What Should You Do Once You Get Medicare
Although you can rely on Original Medicare alone, 86% of Medicare enrollees also have some type of additional coverage.2 It can be from an employer, a privately-purchased plan or from a government-run program like Medicaid. Original Medicare pays for a great deal of healthcare, but still leaves you with potentially costly gaps in healthcare coverage. Supplementary plans can cover these gaps including deductibles and copayments at a fraction of the out-of-pocket rate.
MedicareGuide.coms plan selector is designed to intelligently bring you the best Medicare Supplement plans. These plans, also known as Medigap policies, fill the gaps in coverage that you would otherwise be charged by Original Medicare.
How Do I Know Im Enrolled In Medicare
After you apply for Medicare, Social Security will review and process your application. Theyll contact you if they need more information.
When youre approved for Medicare Part A and/or Part B, Social Security will send you a welcome packet that includes the following:
- Your confirmation letter
- Your red, white and blue Medicare ID card
- A Welcome to Medicare booklet that walks you through decisions you may have to make with your Medicare coverage
- The Medicare & You handbook
If youve applied for a private Medicare plan such as a Medicare Advantage, Medicare Cost, Medigap or Medicare Prescription Drug plan, when your enrollment is accepted youll get a separate confirmation letter and ID card.
Medicare helps pay for your health care costs and covers preventive care including a visit with your doctor each year. So once you get Medicare Part B, schedule your initial Welcome to Medicare visit with your doctor. And each year you get an Annual Wellness Visit with your doctor.
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You Automatically Get Medicare When You Turn 65
- Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.
Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months of turning 65, you might have to wait to sign up and pay a monthly late enrollment penalty.
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How Do I Get Full Medicare Benefits
If youve worked at least 10 years while paying Medicare taxes, there is no monthly premium for your Medicare Part A benefits. But if you havent worked, or worked less than 10 years, you may qualify for premium-free Part A when your spouse turns 62, if she or he has worked at least 10 years while paying Medicare taxes. However, to be eligible for Medicare, you need to be 65 years old. You also need to be an American citizen or legal permanent resident of at least five continuous years.
So, to summarize with an example:
- Bob is 65 years old. Hes on Medicare, but he pays a monthly premium for his Medicare Part A benefits. He only worked for seven years and no longer works.
- His wife, Mary, has worked for over 30 years.
What Is Part C Medicare Advantage
Part C Medicare is private insurance that is provided as an alternative to federally run Medicare. It combines different parts of Medicare.
You need to enroll in Medicare Part A and Part B, then choose a Medicare Advantage plan and sign up for private insurance., meal services and transportation to your medical appointments can also be covered.
Part C is required to cover what federally run plans Part A and B cover. Some Medicare Advantage plans cover extra services like dental and vision care. Wheelchair ramps and shower grips.
Usually, Medicare Advantage plans are preferred provider organizations or health maintenance organizations .
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D Late Enrollment Penalty
You may incur a late enrollment penalty if at any time after your initial enrollment penalty, theres a period of 63 or more days in a row where you dont have Part D or creditable prescription drug coverage. Youll have to pay the penalty for as long as you have Medicare coverage.
To calculate the penalty, multiply 1 percent of the national base beneficiary premium by the number of full, uncovered months you didnt have creditable coverage. The premium is then rounded to the nearest $0.10 and added to your Part D monthly premium.
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If You Missed Enrolling Your Initial Or General Enrollment Period
If a group health plan covers you through your or your spouses employer or union, you can sign up for Medicare Part A or Part B anytime.
If your employment or group health plan ends, you have an eight-month Special Enrollment Period to sign up for Part A and Part B without facing a late enrollment penalty. Keep in mind that retiree health plans and COBRA dont qualify you for a Special Enrollment Period when that coverage ends.
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What Is Medicare Coverage Is Optional
Optional, though probably a smart and relatively inexpensive choice, is to , the prescription drug program, once you have your Medicare Parts A and B in place. Type in your zip code and you will see what options are available in your area. For example, if you live in central Illinois, you get onto a Part D plan through Walmart pharmacy for about $17 in monthly premiums. On the Medicare web site, you can even see which of the specific medications that you take are regularly are covered. You will need to renew this policy annually. Your premium will vary from $0 to $71 per month depending on your income level.
Medicare Supplemental plans, also referred to as Medigap policies, are probably a wise choice as well, and relatively affordable. If you have a Medicare Advantage plan you will not need a supplemental plan. The supplemental plans are designed to cover what Medicare A, B, and D do not cover.
Do an online search of Medicare Supplemental plans, and you will find the results daunting. There are currently plans A, B, C, D, F, G, K, L, M and N supplemental plans. And there are numerous plans such as United Health , Blue Cross, and Health Alliance to name just a few. Plan F is no longer available for new retirees. Popular Plan F replacements include Medicare supplement Plan G and Plan N.
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Why You May Consider Signing Up For Medicare At 65
If youre approaching age 65 and are not going to keep working, you have employer coverage from an employer with fewer than 20 employees, or your spouses employer requires you to get Medicare to stay on their health plan, then you need to enroll during whats known as your Medicare Initial Enrollment Period . If you dont, youll likely face financial premium penalties for enrolling late.
Your IEP is a 7-month window that generally includes the month of your 65th birthday, the 3 months before and the 3 months after For example, if your 65th birthday is on June 20, then your IEP starts on March 1 and ends on September 30.
This is the time to learn about your Medicare coverage options and get what you do or dont need coverage for. Most who have to get Medicare at age 65 will get Part A , Part B and some form of prescription drug coverage through either a stand-alone Part D plan or a Medicare Advantage plan.
Depending on your situation such as if you still have or want to keep employer coverage you may not need every part of Medicare available. But keep in mind here a simple rule: If you are not eligible for a Medicare Special Enrollment Period you need to get Parts A, B and D when youre first eligible to avoid financial penalties. Also, if youre still working, its a good idea to check with your employer plan benefits administrator to see how Medicare might work with that coverage before making any final decisions.
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Can I Have Medicare And Employer Insurance
Yes, some people qualify to have both Medicare and employer insurance coverage. You can sign up for Medicare Part A and Part B if you or your spouse also have group health insurance through an employer.
Its important to know who pays first when you have more than one insurance provider. There are some cases when Medicare pays first and others when your employers insurance pays first. Here are some general guidelines for combining coverage.
When Can I Enroll In Medicare If I Do Not Qualify For Retirement Benefits:
If you are not eligible for retirement benefits from Social Security or the RRB, you will not be automatically enrolled into Original Medicare. However, you can still sign up for Medicare Part A and/or Part B during your IEP. You may not be able to get premium-free Medicare Part A, and the cost of your monthly Part A premium will depend on how long you worked and paid Medicare taxes. You will still have to pay a Medicare Part B premium.
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The Bottom Line: Know Your Options Enroll On Time
Dont delay making Medicare decisions and dealing with Medicare enrollment. Learn about the choices you have can you delay, must you enroll and then understand the implications of both as they relate to your overall health and financial well-being.
Late-enrollment penalties for Medicare Part B and Medicare Part D are permanent and can have a meaningful impact on your finances so think carefully about what you do and when.
Not sure where to start? A good first step for anyone approaching Medicare eligibility is to know when your enrollment dates are. You can quickly find your dates for your Initial Enrollment Period or Special Enrollment Period using our enrollment date calculator.
Calculate The Best Time To Start Social Security
If you are confused about when to start, you can use the Social Security Explorer part of the NewRetirement Retirement Planner to compare your monthly income and maximum lifetime payout at different ages.
Or, you might consider the following rules of thumb:
- Take Early: The only people who should consider taking their Social Security early are those who absolutely need the money immediately, or those who do not expect to live for very long, due to illness
- Take at Full Retirement Age: Should you have reason to believe that you will not live past the age of 80, then generally speaking you will maximize your social security benefits if you take them when you reach your Full Retirement Age.
- Wait as Long as Possible: On the other hand, if you are confident that you will live past the age of 80 or 85, then most experts recommend that you defer your social security for as long as you can , so as to maximize the benefits you receive from it.
- Other: If you have dependent children, the additional benefits you receive for them might make filing when you are younger worthwhile.
It can also be a very good idea to have an overall retirement plan before you decide when to start your Social Security benefits. The NewRetirement Retirement Planner can help you assess all of your sources of retirement income and whether or not you will have enough to cover your expenses. This tool was recently named a best retirement calculator by the American Association of Individual Investors .
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What Medicare Doesnt Pay For
Its also crucial to remember that Medicare doesnt pay for either self-administered or professionally supplied medications. The Part D Trust Fund assists beneficiaries in purchasing medication insurance under Part D. The trust funds reimburse the professional who administers the drugs and allow a markup for that service for Part B drugs.
Reasons To Delay Medicare
If youre thinking about deferring Medicare, discuss the pros and cons with your current insurer, union representative, or employer. Its important to know how or if your current plan will work with Medicare, so you can choose the most comprehensive overage possible.
Some of the common reasons you may want to consider deferring Medicare include:
- You have a plan through an employer that you want to keep.
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Should I Take Medicare Part B
You should take Medicare Part A when you are eligible. However, some people may not want to apply for Medicare Part B when they become eligible.
You can delay enrollment in Medicare Part B without penalty if you fit one of the following categories.
Employer group health plans may cover items normally not covered by Medicare Part B. If so, and you meet one of the categories above or below, then you may not need to enroll in Medicare Part B and pay the monthly premium.
If you are:
- a spouse of an active worker
- a disabled, active worker
- a disabled spouse of an active worker
and choose coverage under the employer group health plan, you can refuse Medicare Part B during the automatic or initial enrollment period. You wait to sign up for Medicare Part B during the special enrollment period, an eight month period that begins the month the group health coverage ends or the month employment ends, whichever comes first.
You will not be enrolling late, so you will not have any penalty.
If you choose coverage under the employer group health plan and are still working, Medicare will be the “secondary payer,” which means the employer plan pays first.
If the employer group health plan does not pay all the patient’s expenses, Medicare may pay the entire balance, a portion, or nothing. An employer group health plan must be primary or nothing.
How Social Security Determines You Have A Higher Premium
Social Security uses the most recent federal tax return the IRS provides to us. If you must pay higher premiums, we use a sliding scale to calculate the adjustments, based on your modified adjusted gross income . Your MAGI is your total adjusted gross income and tax-exempt interest income.
If you file your taxes as married, filing jointly and your MAGI is greater than $176,000, youll pay higher premiums for your Part B and Medicare prescription drug coverage. If you file your taxes using a different status, and your MAGI is greater than $88,000, youll pay higher premiums , for an idea of what you can expect to pay).
If you must pay higher premiums, well send you a letter with your premium amount and the reason for our determination. If you have both Medicare Part B and Medicare prescription drug coverage, youll pay higher premiums for each. If you have only one Medicare Part B or Medicare prescription drug coverage youll pay an income-related monthly adjustment amount only on the benefit you have. If you decide to enroll in the other program later in the same year, and you already are paying an income-related monthly adjustment amount, well apply an adjustment automatically to the other program when you enroll. In this case, we wont send you another letter explaining how we made this determination.
Remember, if your income isnt greater than the limits described above, this law does not apply to you.
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Do You Have To Take Medicare If You Have Other Insurance
You do not have to take Medicare if you have other insurance, and youâre actually exempt from penalties. That means that if you want to switch to Medicare after youâre 65, you donât have to pay a penalty for waiting.
The most common example is an individual who waits to retire. He or she has group coverage through their employer, so they donât need Medicare. As soon as they retire, theyâre free to sign up for Medicare without paying any of the penalties.
As long as you have some kind of health insurance coverage â even if youâre over age 65 â you canât be penalized when you do decide to make the switch to Medicare.
If youâd like a Medicare specialist to help you one-on-one, schedule a free Medicare planner with one of our licensed agents. Call our team at 833-801-7999.
Asking Employer About Your Obligation To Medicare Enrollment
As a result, its critical to inquire with your employer about whether youll be obliged to enrol in Medicare when you turn 65 or if youll be eligible for Medicare based on your disability. If thats the case, find out how the employers plan will interact with Medicare.
If not, request a written ruling.
In this case, enrolling in Medicare Part B while still having employer-provided coverage will not impair your ability to get Medigap supplemental insurance once your work ends. You have the right to acquire Medigap with full government protections if you buy it within 63 days of your employers coverage expiring if Medicare is your primary insurance.
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If Your Income Has Gone Down
If your income has gone down due to any of the following situations, and the change makes a difference in the income level we consider, contact us to explain that you have new information and may need a new decision about your income-related monthly adjustment amount:
- You married, divorced, or became widowed.
- You or your spouse stopped working or reduced your work hours.
- You or your spouse lost income-producing property because of a disaster or other event beyond your control.
- You or your spouse experienced a scheduled cessation, termination, or reorganization of an employers pension plan.
- You or your spouse received a settlement from an employer or former employer because of the employers closure, bankruptcy, or reorganization.
If any of the above applies to you, we need to see documentation verifying the event and the reduction in your income. The documentation you provide should relate to the event and may include a death certificate, a letter from your employer about your retirement, or something similar. If you filed a federal income tax return for the year in question, you need to show us your signed copy of the return. Use Form Medicare Income-Related Monthly Adjustment Amount Life-Changing Event to report a major life-changing event. If your income has gone down, you may also use Form SSA-44 to request a reduction in your income-related monthly adjustment amount.
