What is Medicare?

Medicare is health insurance for :

• People 65 years and older who have met certain conditions (which we can explain when we talk).

• People under 65 who have been on Social Security Disability for 24 months

• People of any age with End-Stage Renal Disease (ESRD) requiring dialysis or kidney transplant

• People of any age with Amyotrophic lateral sclerosis (ALS)

What does Medicare cover?

Medicare Part A is hospital insurance. It covers things like:

• Inpatient hospital care

• Skilled nursing facility care

• Hospice care

• Home health care

Medicare Part B is medical insurance (outpatient services). It covers things like:

• Doctor visits and services from other providers

• Outpatient hospital services

• Many preventative services

• Durable medical equipment

• Home health care (yes, under Part B also)

Medicare Part D (prescription drug coverage):

Helps cover the cost of prescription drugs. It is important to note that you do not obtain your Part D coverage through Medicare. The plans are offered by Medicare approved private insurance companies that in most cases charge a premium, deductible and co-pays. To avoid paying late enrollment penalties, it is important to join a Medicare Part D plan when you first become eligible. You may, however, be able to delay enrolling in Part D coverage without a penalty if you have creditable coverage, like coverage through your job or your spouse's job. Ask your Human Resources Representative whether your employer coverage is considered creditable. They should know.

What does Medicare NOT cover?

To name a few, it does not cover:

• Dental

• Vision

• Hearing

• Long term care

• Cosmetic Surgery

Many people opt for a "stand alone" plan to help cover the cost of dental, vision and hearing expenses. These plans are usually quite affordable and cover such things as routine and major dental care and dentures, vision exams and eye wear and hearing exams and hearing aids. Contact us to find out what options we offer to help cover these services. Long term care is not covered by Medicare, Medicare supplement insurance plans, or Medicare Advantage plans. Long term care insurance may be purchased through private insurers. Individuals also may be eligible for long term care through Medicaid, but only after assets have been spent down to almost nothing.

Am I eligible for Medicare?

That question can get a bit complicated to answer. It depends on whether you’ve met the requirements alluded to above as well as your work history and citizenship status. Give us a call so we can give you the answer that is right for you.

When can I enroll?

Some people get Part A and Part B automatically. If you are already receiving your Social Security retirements benefits, Social Security disability benefits, or Railroad Retirement Benefits, you will automatically be enrolled in Part A and Part B. Your benefits will begin the 1st of the month you turn 65 (or your 25th month on Social Security Disability) unless your birthday is on the 1st of the month. In that case, your benefit will begin the 1st of the prior month. You will need to sign up for Medicare if you opted to wait and receive your Social Security benefits. If you decide to continue working and have insurance through your employer then you may be able to opt out of Medicare Part B until you decide to retire. You will have a "special enrollment period" at that time and should be able to enroll without a penalty if you kept creditable employer coverage until then.

When can I enroll in a Medicare Supplement Plan or a Medicare Advantage Plan?

You can enroll in a Medicare supplement plan during your "Open Enrollment Period." This occurs on the first day of the month when you are 65 *and* enrolled in Medicare Part B and lasts 6 months. During this time, insurance companies cannot refuse to sell you any plan they offer, cannot subject you to underwriting and cannot make you wait for your coverage to start due to pre-existing conditions, as long as you have had "creditable coverage". In most states, YOU MAY BUY A MEDICARE SUPPLEMENT PLAN UP TO 6 MONTHS PRIOR TO YOUR 65TH BIRTHDAY TO BEGIN THE FIRST OF THE MONTH YOU TURN 65!! Why is this important? Because it allows you to lock in your rate without any risk of a rate increase. This will also undoubtedly give you peace of mind that your Medicare supplement plan is in place, you have your policy and cards in hand and you are ready to embark on this chapter of your life.

You can enroll in a Medicare Advantage plan or Part D Prescription drug plan 3 months before the month of your 65th birthday, the month of your 65th birthday, and the 3 months after the month of your birthday, giving you 7 months to pick up a plan. Once you’ve applied for Medicare and gotten your card, you can enroll in a plan. You will have a special enrollment period if you choose to wait until you leave employer health coverage, but you will pay a late enrolllment penalty if you miss your window, so check with us before you make the leap. And, if you delay your Part B coverage, you only have the 3 months before your Part B effective date to pick up a plan, so we want to make sure to not miss your enrollment window!