- Posted by Canopy KC
- On April 11, 2016
- 0 Comments
Medicare was signed into law by President Lyndon B. Johnson in 1965 in Independence, MO to help people over the age of 65 gain access to health insurance coverage. The average cost of gas per gallon was 31 cents and a loaf of bread was 21 cents during that year. Some of you reading this are probably smiling about the good old days and how life was a little simpler. It is true; Medicare is overwhelming but understanding your Medicare options can be achieved with the right education and guidance, leaving you to smile about the glory days ahead.
How do I Qualify?
- You qualify for Medicare if you are a US resident age 65 or older. Unless you are already receiving social security benefits, do not expect the Social Security office to send you a birthday reminder because it will not happen.
- You qualify for Medicare if you (or your spouse) have worked long enough to be eligible to receive social security benefits, railroad retirement benefits, or you are a government employee who has paid Medicare payroll taxes. If you have not worked, you are still eligible based on your spouse’s (living, deceased, or divorced) work record.
There are special qualifications for those under the age of 65 that will not be discussed in this blog.
Is There a Deadline?
- The initial enrollment period is seven (7) months for Medicare Part A and Part B, three (3) months before your birth month and three (3) months after your birth month. You can delay signing up for Part B if you or your spouse are still working and receiving health care coverage through an employer. However, when employment ends, you only have eight (8) months to enroll in Part B to avoid a higher premium. You can enroll after the seven (7) month deadline but it is not recommended due to possible penalties and delayed coverage.
There are special circumstances including (but are not limited to) disability, residing outside the United States, and if you are not a United States Citizen that are best suited to be discussed with a licensed Senior Market consultant.
Medicare Components at a Glance
- Part A: Part of the Traditional Medicare Coverage. Part A can be considered “hospital insurance,” covering a portion of inpatient hospital stays, skilled nursing facility stays, and hospice. Part A also covers, lab tests, doctor visits and home health. Generally speaking, Part A is “premium” free but does require an annual deductible to be met prior to any associated hospital stay coverage.
- Part B: Also part of the Traditional Medicare Coverage. Part B can be considered “medical insurance,” covering some of the cost related to doctor visits, outpatient care, durable medical equipment, home health, and limited preventative care. Part B has a monthly premium and small deductible that is based on your individual or joint income.
- Medicare Supplement: A Medicare Supplement plan is designed to supplement Part A and Part B coverage and fill in coverage gaps leftover by Part A and B. Generally speaking, a Medicare Supplement will pick up most of what Traditional Medicare does not cover and often times leaves the member with virtually no out of pocket costs. Medicare Supplements do no use a network and instead can be used by any provider nationwide that accepts Medicare patients.
- Medicare Advantage (MA) Medicare Advantage plans are contracted by the government using private health insurance companies to incorporate Part A, Part B and usually include Part D (prescription coverage). These plans are part of Medicare and are not considered supplement plans. Premiums can be as low as $0 and enrollees will have copays, deductibles and coinsurance for services with maximum out of pocket limits, much like a traditional health insurance plan. MA plans use networks of hospitals, doctors and pharmacies for members to use.
- Part D: Part D is prescription drug coverage and again you must be enrolled in Part A and Part B to be eligible. There are guidelines and limitations associated with Part D prescription drug coverage.
As mentioned before, understanding your Medicare Options prior to enrolling is almost as important as enrolling itself. There is a great deal of information and resources available regarding supplemental coverage, other health insurance coverage, low income resources, and where to find assistance if you need help to pay your annual or monthly premiums. The official U.S. Government website is medicare.gov where you will find basic answers to very in depth questions. But like most baby boomers, communicating with a computer is not the preferable way to understanding Medicare options, communicating with a person is.
Understanding your Medicare options can be greatly enhanced by seeking help from a Senior Market consultant here at Canopy. A free face to face or phone consultation will help to answer the most basic to the most complex questions regarding this very important health care coverage. That sounds as good as a 31 cent gallon of gas!
The above defined Medicare options are very brief for their context and are truly complex in rules and regulations.