John has a list of New Year’s resolutions for 2018 including how to celebrate his 65th birthday. John considered adding “sign up for Medicare” to his resolution list, but with the conflicting healthcare plan information flooding the news and what he’s been reading on the internet, John isn’t really clear about his Medicare eligibility, what plan he should enroll in, or what it means for his current healthcare plan.
Like many people nearing 65, or for those getting ready for retirement, the Medicare system can seem overwhelming, so let’s simplify the information.
What is Medicare?
Medicare Part A is hospital insurance which covers hospitalization, skilled nursing facilities, hospice care and some home health care.
Medicare Part B is medical insurance which covers certain doctor’s services, outpatient care, medical supplies, and preventive services. Both are part of the Original Medicare Plan which is managed by the federal government.
Medicare Part C, the Medicare Advantage Plan, is a privately managed plan, found through an HMO or PPO provider.
Medicare Part D is a prescription drug plan.
Who is in charge of the Medicare program?
Medicare is managed by the Centers for Medicare & Medicaid Services. The Social Security Administration works with CMS helping to enroll participants. Once enrolled in Medicare, you will have an opportunity to review your coverage and/or change plans annually.
Who is eligible for Medicare?
Medicare eligibility includes people who are 65, or less than four months from their 65th birthday. Additionally, people under age 65 who have a disability, ALS or End-Stage Renal Disease are also eligible.
When should a person enroll?
A person can enroll when they are almost 65 years of age or preparing to retire. While some people are automatically enrolled in Medicare, most people must enroll themselves. There is an initial Medicare enrollment period of seven months the first time you enroll, which begins three months before you turn 65, your 65th birthday month and the three months after your birthday. If enrollment does not take place during this period a penalty may be assessed for Part B coverage and a gap in coverage may result.
Should I get Medicare if I already have health insurance?
Medicare.gov advises that a person reaching their 65th birthday should enroll in Part A Medicare even if they have health insurance from an employer or other source. Most likely Medicare taxes have been paid while you worked, so a Part A premium would not need to be paid directly. Depending on the type of medical insurance you have, postponing Medicare enrollment in Part B is an option, as everyone must pay a premium for Part B regardless of Medicare tax history.
Medicare works with other insurance coverage, like employer, veteran or union plans. There are varied costs associated with Medicare plans including fees for premiums, co-pays, and prescription drugs, depending upon income, plan selection, supplemental insurance, and healthcare provider acceptance.
What to consider when choosing coverage
Medicare.gov advises that one evaluate the following when choosing a Medicare plan:
- Compare the costs associated with Medicare vs Medicare Advantage for premiums, deductibles and other costs.
- Compare how well each Medicare plan covers the services you need or expect to need.
- Understand how each Medicare plan may work with any other coverage you have.
- Evaluate your prescription drugs needs and how, or if, they are covered in the plans. Consider supplemental drug coverage.
- Evaluate the doctors and hospitals covered in the plans to see if the provider that you want to use are included.
- Read the ratings and reviews of the plans that you are considering for satisfaction and quality of care.
- If you travel, make sure the plans you select include travel coverage for both other states and outside the US.
Long Term Care and Medicare
Medicare does not cover long term care costs that are considered custodial care or, activities of daily living, found in home care, assisted living and nursing homes. Medicare Part A does cover skilled nursing care under certain conditions for a limited time in a ‘skilled nursing’ facility and ‘eligible’ home health care, hospice and respite care. Resources and more information about long term care services, supplemental insurance and care by state, can be found at the Administration on Aging, www.longtermcare.gov.
How to Get Started with Medicare Enrollment
When turning 65 or planning for your retirement, prepare for your health care and long term care needs as well.
Medicare.gov notes that, “You can get personalized health insurance counseling at no cost to you from your local State Health Insurance Assistance Program (SHIP).” Visit Medicare.gov to learn more about Medicare and your Medicare choices.
If you are considering a move to a senior living community like Green Hill, you can make an appointment to learn more about how Medicare is utilized along with supplemental insurance plans to provide the medical care you may need as you age while providing a safe, nurturing and welcoming aging environment. Visit www.green-hill.com for more information.
This article is for informational purposes only and not intended to be a substitute for professional medical advice. Always seek the advice of your physician regarding a medical condition or treatment and before undertaking a new health care regimen.