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The 5 Essential Medicare Facts You Can't Miss!

 

 

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By the time your 65th birthday rolls around, you may think you have insurance all figured out- but insurance can be complicated and confusing, and Medicare even more so. There is a lot to learn and understand, but knowing that there is somewhere to turn for simple explanations and trusted resources can help to lift this heavy burden. We have gathered the top 5 questions our agents are asked almost daily and want to share them, as well as the answers, here with you. We feel that the more you know, the better you will be equipped to manage your health care in the future. 

 

lesley signature-11.) When can I enroll in Medicare?
 
You can enroll in Medicare during your Initial Enrollment Period (IEP). This enrollment period begins three months before your 65th birthday, includes your birth month, and extends 3 months past your birth month. If you are currently receiving Social Security benefits, you don't need to do anything. Your enrollment in Part A and Part B should be automatic and effective the month you turn 65. If you do not receive Social Security benefits, then you will need to sign up for Medicare by calling the Social Security office at 1-800-772-1213 (TTY 1-800-325-0778). 

 

2.) Is Medicare enrollment mandatory?

Enrollment in Medicare is not mandatory, but very few people will opt out of ever having Medicare coverage at all, and here is why- Not having health insurance could be financially catastrophic for anyone.

Medicare as a whole is paramount. It is a complete medical health plan that has a low monthly premium, and once a small deductible is met, it will become an 80/20 plan. However- even a 20% exposure of medical expenses can be calamitous to a Beneficiary, and that is why a secondary plan is essential in addition to having Original Medicare.
There are two types of plans to choose from,  that will meet anyone’s budget. One will have a monthly premium that will give you the freedom to go to any physician or facility that accepts Medicare. This is in addition to your Part B premium.

The other type of plan may have a low to zero monthly premium that usually has a network of doctors and may offer additional benefits not covered by Original Medicare. You will still have to have Medicare Part B to have either of these plans. 

*If you don’t sign up for Medicare when first eligible and don’t have qualifying coverage elsewhere, you may have to pay a monthly penalty that lasts as long as you are enrolled in Medicare.

 

3.) I am still working and have insurance through my employer. Do I still have to enroll in Medicare?

 

Most workers choose to enroll in Part A because you usually do not pay a monthly premium for it if you or your spouse paid Medicare taxes while working for at least 40 quarters, which is 10 years.

Whether you should enroll in Part B while you are still working depends on how many people work for your employer. If the company has 20 or more employees, you most likely would not have to sign up for Part B right away as your employee health plan would be the primary insurer. Primary Insurers pay first. In most cases you do not need Part B Medicare if you have employer coverage that pays primary unless you are unhappy with that coverage. You will want to consider if paying for both types of coverage would offset your health care costs, or whether it would be cheaper to have one or the other.

However if there are fewer than 20 employees you should enroll in Part B when you are first eligible. Medicare would be the primary insurer, meaning that they would pay before your employee insurance pays. In this case, if you do not enroll, your employer’s plan can refuse to cover you for services that Medicare would have covered. That means you would be responsible to pay for those services out of pocket.  

 

*It is advised that before you enroll in Medicare Part A and/or Part B, that you contact your Human Resources Department to confirm that your Group Plan is considered Creditable by Medicare, including Prescription Drug Coverage. 



4.) What is the difference between a Medicare Advantage plan and Medicare Supplement plans?

Medicare Advantage (MA) and Medicare Supplemental Insurance, or Medigap, are both intended to enhance the value of traditional Medicare coverage for seniors and other eligible beneficiaries, as well as significantly reduce exposure to out of pocket expenses.

Medicare Advantage refers to Medicare Part C and provides the same benefits as Part A and B, except for hospice care, a service covered by Part A. Under this plan, members would continue paying their Part B premium. Many MA plans offer Part D, which covers prescription drugs. This plan offers doctor visits, hospital stays and other health care providers within a network. Medicare Advantage usually requires co-pays and deductibles. However, unlike Original Medicare, these payments put annual limits on how much you pay out-of-pocket. Once you’ve reached that limit, the plan will cover your medical bills for the remainder of the year. This means you won’t have to pay anymore after reaching the spending limit.


Medicare Supplement or Medigap, is private plan coverage that pays for most of your out-of-pocket costs like co-pays, deductibles, and premiums and picks up where Original Medicare stops. Medicare Supplement has 10 sub-plans in 47 states, while three states—Wisconsin, Minnesota, and Massachusetts have their own customized plans.

The 10 standard Medigap plans are marked by the letters A, B, C, D, F, G, K, L, M, N. Once enrolled in Medigap, your plan will cover the portion of your bill, once Original Medicare has paid its claims. However, Medicare Supplement plans do not cover prescription drugs and in this case a Beneficiary should enroll in a Part D Prescription Drug Plan



5.) I am already enrolled in Medicare due to disability but I am about to turn 65. What do I do?

If you have ALL of the Parts of Medicare and are happy with your current plan, you don’t have to do anything and your plan will renew the following Medicare year. However, many SSDI recipients don’t realize that when you turn 65—you receive a new Initial Enrollment Period. This can be extremely valuable for a couple of reasons.

Reason one: One advantage is that you receive a new guaranteed issue rights period, meaning you can sign up for supplemental coverage, or Medigap, without underwriting. Even if you already have Medigap, you could see reduced premiums at age 65, and it could be a great benefit for you to shop around.

Reason two: A second advantage is that you may now have other Medicare plan options available to you that previously were not accessible because you were eligible by disability, and not by age. If you have acquired a Late Enrollment Penalty for Part B or Part D, your Initial Enrollment Period resolves the penalties and gives you a fresh beginning. 

So it’s important to revisit your Medicare plan as you get ready to turn 65, even if you have been on Medicare for several years already because of your disability.


With so many Medicare options to consider, and so much to compare and contrast, when left to your own devices choosing the right Medicare path can be difficult.  Whether your health care needs are straightforward or more complex, the various choices can leave anyone feeling overwhelmed and confused.

Taking the time to speak with an experienced Medicare insurance agent can not only save you time,  they can help make clear what your options are, while also helping you navigate costs so you can get the best value no matter your financial situation. We are here for you.. Give us a call today for your no hassle, no obligation consultation. When it comes to Medicare, for us, it is all about love and trust. 

 

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