventive services if you get the services from a healthcare provider who accepts assignment.
What Original Medicare (Part A & Part B) doesn’t cover
It’s no secret that Original Medicare doesn’t cover everything, nor does it pay in full. You could be stuck paying out-of-pocket for the portion not covered by Medicare, unless you have other insurance (Medicare Supplement or Medigap policy), or you’re in a Medicare health plan (like Medicare Advantage Plans). With Original Medicare, you could be responsible for your deductible, coinsurance, or copay. Purchasing a Medicare supplement or Medigap policy can help pay some of the healthcare costs that Original Medicare doesn’t cover.
Also, when you purchase a Medicare Supplement, such as a Medigap policy, it could cover up to 20%. This could help you have less out-of-pocket expenses when your personal health isn’t at its best. For instance, a Plan F Medicare Supplement would insure maximum coverage.
You can purchase a Medicare Supplement at any time during the year, unlike Medicare Advantage plans (Part C). All Medicare Supplements are standardized, so a Plan F with one carrier has the same coverage as a Plan F with any other carrier.
Plan G is also very popular because the only difference between a Plan F and a Plan G is the Medicare Part B deductible cost. With Plan F, you pay nothing, but with Plan G, you pay a one-time cost of $183 (current cost as of 2017) for Part B services. This deductible typically changes and starts over on January 1st of each year.
These plans are considered portable because you can use your insurance in any state in the US, as long as the doctor accepts Medicare. Medicare Supplements typically don’t cover long-term care, vision, dental, hearing aids, eyeglasses, private-duty nursing, or Prescription Drug Plans (Part D). You can purchase these as stand-alone policies if it fits your needs.
To compare prices of different Medicare Supplement plans and carriers located in your area, click here.
Part D (Prescription Drug Plans)
Prescription Drug Plans are important and you will need to make sure the plan you choose is considered creditableprescriptiondrug coverage. If you don’t have creditable prescription drug coverage, you could pay a late enrollment penalty. This means, you will be required to pay a higher monthly premium and that penalty continues each year. We suggest, if you are currently not taking any drugs, you will still need a low-cost premium plan to prevent having to pay high or late enrollment penalties later in life. Medicare multiplies 1% of the national base beneficiary premium by the number of full, uncovered months you didn’t have Part D or creditable coverage. That amount is added to every monthly premium for the remainder of the service. This can be an issue for those on a strict budget, therefore, we want to help prevent you from being penalized.
Medicare Advantage (Part C) plans administer Original Medicare (Part A & B). Most Medicare Advantage plans offer prescription drug coverage. With Part C plans, you must have a primary care physician and you may have to be referred before you can see a specialist. You must also choose a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service Plan, Special Needs Plan, and Medicare Medical Savings Account Plan. These plans are not typically considered portable because of the network stipulations and regulations.
Initial Enrollment Period
If you are new to Medicare, turning 65, and ready to hop on the Medicare bandwagon, you can sign up for a Medicare Advantage or Part D (Prescription Drug Plan) during your Initial Enrollment Period. Your Initial Enrollment Period begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
Open Enrollment Period
Medicare Supplement (Medigap policy) plans have a different time period that you can sign up with no health questions. When you first enroll in Part B, you can enroll in a Medicare Supplement with no medical underwriting starting 6 months before your Part B effective date until 6 months after your Part B effective date.
There are definitely different ways you can obtain creditable coverage and navigate the Medicare maze. Everyone’s situation is different and there isn’t one option made to fit all. We advise you to look at a several different avenues to see which option best fits your needs. I hope the information you take from our blog will leave you more knowledgeable and happy! Life is too short to worry about which road to take when navigating the Medicare maze. Give us a call at (877) 759-5760 or send us an email at firstname.lastname@example.org. Be sure to mention that you heard about us through our blog. Have a great day!