Medicare / Your Medicare Advisor

Help! I’m Retiring Soon

retiring

Dear AMAC,

I am getting ready to retire and confused with how to approach the labyrinth of Medicare. I read that there is a penalty for not signing up for Medicare when you turn 65. Well, I’m 70 and I have Part A only, not Part B. I’ve always carried my employer insurance, but I won’t have the option to keep it once I leave. Any advice?

 -Beth (Bel Air, MD)

Hello Beth,

This a great question! With so much information floating around it can be difficult to understand what you should really do next. I know retirement is right around the corner, so let’s analyze your situation.

First, once you turned 65, you were eligible to enroll in Original Medicare (Part A and B) during your Initial Election Period (IEP). Your IEP is a 7-month window that surrounds your 65th birthday, beginning 3 months before and ending 3 months after your birth month. Some people who do not pick up Original Medicare during this time may be penalized and/or must wait until the General Election Period (GEP) to enroll in it. The GEP for those who missed their IEP is January 1st to March 31st of each year. However, beginning in 2023 Social Security may allow some to enroll sooner based on individual circumstances.

Now, if the coverage you carried through your employer was considered credible, you’re not subject to penalties and won’t need to wait longer to pick up Part B. Usually your employer will send out an annual notice that informs you whether the coverage you carry is considered credible. If you do not have this statement, be sure to contact your benefits administrator or Human Resources office.

If your coverage is credible, you can proceed to the next step which would be applying for Part B of Medicare. You can do this by calling Social Security or going online to ssa.gov. You will have an 8-month window following your loss of coverage or retirement date (whichever happens sooner) to apply for Part B. Be sure to keep any notices you receive about your employer coverage because you will have to present Social Security with proof that you were covered from the time you turned 65 until now.

Most people receive Part A premium-free, but Part B does have a standard premium of $170.10. Part A and B are hospital and medical insurance, also known as Original Medicare. There are many things that Original Medicare does not cover like prescriptions, routine dental, vision, etc.

Since Original Medicare does not cover everything, most people pick up either a Medicare Advantage Plan (Part C) or a Medicare Supplement Plan (Medigap) to help lower their out-of-pocket costs. Keep in mind that neither of these options are mandatory to enroll in, and there is no penalty for choosing not to enroll.

However, if you do not pick up prescription coverage (Part D) within 63 days of losing your employer coverage, you may be penalized later or have to wait longer to pick up drug coverage. Drug coverage can be purchased as a stand-alone Prescription Drug Plan, or as part of a Medicare Advantage Plan.

When looking at additional coverage options, many people ask, “What’s better, a Medicare Advantage Plan or a Prescription Drug Plan?” Although this is a valid question, the answer really depends on the person asking the question since everyone’s needs are different. Below you will find a helpful chart to aid you in comparing your options. I hope this helps as you start your journey with Medicare, Beth!

-Your Medicare Advisor

 Medicare Supplement (Medigap)Medicare Advantage (Part C)
How they workWorks with your Original Medicare benefits (Parts A & B)Replaces your Original Medicare benefits (Parts A & B)
EligibilityMust have Medicare Parts A & BMust have Medicare Parts A & B and live in the service area1
EnrollmentMay apply for coverage year-roundHas specific enrollment periods2
UnderwritingSubject to Medical Underwriting3 if applying outside of an Open Enrollment4 Period or Guaranteed Issue period 5 (state specific exceptions may apply)No underwriting requirements
PremiumsOften higher premiums but may have little to no out-of-pocket expenses for Medicare approved servicesOften lower premiums but may have deductibles, copays, and coinsurance for Medicare approved services
NetworkNo network- can see any provider throughout the country that accepts Original MedicareNetwork plans (HMO, PPO, PFFS): the provider must agree to accept the plan unless in an emergency/urgent situation
Insurance cardsUse both your Medicare card and Supplement insurance card for medical services- you will have a separate card for prescriptions (if you purchased Part D)Use only your Medicare Advantage insurance card for medical services and prescriptions (if included in plan).
PortabilityCan be used in any US state or territory. Some plans offer foreign travel emergency benefits for international travelers.Emergencies and urgent services are covered when travelling domestically or internationally (up to plan limits). Routine services may not be covered when travelling
PrescriptionsPrescription drugs are not covered. May purchase a Stand-alone Prescription Drug plan (Part D) at an additional costThese plans can be purchased with or without prescription drug coverage  
Additional BenefitsNot coveredMay offer additional benefits like Dental, Vision, OTC allowance, Hearing, etc.
RenewabilityGuaranteed renewable6 if you pay the premium when duePlans are subject to change each year

1. Service area: A geographic area where the plan accepts members. The plan may limit membership based on where people live.

2. Enrollment period: Defined period of time with a specific start and end date for registering in a plan to receive benefits.

3. Medical Underwriting: A process used by insurance companies to try to figure out your health status when you’re applying for health insurance coverage to determine whether to offer you coverage, and at what price.

4. Open Enrollment Period: This period automatically starts the first month you have Medicare Part B

5. Guaranteed Issue: Rights you have in certain situations when insurance companies must offer you certain Medigap policies.

6. Guaranteed Renewable: Once you are a member, the insurance company can’t cancel your Medigap policy if you pay the premium when due.

If you would like to review specific plan options, the licensed agents at AMAC are happy to assist you. We are licensed with top-rated insurers throughout the country.

Call 1-855-611-4856 or request a quote below!

Get a Quote Here!


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Judy
27 days ago

I did not sign up for Medicard when I retired and now see I should have. When I contacted SS I found out I will have to pay the penalty. That penalty is not a one time thing but monthly and will cost me $400 a month. Is there any way to get this reduced?

Paul Peirce
1 month ago

I will be 63 soon and I am planning to retire soon. Are there any health insurance plans to help cover between 63 and 65?

GTPatriot
3 months ago

Well written response to an excellent question. I am 75 and have been on medicare since 65.
My best suggestion ( and the response covers this well ) is to get what is called Medicare
Supplement ( not advantage) which is referred to in this response as Original Medicare ( parts A and B and C together). It requires a monthly payment but covers all of your part B expense ( doctor fees). Advantage, which is more popular, costs nothing but covers only 20 % of doctor fees. Imagine what your doctor would charge for triple bypass surgery. With Supplemental you also must obtain a part D (drug) plan which should cost $25-$30 per month. Advantage will provide part D in its no charge program so thus is much more popular.
The key point to know is that after your 7 month Original Medicare ( which is Supplemental) open
enrollment period, you cannot get this without passing a physical which will determine your rate.
If you get Supplemental as soon as you quality during the open enrollment period and want to later
change, you can always get Advantage whenever you want with no charge. It takes a lot of
effort to learn what Medicare options are available. Don’t just do what your best friend does.
Find a good broker ( not agent) who sells insurance from a a variety of companies . Don’t deal with someone who sells one company’s service only.

Kim
3 months ago
Reply to  GTPatriot

I agree that an insurance broker licensed to recommend insurance for Medicare is the best way to go. My agent doesn’t charge me anything, and searches for less expensive coverage. I also prefer Original Medicare with supplemental coverage; for anyone facing surgery or expensive medical treatments, this has lower out-of-pocket costs.

When my prescription coverage doubled in price, I asked Mr. K to hunt for a cheaper provider. He found one that charges $7.00/month (2 generic Rx’s) with home delivery. Sometimes you have to ask for home delivery of medications to get the cheaper rate. Picking them up at the grocery store while shopping is much more expensive.

Dan W.
3 months ago
Reply to  Kim

And always ask your pharmacist if they have a discount card that they can use that may be cheaper than your copay from your prescription drug insurance company.

Not too important if your insurance company’s copay on a particular prescription drug happens to be $4 or $5.

However, I’ve had some prescription drugs where my insurance company’s copay was over $100 and by substituting one of the discount cards that the pharmacist had on hand, my charge was reduced by more than 50%.

Kim
3 months ago
Reply to  Dan W.

A couple of years ago, I needed to fill a prescription for an expensive antibiotic because I’m allergic to the cheap ones. Medicare prescription insurance wouldn’t cover more than a little of the $120 bill, so I gave the GoodRx card (came in the mail) to the pharmacist, and he reduced the price to $30.

Editor
Sabrinah Cave
3 months ago
Reply to  Dan W.

Wow Dan that is great to hear! Thank you for the helpful tip.

Editor
Sabrinah Cave
3 months ago
Reply to  Kim

Hello Kim,

You are right, many drug plans offer lower copays if you utilize a mail order pharmacy instead of a retail pharmacy. This option has become more popular in recent years because of its cost savings!

For those reading: If you are comfortable with having your prescriptions mailed to your home, this is definitely something to keep in mind the next time you shop for new coverage.

Our team of licensed Medicare advisors offers assistance in helping our clients find the most suitable plan for the lowest price. Give us a call at 1-855-611-4856 and we can help you with your Medicare needs.

Editor
Sabrinah Cave
3 months ago
Reply to  GTPatriot

Hello GTPatriot,

Thank you for your input! Your advice to learn about the options available is great advice. Like you said, don’t just do what your friend does! Insurance is like a pair of glasses… meaning everyone’s needs are different. For that reason we refrain from endorsing just one plan type.

At AMAC, our goal is to help you understand your options and find a plan that is suitable for your specific needs. We operate as a brokerage and offer Medicare Advantage (Part C), Medicare Supplement (Medigap), and Prescription Drug plans (Part D) from the top carriers in each area. Since specific pricing and copays vary accross the country, we welcome anyone who is interested in shopping around to give us a call at 1-855-611-4856.

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