How good are you at solving mazes? They can be really difficult for me at times. There are people that find it difficult to figure out their Medicare decisions. It is like a maze to them. If they make the wrong choice, they can get lost and confused. I’m here to help you in solving the Medicare maze.
Three to six months prior to your 65th birthday you will receive a book from the Department of Health & Human Services, entitled “Medicare and You.” It says “the official U.S. Government Medicare handbook” at the very top. This is the most comprehensive information you will receive. It could be the only book you will need to read. You do not have to read every word, but it’s a great resource for clarifying things. Keep this book until you have made your decisions and maybe for the rest of your life in case you want to make changes in the future.
You should also receive your Medicare card from CMS – Centers for Medicare & Medicaid Services. It should be in the same envelope as Medicare & You. It is a 5 1/2 x 8 1/2 piece of heavy-weight paper. This is your actual Medicare card. If you want Part B, you keep this card, cutting or tearing it out of that paper. Put it in your wallet. You only need it when you get medical services, so you can choose to carry it for medical appointments only. But then you need to remember to take it with you every time you have an appointment. Likely, you won’t have it in an emergency. However, your insurance plan may send you a card to use that will be plastic, like a credit card. If you do not want part B you would follow the directions and return the entire card back to Western Program Service Center. They will send you a new card.
Watch your mailbox
You may not be thinking about signing up for Medicare, but you will get a lot of reminders. Nearly every insurance company you have heard of, and some you haven’t heard of, will send you information about their plan. Some of the envelopes will say “Important benefit information enclosed,” or “Medicare initial election update,” “Return reply enclosed,” or “an important Medicare decision is fast approaching.” The companies almost make it sound like they are the company you need to choose. And many of the companies will send you multiple requests for you to pick their insurance for Medicare. Do not be fooled by them sending you the application to complete and return. They want your business, but that doesn’t mean they are the best choice for you.
Signing up
When you’re deciding about Medicare, keep in mind that this is an important decision that you can only change once a year from October 15 until December 7. So please take some time to go through the Medicare & You book to help you understand your choices. You may already have your health insurance with a company that you really like and you are determined to stay with them. That was the case with my husband and me. Since I have a history of having a brain tumor removed, I wanted my same neurologist to operate if needed. My tumor could need removal again if the small amount they were unable to remove, were to increase in size.
Your initial coverage will start on the first of the month, of your birth month. However, there is an exception. If your birthday is on the first of the month, your Medicare will start a month earlier. So as an example, if you were born on May 1, your coverage would start on April 1. My husband had that situation and no one explained it to us, so I finally called to find out why he started a month earlier, and I did not. Your sign-up period starts three months before your birthday, the month of your birthday, and three months following your birthday. So that equals a seven-month sign-up period If you fail to sign up for Medicare on time you may be assessed penalties.
Changing your plan
Your coverage will continue until you make a change. October 1 is when Medicare would like you to start comparing the coverage you originally picked with other plans. You may compare other plans and decide to switch from what you initially picked. You can make that change from the 15th of October until the 7th of December.
Original Medicare Part A
Basically, there are two main choices to get Medicare. There is the Original Medicare and Medicare Advantage.
Original Medicare includes Part A & B. Part A is coverage for hospital care. Part B covers medical appointments. You are not required to sign up for Part B, except as noted below. There is usually no cost for Part A. The cost for Part B is $148.50 in 2021. It increases slightly each year. And depending on your income level, the cost could be higher.
Keep in mind that Part A is free, but it only covers hospital costs. These are limited to the hospital room and meals, and prescription drugs received at the hospital. It also pays for general nursing at the hospital, hospice care and skilled nursing facility care (not long-term care), and limited home health care. You can find a list of everything covered in your Medicare and You book. (pages 26-29 in the 2021 book.) There are some limitations on these items. And there are copayments with part A. You become eligible for Part A when you are over 65 and qualify for retirement benefits from Social Security or the Railroad Retirement Board. If you did not pay toward Medicare through payroll deductions, it can be purchased.
Original Medicare part B
Part B can only be purchased if you have Part A. Part B covers doctor visits, an annual physical exam, physical, occupational, and speech therapy, breast cancer screening, cardiac rehabilitation, colorectal cancer screening, chemotherapy, diabetes screening, emergency department services, kidney dialysis service and supplies, Flu, Hepatitis B and Pneumococcal shots. And many more items that at listed in your Medicare and You book. (see pages 29-52 in the 2021 book.)
If you need/want both medical and hospitalization insurance you will need both Part A and Part B.
If you are still working at age 65 you can sign up for Part A only and add Part B once you no longer have your employer’s health insurance coverage.
Medicare Advantage
If you do not sign up for Part B, you cannot sign up for Part C or Part D.
Part C usually covers prescription drugs, basic dental, routine vision, hearing exams, and hearing aids. Some insurance companies also have possible gym memberships and fitness programs. I stress usually since it depends on the insurance company you choose for your coverage.
Part D is for prescriptions only. Some companies include prescriptions in Part C as part of Medicare Advantage, but not all do. So it is best to check if your Part C will cover prescriptions, or you may need to add Part D if you need prescription coverage.
Choices
It was important to me to have coverage on both hospital and doctor visits so I purchased part B. I added part C to receive the prescription, dental, vision, and hearing coverage. It is very likely your cost will be different but my cost for Part C coverage is $31 a month.
Which Parts are best for you?
- Think about your current and possible future needs. If you have cancer you may want to add Part B and possibly Part C.
- Prescriptions are a choice you need to make. If you don’t use any, you may not want to pay extra for coverage. Even if you have the coverage you may still have a copay due on the prescriptions you purchase. It depends on if it’s name brand, generic, etc.
- Dental, hearing, and vision are optional. Depending on your past history you may want to add these. They only cover some expenses, not everything.
- Another consideration is your income. Can you afford the premiums each month? Check around because there may be a health insurance company out there that can save you money.
- If you see the doctor often, Part B could be a must-have for you to save money overall.
- Beyond the Parts of Medicare you desire, look into several different insurance companies to see if they have any savings available to you.
- Check to see if the prescription drugs you need are covered by the medical insurance provider you choose.
- If you are currently being treated for a long-term illness and do not want to switch doctors you may need to stay with your current health insurance provider.
And then there is Medigap
There is one more thing, that is available to you. It is Medicare Supplement Insurance also known as Medigap. Not every medical cost is covered by Medicare. One example is medical care when you travel to another country. Medicare will cover nothing. If you are out of the country often, this may be something you will want to consider. The plans that cover foreign travel only cover 80%. There are several different Medigap plans, lettered A-D, F, G, K-N. These will pay a portion, up to the full amount, of deductibles and copayments, depending on the plan letter. Some only cover a few items of your care like blood costs, hospice, and Part B items.
Medigap insurance is purchased from a private insurance company, not from Medicare. It is possible to purchase it from the same company you purchase your other parts from, but they may require a separate check. In order to purchase Medigap insurance, you must have Part A and Part B of Medicare. If you want to read more about Medigap, the Medicare and You book for 2021 covers it on pages 71-71. If you have a newer version of Medicare and You, your pages may be different, but I am trying to give you an estimated page location.
More important information
When you are making your decision, be sure to make the right decision for you. Don’t be persuaded to go with the choice that your neighbor or uncle picked. Research your options.
Depending on the company you pick for your Medicare policy, you may apply online, by phone, or through the mail. You will be notified by the insurance company and social security since any premiums will be taken from your social security if you have started taking it already. It’s possible any extra premiums, besides Part A & B, may be paid directly to your insurance company. It depends on how everything is set up.
Your costs for all Parts will be determined by the insurance company you pick. Part B could be less money or even free. Be sure to check all costs before you make your final decision.
Happy 65th birthday
When you celebrate your 65th birthday you most likely will have figured out your plan for Medicare. If not you do not need to panic, because you are given extra months to sign up. On my 65th birthday, I received approximately 50 phone calls from people saying I had signed up for information about my health care. I had not. I quit answering after the first few calls. If I didn’t answer, they would not leave a message, instead, they would call back in 5 minutes. Why were they trying to ruin my birthday by continuously calling me on my cell phone? I finally set my phone to not ring if it was not someone in my list of contacts. On your birthday, it’s nice to know that you have already made your decision and you can safely ignore those calls.
Are you approaching the time to sign up for Medicare? I hope this information helps you to better understand the process. Is there anything I missed that you would have liked me to explain? If you have a question or comment let me know in the reply section below. And I wish you a very Happy Birthday when your 65th birthday arrives.
