Every day thousands of people turn 65 and are therefore eligible for Medicare. For many, Medicare options can be confusing.
Medicare has evolved for more than 50 years from Original Medicare (Parts A and B) to now include Part C (Medicare Advantage plans) and Part D (prescription drugs). Medicare Parts A and B continue to be referred to as Original Medicare.
- Part A does not require a monthly premium and pays for hospitalization costs.
- Part B costs a monthly premium of $135.50 and pays for physician services, lab and X-ray services, durable medical equipment, outpatient services and other services.
- Part C Medicare Advantage Plans are HMO or PPO plans offered by private insurance companies approved by Medicare. Many plans have no monthly premium.
- Part D assists with the cost of prescription drugs. Monthly premiums are $12 and up.
How and when do I apply?
Medicare is available to people who have worked and contributed to Social Security for at least 10 years and people eligible as a result of a disability.
If you are already collecting Social Security benefits, you will receive your Medicare card about three months before your effective date. Coverage always starts on the first day of the month you turn 65.
You can apply online at www.ssa.gov or in person at your Social Security Administration Office. You should complete the application at least three months before your birth month.
How do I select a plan?
This is an important decision. Do you want your care through a network plan (Medicare Advantage with prescription medicine, extras and sometimes no additional premium), or do you want to choose your own health care providers as long as the providers accept Medicare and a separate standalone prescription plan?
If you choose to purchase a Medicare Advantage plan, confirm that your doctors and other providers are included in the plan and check to see whether your medicine is covered and at what cost.
Enhancements to Medicare Advantage plans were introduced in 2019 and offer:
- Over-the-counter, no-cost mail order purchases of covered items
- Fitness benefits at no or low cost
- Virtual doctor appointments
- Rewards for fitness assessments
- Free, home-delivered meals after a hospital stay
If you are in a Part C HMO or PPO, you have until March 31 to change plans to another HMO or PPO to take advantage of these new improvements.
Original Medicare/ Medicare Supplements
Original Medicare usually pays for 80 percent of your Medicare-approved costs, so some people purchase a Medicare Supplement (Medigap) plan to help pay for the other 20 percent.
You will also usually want to select a Part D prescription drug plan.
You can select your Medicare Advantage or prescription plan from three months before the effective date (the month of your 65th birthday) to three months after your birthday. Medigap plans can be selected up to six months before your birth month.
Learn your options
Your mailbox will be filled with offers. People have told me they received 10 to 12 offers daily for the four to five months before their birthday. Make an informed decision that fits your needs. You can attend a no-sales information session, contact the Area Council on Aging in your area, talk to a friend and contact Medicare brokers that offer the plan in your area.
Don’t go it alone!
Gloria Smith is an independent insurance broker based in Maricopa who also holds meetings in Arizona City. For more information or to register for one of her free information sessions with no sales, contact her at 520-568-6750 or firstname.lastname@example.org. | PW