What does Medicare Part A cover?
Original Medicare covers many essential services including: Part A helps pay for hospital stays and inpatient hospital care. It also covers inpatient mental health care, skilled nursing, hospice care, and some blood transfusions.
What does Medicare Part B cover?
Part B covers doctor and outpatient visits such as physician services, outpatient hospital, ambulance transportation, outpatient mental health, lab services, and durable medical equipment, outpatient physicals, physical and occupational therapy, speech therapy and some preventive care.
What does Medicare Part C cover?
Part C of Medicare is called Medicare Advantage. Because Original Medicare has deductibles and coinsurance with no protection against out-of-pocket costs, most people agree they need additional coverage beyond what Parts A and B offer. Medicare Advantage (or Part C of Medicare) is one way to get that additional coverage. Medicare Advantage Plans, like Prescription Drug Plans, are managed by Private Insurance Carriers who have contracts with Medicare. Medicare Advantage Plans bundle Parts A and B of Medicare. They must cover everything Original Medicare covers at least as well as Original Medicare. Sometimes they offer more coverage and more benefits than Original Medicare. For instance, Original Medicare does not cover Dental, Vision, or Hearing; and most Medicare Advantage Plans do. Medicare Advantage Plans often have $0 premiums and include Prescription Drug Coverage. In order to qualify for Medicare Advantage, you must continue to pay your Part B premiums.
What does Medicare Part D cover?
Part D covers Prescription Drugs and is provided by Private Insurance companies who have contracts with Medicare. It is important to enroll in Part D upon qualifying for Medicare to ensure that you do not receive a Late Enrollment Penalty later. Because Part D is offered through Private companies, the cost and coverage will vary from plan to plan. So, it is important to research different Part D plans to make sure you find the best fit to cover the medications you need. It is also important to review drug coverage each year because drug formularies, plan designs, and premiums change year to year. How you receive your drug coverage will depend on if you choose Original Medicare with a Medigap plan or opt for a Medicare Advantage Plan (Part C of Medicare).
What are Medigap Plans?
Another way to get necessary additional coverage is to purchase a Medicare Supplement (also called Medigap) plan. These plans are called Medigaps because they help fill the gaps in Original Medicare that are your deductibles, copays and coinsurance. These plans are offered by Medicare approved Private Companies. Medicare Supplements come in standardized plan designs A-N. To be eligible for a Medicare Supplement (Medigap) plan, you must be enrolled in Parts A and B and reside in the state in which you purchase the plan. In general, you must be at least 65 to qualify for this type of coverage.
What happens when I turn 65?
Most Americans who are 65 and older qualify for Medicare. If you are already enrolled in Social Security, you will be automatically enrolled in Part A and B to be effective the first of your birthday month. In this case, you should receive a Medicare Card in the mail about 3 months before your 65th birthday. Part A (Hospital Coverage) is free for most people. Part B (Outpatient Coverage) has a monthly premium. In 2021, the standard Part B Premium is $148.50 per month, which is usually taken out of your social security check. Because there is a premium for Part B, it is optional coverage. However, if you decline Part B, without having creditable coverage in place, you can be charged significant penalties if you choose to enroll in it later.
What if I’m turning 65 and not retiring yet?
If you are not taking Social Security yet; you will have to actively enroll in Medicare. It is best to do this starting 3 months before your 65th birthday. Social Security recommends first going on-line to ssa.gov to create a My Social Security Account. https://www.youtube.com/watch?v=xxLG6l4tvlA You can then click on the button to Apply for Medicare Only. You can also always call your Social Security Office to make a telephone or face to face appointment.
When do I apply for Medicare if I am not receiving Social Security?
Your Initial Enrollment Period (IEP) begins 3 months before the month you turn 65, includes your birthday month, and ends 3 months after your birthday month.
If you sign up for Part A and/or Part B within the first 3 months of your IEP, your coverage begins the first of your birthday month. If your birthday is on the first day of the month, your coverage will begin on the first of the prior month.
It is usually best to enroll within the first 3 months of your IEP, before your 65th birthday; because if you enroll in your birthday month or within the last 3 months of your IEP, your Part B coverage date will be delayed.
When do most people enroll in Medicare?
Most people take Part A when eligible because it is free. However, if you are contributing to an HSA (Health Savings Account) at work, it is important to know you cannot have an HSA and Medicare at the same time. So- if you want to continue your HSA, you will not want to enroll in Part A. It is also important to know that if you delay Part A, it will be effective six months retroactive to your eventual start date. You will want to discontinue your HSA at least 6 months before you start Part A to avoid tax consequences.
Many people who are still working, often decide to delay their Part B until later.
If you work for a company with at least 20 employees; and continue to maintain creditable Employer Health Coverage or have creditable coverage somewhere else (such as through your spouse’s work)- that is fine! You will be granted a Special Election Period (called loss of Employer Coverage) to enroll in Part B when you are ready. Sometimes people opt for Medicare when they turn 65 even if they are not retiring, because it might cost them less and cover more. This is fine too! You do not have to be officially retired to take advantage of your Medicare. It is important to compare all your options to make the best-informed decisions for yourself!
If you are under 65, you still may qualify for full Medicare benefits if:
- You are entitled to Social Security Disability benefits for at least 24 months (can be nonconsecutive)
- You receive a disability pension from the Railroad Retirement Board and meet certain conditions
- You have ALS (amyotrophic lateral sclerosis), also called Lou Gehrig’s disease
- You have End-Stage Renal Disease (ESRD)
If you are under 65, on Disability and transitioning to Medicare from a Marketplace Plan or Expanded Medicaid, we will help make sure you get a plan that has your doctors, specialists, hospital networks, and prescriptions covered! We will also review your eligibility and help you apply for Extra Help with Prescriptions and Medicare Savings Programs! We specialize in helping you get your Part B Premium paid and getting you Patient Assistance Programs to help make your Healthcare more affordable beyond Medicare. Our Medicare Advisors can help you navigate your transition from Medicaid or Marketplace Plan to make sure you have all the information you need to protect yourself from out-of-pocket costs such as Part B premiums, Network changes, Prescription Drug costs, and more.
What are the Medicare Plan choices?
As Independent Insurance Brokers, contracted with all major carriers in Ohio; Senior Benefit Advantage offers you unbiased advice about your Medicare options. We strive to serve you beyond your Medicare plan to offer ongoing assistance and support when you need us throughout the year. We also make sure you are armed with the information you need to make the best- informed choices at renewal time each year. We are compensated by insurance carriers, so our services are always free to our clients!
When do I enroll in a plan?
You can enroll within 3 months before your Medicare is first effective, or within 3 months after it is effective. This is called your Initial Enrollment Period. If you are older than 65 and losing coverage through work, you can enroll during a special enrollment period for loss of employer coverage. Your plan will be effective the first of the month after you enroll.
Note: If you are under 65 and qualify for Medicare- You can enroll in a Medicare Advantage Plan or continue Original Medicare with a Prescription Drug Plan. Once you are turning 65, you can decide to enroll in a Medigap plan with no health questions, or you can continue to be enrolled in Medicare Advantage. You always have the right to return to Original Medicare with a Prescription Drug Plan.
Note: Those who are turning 65 are in their Open Enrollment for a Medigap plan. This means you are guaranteed acceptance in the available plan of your choice with no health questions. Those who are enrolling in Part B after 65 because of losing Employer Coverage, are in their Guaranteed Issue Enrollment Period for a Medigap Plan with no health questions. The Open Enrollment and Guaranteed Issue periods start the month Part B is effective and last for 6 months.