For many of us, as we approach retirement or age 65 we begin to think about Medicare. Many people just aren’t sure where to get started and are unsure of where to turn for help. This post is a resource to help with the basics and some common questions. For more detailed questions or additional help at no cost, you can talk to a trusted licensed insurance agent or broker or your local State Health Insurance Assistance Program (SHIP) office. Medicare can also be contacted by
phone 1-800-MEDICARE (1-800-633-4227) or online at Medicare.gov. You should be wary of any phone calls you receive about Medicare and even advertisements on tv, in the mail and online. Despite many rules, ads and calls can be aggressive and
sometimes misleading.
I am turning 65 this year, what should I do about insurance?
Most people decide to sign up for Medicare when they turn 65 unless they prefer to continue using their employer sponsored health plan if they are still working. Some employers require you to switch to Medicare when you are eligible, consult your HR department for more information, including when employer coverage might end.
I have decided to sign up for Medicare, how do I do that?
You can contact Social Security up to 3 months before you turn 65 (and no later than 3 months after your birthday) and make an appointment in the office or call 1-800-772-1213 or go online ssa.gov/benefits/medicare. Some people will automatically get Part A and Part B if they are already getting benefits from Social Security or the Railroad Retirement Board (RRB) or are under 65 and have a disability.
What is Part A? Part B? Part C? Part D?
Parts A and B are considered Original Medicare. Part A is basically hospital coverage and most people do not have to pay
for Part A, Part B is basically your non-hospital medical services and essentially you pay a deductible and then 20% of the costs, the standard monthly premium for 2023 is $164.90 but you may pay more if your income is above certain amounts. Part
C is also called Medicare Advantage or an All-in-one plan, these include parts A & B and usually Part D which is your prescription drug coverage. Essentially, Part C is a private company’s version of Medicare, each plan is required to cover at least everything Medicare does or more and can also include extras like dental, vision, hearing, fitness membership, over the counter allowance for things like vitamins and bandages, transportation, and more. These plans are often advertised on tv and mailings. If you have an Advantage plan you continue to pay your Part B premium to Medicare and you can choose how to pay the premium for the Advantage plan if there is one (many are $0 premium). Many of these plans do not have a deductible,
you pay set copays and there is a maximum out of pocket amount which is the most you pay in a calendar year for copays and coinsurance. If you do not sign up for Part B and Part D when you are first eligible, you may have to pay late enrollment fees
every month as long as you have Medicare. If the delay in enrollment is because you had coverage through your employer you may not have the penalty.
And those other plans like G and N?
Those other letter plans like F, G, and N are Medicare Supplement Plans which help to pay what Medicare doesn’t. These
supplement plans often have a rate increase yearly and are a much higher premium up front than Advantage plans and do not include dental, vision, hearing, or the extras. You also need to continue paying your Medicare premium and you need a
separate Part D prescription drug plan with its own premium in addition to the medication copays. With these plans you pay more upfront whether you use the plan or not and you can use it anywhere that accepts Medicare. Advantage plans are
more of a pay as you go type model that use networks and they offer the extra perks.
I am a federal employee, what should I do?
Contact your HR department for guidance. If you leave the federal employee benefits you may not be able to get them back. Each branch of government has its own options and they can vary widely.
I am a veteran and get healthcare at the VA, do I need anything else?
Many people with VA coverage choose to have a $0 premium Medicare Advantage Plan as a backup option if they cannot get care at the VA or want to see a specific doctor or practice. There are plans specifically designed with veterans in mind that offer dental, vision, hearing, fitness membership, transportation and other extras. If you go to the VA you use that coverage, if you go outside the VA you use the Advantage Plan coverage but never both.
How do I figure out which type of coverage is best for me?
First, think about what is important to you. Coverage of certain prescriptions? Dental/Vision/Hearing coverage? Concern about paying copays? Will you be traveling? Certain doctors being in the network? What is your budget for healthcare? Then talk to a licensed agent or broker, call Medicare or research plans on the website above (Medicare provides links to each insurance company’s website for additional details), or contact your local State Health Insurance Program office. Everyone has a unique
situation and what works for your friend might not work for you.