Inside Medicare: Dollars are in the Details
October 08, 2019
It’s important to look before you leap into Medicare. The options can be daunting – especially at first glance – and a misstep can result in penalties which follow you for the rest of your life. Start by learning the ropes: Eligibility, Elements and Enrollment – plus Expertise to help you find your way.
Age 65 – Medicare is the Federal government health insurance program for those age 65 and older. You don’t have to be retired or collect Social Security to receive Medicare.
Before Age 65 – You may also become eligible before age 65 if you have a permanent disability or end-stage renal disease.
Medicare includes Parts A and B, C and D. These parts are grouped into Original Medicare and Medicare Advantage.
Offered by the Federal Government, covers much – but not all – of your care and has deductibles and coinsurance.
Part A - Hospital Insurance helps cover:
- Skill nursing facility care
- Hospice care
- Home health
Part B - Medical Insurance helps cover:
- Doctor appointments
- Outpatient care
- Preventive services (screenings, immunizations, annual wellness visits)
- Occupational/physical therapy
- Medical equipment (wheelchairs, walkers, etc.)
Offered by Private Companies - Medicare Advantage is considered an “all-in-one” alternative to Original Medicare and has separate premiums.
Part C - Medicare Advantage includes:
- Medicare Parts A and B, and usually Part D
- PPO or HMO network of providers
- Some plans also offer:
- Lower out-of-pocket costs
- Extra benefits (vision, hearing, dental)
Part D - Prescription Drug Coverage helps cover:
- Prescription drug costs
Note: Part D is available as a stand-alone option. If you don’t join a Medicare prescription plan when you’re first eligible but do join later in your life, you may be required to pay a late enrollment penalty for the remainder of your life.
It’s easy to get overwhelmed by the complexities of Medicare, but help is available.
If you collect Social Security at age 65, you are automatically enrolled in Medicare Part A and B.
If you don’t collect Social Security, you can enroll during one of three enrollment periods.
1. Initial Enrollment Period (IEP)
- 3 months prior to the month you turn 65 (birthday month)
- Your birthday month
- 3 months after your birthday month.
This is when most individuals enroll in Medicare for the first time.
2. General Enrollment Period
- Jan. 1 – March 31
If you didn’t sign up for Part A and/or Part B during the Initial Enrollment Period, you can sign up during General Enrollment. Your coverage won’t start until July 1 of that year, and you may have to pay a higher Part A and/or Part B premium for late enrollment.
3. Special Enrollment Period (SEP)
- Medicare allows for enrollment anytime during the year when certain life events occur. Some examples of such circumstances include leaving a current employer’s sponsored health plan, a relocation to a new area or your qualification for Medicaid or Extra Help changes.
4. Annual Election Period (AEP)
- Oct. 15 – Dec. 7
Already have Medicare? Medicare’s Annual Election Period is the time when all Medicare beneficiaries are able to change their Medicare participation options for the upcoming calendar year. During this fall’s Annual Election Period you can change your Medicare health or prescription drug coverage for 2020.
Medicare Myths and Facts
Myth: I won’t qualify for Medicare because my health is poor.
Fact: Medicare cannot reject you because you’re sick or have a preexisting condition. Your acceptance into Medicare is guaranteed regardless of your health, once you reach the age of 65 (unless you qualify by disability).
Myth: I’ll be notified when it’s time to enroll in Medicare.
Fact: You generally have to remember to enroll on your own. Penalties may apply if you fail to enroll in parts B or D, and those penalties follow you for the remainder of your life.
Myth: Medicare is free.
Fact: Some parts of the program may be offered at no cost; however, enrollees are expected to cover some premiums, deductibles and out-of-pocket expenses.