If you’re turning 65, you’ll begin to qualify for Medicare, federal government sponsored healthcare. Here's how to sign up to for Medicare.
If you’re turning 65, you’ll begin to qualify for Medicare, federal government sponsored healthcare. You’ll need to know how to sign up to get started.
The different parts of Medicare include Part A. This covers skilled nursing home care, hospice care, and home healthcare.
Part B, which amounts to medical insurance, covers services for doctors and other healthcare providers, outpatient care, home healthcare, durable medical equipment, and some preventive services.
Part C, which is run by Medicare-approved private insurance companies, include Parts A and B, usually includes Medicare drug prescription coverage (Part D), and may include extra benefits and services at an extra cost.
Important information includes your social security number, Medicare number, Medicare plan enrollment, other insurance plans and policy numbers (including long-term care insurance), contact information for healthcare providers, a list of current prescription drugs and dosages, current health conditions, symptoms, and treatments, a history of past health problems, emergency contacts, and financial and legal information, according to Medicare.
Despite popular belief, Medicare isn’t free, and it’s important to understand the ins and outs before signing up. Even if you’ve been on Medicare for years, you may want to consider switching plans.
"I think everyone should consider switching," says Lita Epstein, author of "The Complete Idiot's Guide to Social Security and Medicare." "Plans change, benefits change and the premiums change," she told U.S. News.
It’s particularly important to consider changing plans if you have a Medicare Part D drug plan because those can change significantly from year to year
"Even if (you’re) completely happy with their plan, (you) have to look because things change," says Diane J. Omdahl, founder and Medicare expert at 65 Incorporated, which helps people choose Medicare coverage.
The first decision Medicare beneficiaries must make is whether to go with traditional Medicare (Parts, A, B, and D) or a Medicare Advantage Plan (Part C).
Medicare Advantage Plans usually have lower premiums but work like HMOs, limiting care from network hospitals and doctors. Both options have deductibles, copayments, and coinsurance, under which you pay a percentage of the bill.
"They look at their lives, they look at their health, they look at their pocketbooks, and they chose the parts they want," Omdahl says.
Those who choose traditional Medicare usually add a Medigap policy, which is a supplemental policy that covers what Medicare doesn't. There are 10 types of Medigap policies, offered by private insurers or groups such as AARP, and costs vary considerably, based on gender, age, health, whether you smoke, your location, and company.
"You can go through your life with just A and B, but the out-of-pocket costs will get you," Omdahl says. The reason is Medicare lacks a maximum for out-of-pocket costs. But with a Medigap policy, most of those costs are covered.
You may enroll in Medicare three months prior to the first month in which you would be eligible for benefits, and for three months after your first month of eligibility. This period is referred to as the "initial enrollment period," according to the Center for Medicare Advocacy.
Enrollment in the first three months of the initial enrollment period will result in coverage beginning on the first day of the first month in which you reach age 65. Enrollment in the month in which you reach age 65 will result in coverage beginning in the following month. Enrollment during one of the three remaining months of the initial enrollment period will result in coverage beginning on the first day of the second month following the month in which the individual enrolls.
In other words, if you reach age 65 in May, coverage begins in May if you enroll through April. If you don’t enroll until May, coverage begins June 1.
Once you’re eligible for Medicare, coverage can’t be denied.
If you continue working beyond age 65 and are covered by your employer's medical plan as an active employee, make sure you understand how that plan coordinates with Medicare.
“The best way to do this is to consult with your HR department or benefits administrator. Many employer-sponsored plans require you to enroll in Medicare Part A but not Part B.,” according to CBS News.
Remember that if you don't sign up for coverage before your 65th birthday, coverage can be delayed, and late penalties may apply. You'll also want to enroll in Medicare Part D before your 65th birthday, unless you're getting coverage from another source. If you delay signing up for Medicare Part B or Part D after you're first eligible, there might be a penalty applied to your premiums.
Medicare doesn’t cover everything. It won't cover cosmetic surgery, healthcare you receive while traveling outside the United States, hearing aids, most hearing exams, long-term care, most eyeglasses, and most dental care and dentures.
Finally, don’t confuse Medicare with Medicaid, as people often do. Medicaid is a state-run program that provides hospital and medical coverage for people with low income and little or no resources. Each state has its own rules about who is eligible and what is covered under Medicaid. Some people qualify for both Medicare and Medicaid.
November 14, 2017
Christopher Nystuen, MD, MBA