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Here’s some good news: if you’re turning 65 soon, you’ll also be eligible to join Medicare—a federally funded program that provides hospital and medical insurance to older Americans. Transitioning to Medicare for the first time can be confusing and you’re not alone if you have a few questions. Here’s a great resource to get you started—important tips and things to think about as you plan for Medicare coverage.
Enrollment In Medicare Is Automatic
If you’re worried about how to sign up for Medicare before your birthday, don’t be. For most seniors, enrollment in Original Medicare (Part A and Part B) is automatic. As long as you receive Social Security or Railroad Retirement benefits, you don’t need to do anything at all and your Medicare card will be sent to you by mail.
Expect to receive your card 3 months before you turn 65, with benefits beginning on the first day of your birthday month. If you do not receive retirement benefits, you may need to enroll in Medicare manually through the Social Security Administration or Railroad Retirement Board.
Accepting or Opting Out of Part B
While Part A (hospital insurance) is free for most people, Part B (medical insurance) is not. A monthly premium will be deducted from your Social Security check each month. In 2020, the standard Part B premium is $144.60 (or higher depending on income).
If you are still working, covered through an employer or a spouse’s employer, you do not need to keep Part B coverage or pay for it. You can choose to opt-out of Part B coverage on the back of your membership card.
Important tip: If you opt-out of Part B coverage, and do not have comparable coverage through an employer or spouse, you may end up paying a late enrollment penalty when you decide to join.
Initial Enrollment Period
When you first become eligible for Medicare, you enter what is called your Initial Enrollment Period. This is a 7-month period of time beginning 3 months before your birthday month, and extending 3 months after your birthday month. For example, if you were born in July, your Initial Enrollment Period would be April 1 through October 31. This is the time to enroll in Medicare (for those not enrolled automatically) or enhance coverage with additional benefits.
Important tip: If you’re looking to add additional coverage to Original Medicare, your Initial Enrollment Period is the time to do it. If you delay, you may have to wait until the General Enrollment Period (Jan 1-Mar 31) of the following year and may also be charged a late enrollment penalty.
Adding Benefits to Original Medicare
Original Medicare covers much of your health care needs, but it doesn’t cover everything. It’s up to you to decide if you want to enhance coverage with extra benefits and how. Understanding your options will make it easier to choose the perfect complement to your Medicare coverage.
There are only two ways to receive Medicare: through Original Medicare or through Medicare Advantage (Part C). Original Medicare provides Part A and Part B. Medicare Advantage Provides Part A, Part B, and additional benefits. Medicare Supplement Insurance and Prescription Drug coverage (Part D) may be added to Original Medicare for additional benefits.
- Medicare Supplement – Helps pay the out-of-pocket expenses associated with Medicare, like deductibles, coinsurance, and copays. While there are no benefits for dental, vision, or prescription drugs, some plans provide coverage while traveling outside of the country. You are responsible for paying a monthly premium for coverage as well as your Part B premium.
- Medicare Advantage – Part C extends Original Medicare by delivering all of your Part A, Part B and additional benefits from one plan. Dental, vision and prescription drugs are often covered. If you join a Medicare Advantage plan, you’re still enrolled in Medicare, you simply enhance coverage with extra benefits. You are responsible for paying a monthly premium for Medicare Advantage as well as your Part B premium.
- Prescription Drug Coverage – Part D Original Medicare does not include benefits for prescription drugs. If you wish to add coverage, there are only two ways to do it: join a standalone Part D plan, or join a Medicare Advantage plan that already includes prescription drug benefits.
Important tip: you cannot combine Medicare Supplement and Medicare Advantage benefits. If you’re looking to extend benefits beyond Original Medicare, you need to decide which makes the most sense for your specific needs—extra medical benefits or help with expenses.
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Last week, the Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2022 Medicare Part D income-related monthly adjustment amounts.
It seems that nothing ever changes when it comes to hawking insurance to fill the gaps in Medicare coverage for seniors. The fervent sales pitches, the misinformation and the incomplete and deceptive information continue to proliferate. The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. 15 and runs through Dec. 7.