When Do I Get Started?
Refer to the Medicare and You 2014 handbook pages 20-28
To begin, you must be at least 64+8 months old. First eligibility to enroll will start three months before your 65th birthday, through the month of your birthday and lasts for three months afterwards; a total of seven months. Benefits will start the first day of the month of your 65th birthday if you apply during the first three months before your birthday month.
Part A is entitled to you once you have worked 10 years, (40 quarters) or have been on disability for 24 complete months. If you are part of a union group, have an HSA account or receiving a benefits package, talk to your HR representative first before you make any decisions; in most cases, once you drop the benefits you can’t return.
Part B comes automatically with part A, but you can elect not to receive it at this time if any of the above apply or if you decide to continue working. Part B will charge a premium that will be deducted monthly from your Social Security check. Call a Trusted Agent here in the office and we will answer your questions.
What is Covered and What Do I Pay?
Refer to the Medicare and You 2014 handbook pages 29-33
Part A covers your hospital care; there is a deductible that has to be met before Medicare pays their part, it can change annually, this year it is $1,216. Other services that are covered are hospice, skilled nursing, home health and inpatient rehabilitation care. Each Medicare Plan will explain their co-pays for these services.
Let’s Discuss That Part B 20%
Refer to the Medicare and You 2014 handbook pages 34-56
Part B is the preventative and medical services of Medicare. Part B has a monthly premium and with Original Medicare, there is an annual deductible that must be met for doctor services. This year the deductible is $147, once this is reached, Medicare will pay 80% of services and the beneficiary is responsible for the 20%. Medicare Part B services are used by doctors when we receive check-ups, get preventative care like flu and pneumonia shots, and ambulance. Other costs we are responsible for is durable medical equipment; scooters, canes, and oxygen are a few examples.
What about Part D?
Refer to the Medicare and You 2014 handbook pages 57, and 87-102
When you receive your Medicare card, also known as your Red, White and Blue Card, it will not have Part D. Part D is for prescription drug coverage and is provided by private insurance companies that are approved by Medicare. You will apply for this coverage separately and the premium is up to the company; an annual deductible will also be required. If you have “creditable coverage” from your employer then you will not need to enroll with a Medicare Part D plan. However, if you lose this coverage at any time you will need to contact Medicare within a specific time; delaying Part D enrollment can cause a penalty that is indefinite.
Refer to the Medicare and You 2014 handbook pages 67-71
There are options to help pay for those gaps in insurance (the 20%) that Medicare does not cover, these are called Medigap or Supplement plans. These plans are standardized which means that the benefits are the same between carriers, however premiums may be different, and there are no co-pays. Having a “gap” plan will allow you to go to any doctor that accepts Medicare without a referral. You will still need to select a Part D plan.
Medicare Advantage Part C
Refer to the Medicare and You 2014 handbook pages 72-82
Medicare Advantage or Medicare Part C has very unique features; it incorporates A, B, and in most cases, D. You must have A and B to qualify to enroll, and they have a very low to zero premiums. In fact they carry no deductibles; instead, they have co-pays. The advantage to a Part C plan is the “extras” that a lot of carriers have; vision coverage, hearing services, dental care, transportation, and over-the-counter benefits, to name a few. The extra benefits will be different by service area and plan availability. If you have a Medigap plan you cannot enroll in an Advantage plan at the same time or vice-versa. Call one of our Trusted Senior Specialists at and we can help you further understand the benefits and difference in these two types of insurances.
How Do I Know Which Type of Insurance is a Good Fit for Me?
Refer to the Medicare and You 2014 handbook pages 57-60
Ask yourself this:
Do I want to pay ahead and have services covered in advance, or pay as I go?
The cost of your premiums and applicable deductibles will depend on the company you enroll with. So the biggest question that you want to ask is; “What is my annual out-of-pocket limit?” All insurance companies have one and it will also vary. This means that if all your co-pays, deductibles, and co-insurance reach the limit, then the insurance company will be responsible for any further cost till the remainder of the year. The New Year begins a zero balance.
Check to see if your primary doctor, specialists, and preferred hospitals are in the network if you have to use a network. Do you have to get referrals? Are all the services you need covered in the plan you are interested in? What happens when I travel locally and abroad? Are all of my medicines covered by the plan and will they require me to use Step Therapy (trying generics before brands) or set Quantity Limits (restricting my refills until the next month)?
– See more at: http://www.trustedseniorspecialists.com/new-to-medicare.html#sthash.sjQ3yiie.dpuf