Thousands of Americans turn 65 every week. We’re delighted to help hundreds of them get their Medicare health insurance. It’s not easy. Even the most educated have questions about the national health insurance for people 65-and-over called Medicare. To understand why you may need help, just look at the answers to 3 very simple questions.
1.Will I automatically be enrolled in Medicare?
If you are already collecting Social Security benefits, you will automatically be enrolled in Medicare
Part A (covers hospitalization) and Part B (covers doctor visits and other outpatient services).
BUT whether you must do that when you turn 65 depends on what kind of health insurance you have when you turn 65. If you’re still working for a company with 20 or more employees and have employment- based insurance – or if you’re covered by your spouse’s policy – you have what’s called “credible coverage” and you probably can wait.
BUT if you have a retiree insurance plan or COBRA, or if you’re enrolled in an Affordable Care Act plan, you will need to enroll in Part B by the end of the third month following your 65th birthday. If you don’t, you’ll be subject to a late-enrollment penalty for as long as you’re on Medicare. Go to ssa.gov./medicare to enroll.
AND you’ll have to sign up for Part D (covers prescriptions) in that same time period or be subject to a late-enrollment penalty for as long as you’re on Medicare. You don’t sign up for Part D through the government. You’ll need to go to a private insurer to get a plan that fits your prescriptions and where you get them filled.
2.What does Medicare cover?
There is a host of codes for Medicare Part A (in-hospital care) or Part B (out-of-hospital care) that are used by doctors who accept Medicare everywhere in the country. They create a Plan of Care” using these codes to have Medicare pay for your care. This coverage has stayed pretty stable over the years. Called “Original Medicare” it doesn’t cover hearing aids. Not all plans offer dental or vision benefits. Remember, you’ll need a separate plan, Part D, to cover your prescriptions.
BUT there is a Medicare Part C called Medicare Advantage. It is bought through private insurance companies. Advantage plan packages can cover A and B and D and hearing aids, dental, vision, health club discounts and other perks. However, the network of doctors and hospitals you can use are controlled by the insurance company and the plan you have. You may not be able to use them everywhere. These plans and their benefits can change from year to year.
3.What does Medicare cost?
Like all insurance, Medicare has premiums. Most people have paid into Medicare through their wage or self-employment taxes. This pays premiums for Part A.
BUT Part B monthly premium will automatically be deducted from your Social Security, or, if you’re not taking SS yet, you will arrange to pay it to the government when you sign up. The usual premium is $148.50/month.
BUT if the income you reported on your last federal tax filing is above the average set, you may pay more for your Part B. Your age may also be a factor.
PLUS like all insurance, Medicare Parts A, B and D have deductibles depending on the plan you choose.
PLUS after you meet your deductible, Parts A and B pay 80% of the approved charges. That leaves you with 20% of the bill to pay. Unlike Under-65 Affordable Care Act plans, there is no Maximum Out of Pocket. You will always be paying 20% of the bill.
BUT most people buy a Medicare Supplement. (Also called Medi-gap). When you give your doctor or hospital your Medicare Supplement card along with your Medicare card, they automatically file claims with both to have the balances paid. Medicare Supplements are bought through private insurance companies. Their cost depends on the company and the Supplement.
Anyone turning 65 will be getting tons of advertising by mail, email and phone. It’s important to have a trusted advisor to get all the benefits you’re entitled to and to avoid penalties. That’s why we give the same advice to the over 65-ers that we give the under 65-ers. Don’t do this alone. Don’t do this online. Call us. Our services are free. We have the expertise. We’ll be with you every step of the way. Medicare is a wonderful thing when done right. Just call us – or have someone you care about call us – at 847-362-8888.