Learn beneficial information about this government health insurance that includes inpatient, outpatient, and prescription drug coverage for older individuals.
Why do people need Medicare?
Medicare is a federal health insurance program in the United States for people aged 65 and older, or for younger people with qualifying disabilities.
Medicare provides health and financial security to citizens of older age and those with disabilities. It is a government run healthcare program that helps folks cope with the rising costs of healthcare and live well as they age.
Parts of Medicare:
Original Medicare
Traditional Medicare, known as Original Medicare, has two main parts, A and B. Part A covers inpatient hospital stays, skilled nursing facility care, some home health care, and hospice care. Part B generally covers doctor’s visits and other outpatient care, preventative services, and durable medical equipment like wheelchairs and walkers. Neither Part A nor Part B cover everything, so it is important to understand your additional coverage options.
What is a Medigap?
A Medigap policy is supplemental insurance sold by private companies to help cover Original Medicare costs for expenses like deductibles, copayments, and coinsurance and is often worthwhile. Although Medigaps do not cover medications, beneficiaries can choose to enroll in a separate, stand-alone Prescription Drug Plan, also known as Medicare Part D. It is essentially secondary insurance that people can buy to “fill the gaps,” hence the name, Medigap.
Medicare Advantage (Part C)
Medicare Advantage plans, also known as Medicare Part C, are offered by private insurance companies and are Medicare approved. They replace Original Medicare and cover things that would be covered by Part A, B, and frequently Part D. Medicare Advantage may include additional benefits like vision, hearing, dental and other health perks. Medicare Advantage plans may have rules about which doctors and hospitals prescribers you can use, and costs vary from plan to plan.
Is Medicare enrollment mandatory?
Medicare enrollment is not mandatory. Some choose to bypass it altogether if they already have creditable coverage that suits their needs. Others may decide to delay enrollment, for instance, if they continue to work and remain on an employer health plan until retirement. Bear in mind that penalties for postponing enrollment may be incurred. Read on to learn why.
Why do penalties exist for signing up late?
Like other insurance programs, Medicare relies on a pool of healthy and unhealthy people to support the program. Essentially, they don’t want people to wait until they are sick to sign up and stress the system. Late enrollment penalties (LEP) not only encourage timely enrollment in Medicare to build a secure funding base, but it also supports fairness among beneficiaries.
Medigaps and Medicare Part C are optional—you won’t be fined for not having them. There are different Late enrollment penalties (LEP) if you delay in enrollment in parts A, B, and D, and do not have creditable coverage in the meantime.
Get advice
Consult a licensed insurance agent if you’re thinking about declining Medicare altogether. Part A is premium-free for most people and doesn’t cost anything if not used. Part B has a standard monthly premium, but it can be higher depending on your income. Turning down Part A and B benefits is possible, but this means that people can no longer receive Social Security or RRB benefits.
How to sign up for Medicare
Some people get Medicare automatically and others must sign up (depending upon when one starts to get retirement and disability benefits). People can apply for Medicare online, by phone, or in person at a Social Security office when they are eligible. One common misconception is that people must sign up exactly on their birthday.
Truthfully, when you turn 65, you enter an initial enrollment period (IEP). This offers a 7-month window around the month of your 65th birthday (3 months before, the month of, and 3 months after) in which to sign up. If you miss the initial enrollment period, you may have to wait to sign up and possibly encounter some penalties.
What is the Annual Enrollment Period?
The Medicare Annual Enrollment period (AEP) allows people to change their existing coverage to meet needs for the upcoming year. AEP happens annually from October 15 to December 7, and enrollment changes go into effect on January 1.
Note: It is wise for people to review plans annually and consider factors such as plan costs, what’s covered, and providers.
What is the General Enrollment Period (GEP)?
The General Enrollment Period, or GEP, takes place from January 1 to March 31. It allows a person to enroll in Part A and Part B if they didn’t do so when first eligible. One must generally be enrolled in Plan A and B to get Medicare Advantage.
What are Special Enrollment Periods?
The Medicare special enrollment period (SEP) allows people to make changes to their Medicare plans outside of the Annual Enrollment Period due to special circumstances. Qualifying life events, such as moving out of a plan’s service area, may prompt the necessity for change in coverage.
Is AMAC a dependable Medicare resource?
AMAC’s Medicare Advisory Service provides guidance and support to its members in navigating the complexities of Medicare coverage. AMAC provides one-on-one assistance from licensed and certified insurance professionals who are knowledgeable about Medicare plans. AMAC Medicare helps members compare plans options, including Medicare Advantage and Medicare Supplement (Medigap) plans, and understand the benefits and costs associated with each to make the best choice.
Disclosure: This article is purely informational and is subject to change. For professional advice, consult a Medicare advisor.
I’m 76 years old, I worked until I was 70,. I enrolled in Medicare A & B at 65, took my social security at 70 and retired. So now it’s six years after I retired and I’m still paying the same higher amount for part B. Why?