Each day, approximately 10,000 Baby Boomers turn 65 – and thereby become eligible for Medicare.
But becoming eligible for and actually enrolling in Medicare are two very different things. In fact, if you miss the initial window to sign up for certain parts of Medicare and later decide to enroll, you could wind up paying significantly higher premiums for the rest of your life.
If you’re approaching 65, get familiar with these Medicare basics now:
Medicare provides benefits to people age 65 and older (and those under 65 with certain disabilities or end-stage renal disease). For most people, the initial enrollment period is the seven-month period that begins three months before the month they turn 65. If you miss that window, you may enroll between January 1 and March 31 each year, although your coverage won’t begin until July 1.
Medicare offers several plans and coverage options, including:
Medicare Part A helps cover inpatient hospital, skilled nursing facility and hospice services, as well as home health care. Most people pay no monthly premium for Part A, provided they or their spouse have paid FICA taxes for at least 40 calendar quarters.
Medicare Part B helps cover medically necessary doctor’s services, outpatient care, durable medical equipment and many preventive services. It’s optional and has a monthly premium. For most people there’s a $147 yearly deductible; after that’s met, you’ll be responsible for 20 percent of the Medicare-approved amount of the service, provided the doctor or other provider accepts Medicare.
Medicare Part C (Advantage) plans are offered by Medicare-approved private insurers as alternatives to Original Medicare Parts A and B. Most cover prescription drugs and some include additional benefits such as dental and vision coverage for an extra cost. You’re usually required to use the plan’s doctor, hospital and pharmacy provider network, which may be more restrictive than providers you can access through Parts A and B.
Medicare Part D helps cover the cost of prescription drugs. It’s optional and carries a monthly premium. These privately run plans vary widely in terms of cost, copayments and deductibles and medications covered. If you’re enrolled in a Part C plan that includes drug coverage, you don’t need Part D.
Many people purchase additional Medigap (or Medicare Supplemental) insurance, which is offered by private insurers and helps pay for many items not covered by Medicare. Medigap plans can vary widely in terms of cost, covered benefits and states participating so compare your options carefully.
Keep in mind:
For all Medicare plans, deductibles, copayments and coinsurance may apply, depending on the service provided.
With Parts B and D, you’ll often face sizeable penalties if you don’t enroll when first becoming eligible – Part B premiums could increase 10 percent for each 12-month period you were eligible but didn’t sign up (the Part D penalty is more complicated); however, if you’re currently covered by an employer’s plan you can enroll later without penalty.
Terms of Advantage and Part D plans such as premiums, copayments and covered medications can change from year to year, so carefully review enrollment materials from your current plans to make sure they still match your needs.
Understanding and choosing the right Medicare options for your individual situation can be a complicated and time-consuming process. For assistance, call 1-800-633-4227 or visit www.medicare.gov, where you’ll find “Medicare & You 2014,” a detailed guide that explains Medicare in easy-to-understand language, and tools to compare prescription plans, hospitals, nursing homes, home health agencies and Medigap plans in your area.
By Jason Alderman