** October 15th starts the Annual enrollment period for Medicare, the following is an updated reprint of this article originally from 2015.
For help with Medicare advantage, Medigap and Prescription drug plans click HERE
You’ve reached that magical age of 65, Congratulations, you are now Medicare eligible.
But, where to start?? It can be one of the most confusing and consequential choices folks make in their retirements. It may be the only time that you have certain guarantees of coverage choices, so your choice needs to be informed.
Do you still have coverage at work? You need to contact the Center for Medicare. And don’t forget to ask HR if your prescription drug coverage is creditable; you don’t want penalties in the future. What about the alphabet soup of Medicare letters… Parts A, B, C & D? and what about those letters in the Medigap supplement universe that go further up into the alphabet?
ITS ALL SO OVERWHELMING!!! WHAT DOES IT ALL MEAN???
If you’re confused, you are not alone.
And now that it is October, Medicare is all over television, as we are enter the perennial enrollment period for something called Medicare advantage plans & prescription drug coverage.
So let’s try to break it down into a ten point primer…
- Generally at age 65, you are eligible to enroll in original Medicare. Some people who receive social security disability benefits for more than two years are also eligible.
- Medicare Part A covers Hospital inpatient care, skilled nursing facility care, home health care, hospice care, and blood. For most people who have a work history or have a spouse that worked, there is no premium for Part A.
- Medicare part B covers doctors services, outpatient services, diagnostic, preventative services and other care. There is a premium for Part B; for most people it is $134 for 2018. It can be more for people with higher incomes.
- Having only “Original” Medicare A & B coverage leaves a lot of holes in your coverage. For instance Part A has a deductible of $1,340 in 2018 for the first 60 days in hospital, after that it gets even more expensive.
- Part B also has a $183 deductible for 2018, and leaves you responsible for 20% or more coinsurance for most covered services on top of that. There is no maximum out of pocket and no coverage for prescription drugs.
- So how do you fill the gaps? You can look to a either a Medigap supplement or a Medicare Advantage Either way, you still need to pay your part B premium.
- A Medigap supplement is insurance coverage offered from private insurance companies. They supplement parts A & B; A.K.A. – fill in some of the ‘Gaps’. They range from Policies A, B, C, D, F, G, J, K, L, M, and N! F & G are the most comprehensive, where you would be well covered for most medically necessary services. Medigap supplements also are accepted by any doctor or facility that accepts original Medicare; so no doctor networks.
- Soooooo……why wouldn’t you buy a comprehensive supplement like F, and be done? Because they are usually more expensive than a Medicare advantage Depending on where you live and what your age is, you may pay far more for a supplement than for aMedicare advantage plan. In addition, new supplements don’t offer drug coverage, which is an additional cost, while many advantage plans have them built in.
- Which brings us to Medicare part C, the above mentioned Medicare advantage These plans take the place of original Medicare parts A & B, and generally work like the private insurance you may be used to if you had an individual or work policy. Most plans are HMOs or PPO like plans, meaning you have a network of providers and facilities and often have co-pays. The premiums are often less expensive than supplements, with some plans have a zero monthly premium. In addition many plans have the prescription drug benefit built in. Some include extra benefits like Dental, vision, hearing aids and other wellness extras. Also, for some low income folks, they may be able to get assistance with premiums and copays.
- And what is part D? That’s the one most people know, and those are prescription drug plans.
As you can see, even this short primer about Medicare only scratches the surface. There are many pitfalls to avoid, and planning at the beginning of your initial eligibility will give you time to make a sound decision..
Trying to navigate this government benefit can be nerve racking… Don’t be afraid to ask for help! (You can even contact us HERE for help at no cost), or search for Medicare policies in your area HERE
