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As you transition into Medicare, it’s important to know the basics.

Medicare Eligibility

You are generally eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment, and you are 65 years old and a citizen or permanent resident of the United States.

If you are not 65, you might also qualify for coverage if you have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant).

Getting Started with Medicare

When can you sign up?

If you’re over 65 (or turning 65 in the next 3 months) and not already getting benefits from Social Security, you need to sign up to get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). You won’t get Medicare automatically.

If you already get benefits from Social Security, you’ll get Medicare Part A and Part B automatically when you’re first eligible and don’t need to sign up. Medicare will send you a “Welcome to Medicare” packet 3 months before you turn 65. You’ll still have other important deadlines and actions to take, so read all of the materials in the packet. (If you live in Puerto Rico, you’ll only get Part A. If you want Part B, you need to sign up for it.)

How can you sign up?

Online at www.SocialSecurity.gov.
By calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday.
In-person at your local Social Security office.

What documentation is needed?

There are no forms to sign and usually no documentation is required. Social Security will process your application and contact you if they need more information.

When will you receive my cards?

When you’re enrolled in Medicare, you’ll get your red, white, and blue Medicare card in the mail. If you’re automatically enrolled, you’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of getting disability benefits.

Medicare

Original Medicare has two main parts: Part A is hospital insurance. Part B is medical insurance. Premiums for each part work differently:

Medicare Part A (hospital insurance) helps cover inpatient care in hospitals, including critical access hospitals and skilled nursing facilities (but not custodial or long-term care). It also helps cover hospice care and some home health care.

Medicare Part A costs for 2023:

• Premium: If you or your spouse paid Medicare taxes for at least 10 years while working, you may not have to pay a premium for Part A. Otherwise, you may have to pay a monthly premium of either $278 or $506. You also need to enroll in Part B to get Part A.
• Deductible: You pay a $1,600 deductible for each inpatient hospital benefit period before Medicare starts paying. There is no limit to the number of benefit periods you can have in a year.
• Copayments: You may have to pay copayments for inpatient hospital stays longer than 60 days and for skilled nursing facility stays longer than 20 days.

Medicare Part B costs for 2023:

• Premium: You pay a monthly premium of $164.90, or more based on your income.
• Deductible: You pay an annual $226 deductible before Medicare starts paying.
• Coinsurance: You pay 20% of the Medicare-approved amount for each covered service or item after you meet your deductible.

Medicare also covers certain preventive services for free, such as yearly depression screenings and home health care. However, there is no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage like a Medicare Supplement Insurance (Medigap) policy, or you join a Medicare Advantage Plan.

If you do not enroll in Medicare when you are first eligible, you may have to pay a penalty. To avoid the penalty, make sure to enroll in Medicare on time.

Medicare Advantage Plans are health plan options that are part of the Medicare program. A Medicare Advantage Plan is offered by a private insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits.

If you join one of these plans, you will get all your Medicare-covered health care through the health insurance company’s Medicare Advantage Plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

• Medicare Health Maintenance
• Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medical Savings Accounts (MSA)
• Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of the plans, you generally have extra benefits and lower co-payments than original Medicare. Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO), and you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer

Medicare Part A costs for 2023:

• Premium: If you or your spouse paid Medicare taxes for at least 10 years while working, you may not have to pay a premium for Part A. Otherwise, you may have to pay a monthly premium of either $278 or $506. You also need to enroll in Part B to get Part A.
• Deductible: You pay a $1,600 deductible for each inpatient hospital benefit period before Medicare starts paying. There is no limit to the number of benefit periods you can have in a year.
• Copayments: You may have to pay copayments for inpatient hospital stays longer than 60 days and for skilled nursing facility stays longer than 20 days.

Medicare Part D offers prescription drug plans. You can sign up for Part D, and with Medicare starting three months before your 65th birthday.

It’s important to do this on time because there’s a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don’t have insurance for drug coverage from another source.

If you are enrolled in a Part D “standalone” plan, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year. It’s important to remember that costs can change from year to year, so it is a good idea to review your coverage options during the annual Medicare Open Enrollment Period. I can help you compare plans and estimate your costs.

If you choose to enroll in a Medicare Prescription Drug Plan, you’ll generally pay a monthly premium, an annual deductible, and copayments or coinsurance for your prescriptions. The specific costs will vary depending on the plan you choose and the medications you take.

If you have limited income and resources, you may qualify for Extra Help with your Medicare prescription drug costs. You can apply for Extra Help through Social Security.

Overall, understanding your Medicare costs is an important part of managing your healthcare expenses. Be sure to review your coverage options and ask questions if you’re unsure about any aspect of your Medicare benefits.

Medicare Supplement/Medigap Plans

A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like co-payments, coinsurance, and deductibles.

If you have original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs and then your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. A Medigap policy will only supplement original Medicare benefits and doesn’t work with a Medicare Advantage Plan.

Medigap policies are standardized and must follow federal and state laws designed to protect you. Insurance companies can only sell you a “standardized” policy identified in most states by letters.

All policies offer the same basic benefits, but some offer additional benefits, so you can choose which one meets your needs. There are many options from which to choose. As a licensed insurance agent, I can help you understand the differences between the plans so that you can decide on the right plan for you.

Some important things to know about Medigap policies:

1. You must have Medicare Part A and Part B.
2. If you have a Medicare Advantage Plan, you can switch to a Medicare Supplement insurance policy, but make sure you can leave the Medicare Advantage Plan before your Medicare Supplement insurance policy begins.
3. You pay the private insurance company a monthly premium for your Medicare Supplement insurance policy. This is paid in addition to the monthly Part B premium that you pay to Medicare.
4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
5. You can buy a Medicare Supplement insurance policy from any insurance company that’s licensed in your state to sell one.
6. Any standardized Medicare Supplement insurance policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medicare Supplement insurance policy as long as you pay the premium.
7. Medicare Supplement insurance policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
8. It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage plan unless you’re switching back to original Medicare.

Here is a link so you can run a quick quote for a Medigap policy.

You don’t have to navigate all of this alone! Schedule an appointment with Thomas to get all your questions answered and find the perfect plan for you or a loved one…at no cost to you!

Portions of this page were sourced from medicare.gov.