Are you ready to change to Medicare? 5 tips you should know prior to age 65

Are you turning 65 years old soon? Bolster your chances of meeting your health care coverage goals with these 5 tips:

1. Understand the basics of Original Medicare (Medicare) at minimum six months prior to your 65th birthday. What is Medicare? Medicare is the federal health insurance program for the following:

• People 65 and older.

• Certain people who are under 65 with

• People with End Stage Renal Disease (ESRD) – permanent kidney failure requiring dialysis or a kidney

Medicare has four parts:

• * Part A is Hospital Insurance. Generally, for most seniors, there is zero cost for the monthly premium for Hospital Insurance. This benefit helps cover inpatient, Home Health care and other care.

• * Part B is Medical Insurance. This Plan helps cover services such as doctors and other health care providers. There is a monthly premium that you would be required to pay for this benefit.

• Part C is Medicare Advantage Insurance. Private insurance companies sell this benefits Plan. This Plan includes Part A, Part B and Part D services and extra benefits that Original Medicare does not cover such as vision, hearing, and dental services.

• *Part D is Prescription Drug insurance. This Plan helps cover the cost of prescription drugs including approved shots or vaccines.

Medigap or Medicare Supplemental insurance is sold by private insurance carriers too, and helps pay for some of the costs that Original Medicare does not cover such as deductibles, copays, and coinsurance amounts. There is a separate Medigap monthly premium. Like Original Medicare, Medigap insurance does not include benefits for Part D insurance or Prescription Drugs or for long-term care, dental, hearing, and vision services (including eyeglasses) or private duty nursing. Therefore, a separate insurance plan(s) will need to be purchased outside of Medigap for these services. The monthly Medigap premium is generally higher than the monthly Medicare Advantage premiums.

Medigap Insurance offers the following options to seniors: A, B, C, D, F, G, K, L, M, and N. We will cover these different plan options in an upcoming post.

*Please note: Most seniors will automatically be enrolled in Part A Insurance. If not, you should enroll in all of the Plans with an asterisk (*) when first eligible to avoid higher monthly premiums because of penalties.

2. Contact Social Security to enroll in Medicare Part A and Medicare Part B during the Initial Enrollment Period. Your initial enrollment period is centered around your 65th birthday. Just remember the enrollment period is 7 months—3 months prior to your 65th birthday and ends 3 months after the month you turn 65.

3. Compare benefits between Medigap vs. Medicare Advantage policies based on your medical care needs (after you enroll in Medicare Part A and Medicare Part B during the initial enrollment period noted in item #2 above), Make sure you don’t just look at premium costs. Thoroughly examine your health history and compare the benefits for each plan that will help meet your medical concerns. With Medigap insurance, most hospitals and medical providers that accept Medicare will accept a Medigap Plan. Therefore, you don’t have to worry about referrals or in-network and out-of-network providers. This is a very important point to consider if you have a lot of health issues. With a Medicare Advantage plan, you must consider these factors. You also want to make sure your prescription drugs are covered when comparing plans. Keep in mind that “when patients are enrolled in a Medicare Advantage plan for more than 12 months but want to change to traditional Medicare, Medigap plans are no longer obligated to enroll them without underwriting, which involves passing a health screen.” “While the insurance company can’t make you wait for your coverage to start, it may be able to make you wait for coverage related to a pre-existing condition. A pre-existing condition is a health problem you have before the date a new insurance policy starts. In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months.”

Keep in mind, when comparing Medigap plans, all plan options offer the same benefits. For example, if you compare a Plan A benefit between Medigap Insurance Company X with Medigap Insurance Company Z, the benefits will be the same. But the premiums may be different. Make sure you compare the right plan type. When you compare Medicare Advantage plans with other Medicare Advantage plans, make sure you are comparing Plans with the same benefits and not just premium costs.

5. Purchase a Medigap or Medicare Advantage plan during the initial enrollment period described in item #2 above. If you decide to purchase a Medigap policy, please remember that the following policies are not Medigap policies:

· Medicare Advantage Plans (Medicare

Part C)

· Medicare drug plans (Part D)

· Medicaid

· Employer or union plans including the

Federal Employees Health Benefits Program (FEHBP)

· TRICARE

· Veterans’ benefits

· Long-term care insurance policies

· Indian Health Service, Tribal, Urban Indian Health Plans,

· Qualified Health Plans sold in the Health Insurance Marketplace

All Medigap plan policies purchased from an insurance carrier must show on the policy that it is a Medicare Supplemental Policy.

We hope these basic tips are helpful to you as you navigate Medicare. Benefits-4-Retirees only sells Medigap and other insurance products for seniors. We fully understand that this is not everything that you need to know about Medicare and the optional Plans. But it is a great start, if you are new to Medicare!

“I can't change the direction of the wind, but I can adjust my sails to always reach my destination.” ~ Jimmy Dean

Resources:

2023 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare

https://blog.hubspot.com/sales/quotes-about-change

The Problem with Medicare Advantage Plans: Patients and Providers Affected. (March 2023). The Receivable Report. Pages 3-6.