What You Need To Know About Medicare The Basics
If youre one of the 10,000 people who become eligible for Medicare at 65 every day*, and are not sure what its all about, youre not alone. Heres a quick overview for you.
Original Medicare is the federal health insurance program started in 1965. It includes Part A, hospital insurance, and Part B, medical insurance. Its available to qualified people aged 65 and older, and those younger than 65 who qualify due to a disability.
Medicare covers many medical services, but in many cases, it comes with out-of-pocket costs to you. There are premiums, deductibles, copayments, and coinsurance amounts that you might need to pay.
- Medicare Part A generally covers inpatient hospital costs. Your out-of-pocket costs depend partly on how long you stay in the hospital and whether youve paid the Part A deductible. If you have worked for at least 10 years while paying Medicare taxes, you dont pay a premium for Part A.
- Medicare Part B may cover doctor visits, preventive care, durable medical equipment, and other medical services and items. Youll pay 20% of the Medicare-approved costs for many of these services. Most people pay a monthly Part B premium.
Original Medicare is the core of the program, but you might have other coverage options.
When Does Your Medigap Policy Coverage Begin
Once you receive your Medicare card, you can apply for a Medigap policy. Its best to apply as soon as you have your Medicare card. If you apply one to three months before your 65th birthday month, that will allow enough time for your application to be processed and will also ensure your Medicare Supplement Insurance coverage begins the same month that Medicare kicks in for you.
When Can I Enroll In Medicare Prescription Drug Coverage
Medicare prescription drug coverage is optional and does not occur automatically. You can receive coverage for prescription drugs by either signing up for a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes drug coverage, also known as a Medicare Advantage Prescription Drug plan. Medicare prescription drug plans and Medicare Advantage plans are available through private insurers. Please note that you cannot have both a stand-alone Medicare prescription drug plan and a Medicare Advantage plan that includes drug coverage.
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Special Note About Automatic Medicare Enrollment
You are automatically enrolled in only Part A and Part B at age 65 if you are receiving Social Security or Railroad Retirement Board benefits. You still will want to use your IEP to make further coverage choices such as for a Medicare Advantage or Part D prescription drug plan.
If youre not receiving these benefits, you will need to sign up for Medicare yourself online, in-person, on the phone or at your local Social Security office.
A Filled Doughnut Hole For Medicare Part D
In 2020 the dreaded Part D “doughnut hole” was filled. That hole is a coverage gap in which you used to face much higher out-of-pocket costs for your drugs, but that is no longer the case. For 2021, when the total amount your plan has paid for drugs reaches $4,130 then you will pay 25% of any additional costs. Prescription drug manufacturers pick up 70% while insurers pay 5%.
Catastrophic coverage, with the government picking up most costs, begins when a patient’s out-of-pocket costs reach $6,550, the maximum spending limit for beneficiaries in 2021, which is $200 higher than 2020s cap. Any deductible paid before you entered the doughnut hole counts toward that annual maximum as does the 25% you contributed while in the doughnut hole and the 70% that pharmaceutical companies paid on your behalf.
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Do I Have To Sign Up For Medicare If Im Still Working At 65
If you are receiving health insurance through your employer, you can choose to delay your Medicare Part B without being penalized. When your group coverage or private insurance coverage is ending, dont forget to apply for Medicare Part B. Even if you choose to delay your Part B, we suggest you still take out your Medicare Part A when you turn 65.
Dont be afraid to ask questions. Before signing up with a Medicare plan, know what will be covered and what the projected cost of your health needs will be for the year. Caress Insurance Agency, Inc. has agents in San Diego County, and we work with Mercy Scripps Hospital to help answer your Medicare questions and provide you with the latest information on your Medicare Insurance Plans.
Use our online tool to easily compare plans and get a custom quote tailored to your unique needs: !
- 550 Washington St., Suite 841San Diego, CA 92103
Sign Up For A Mymedicaregov Account
After you sign up for Medicare, you can create a MyMedicare.gov account to manage your coverage.
With your MyMedicare.gov account, you can:
- Get details about the plans youre enrolled in and what they cover.
- Update your personal information.
Creating an account on MyMedicare.gov is quick and easy.
How to Sign Up for MyMedicare.gov
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Am I Automatically Signed Up For Medicare When I Turn 65
The short answer is no, unless you are already receiving Social Security or Railroad Retirement Board benefits. If youre already receiving those benefits, youll receive your Medicare card in the mail before your 65th birthday.
Otherwise, youll have to sign up for Medicare on your own and you may or may not be notified about your eligibility. Thats why it is even more important to know your Initial Enrollment Period dates so you are ready to enroll when its your time.
Signing Up For A Medigap Policy
To purchase a Medigap supplement insurance policy, you must first enroll in Medicare Part A and Part B.
Medigap policies are not required but enrolling in one can help you pay out-of-pocket costs, including deductibles, coinsurance and copayments.
The best time to enroll in a Medigap plan is when you are first eligible.
This is a six-month enrollment period that begins the month youre 65 and enrolled in Medicare Part B.
If you apply for Medigap coverage after this six-month window, private insurance companies may not sell you a policy if youre in poor health.
You can find a Medigap policy by using an online tool on the Medicare website, contacting your local SHIP or calling your State Insurance Department.
How to Sign Up for a Medigap Policy Online
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Information And Documents You Need To Enroll In Medicare
Getting ready to enroll in Medicare? You can do that online. But, first, if you don’t have one, you must establish a My Social Security account. In some cases, you may need to prove your identity, age, and citizenship. According to the Social Security website, here are the documents you may need:
- Your birth certificate or other proof of birth
- Proof of United States citizenship or legal residency, such as a passport
- Driver’s license
It would be a good idea to establish this account before you’re ready to enroll. If there are issues confirming your identity, it may take time or a visit to your local Social Security office.
Then, when it’s time to enroll, once the account is established, you may need additional information to answer the questions.
- Your Social Security card, if you are already receiving benefits
- Health insurance information about the type and dates of coverage
- Information about your employment, such as a W-2 form, if you are still working
- US military discharge papers if you served before 1968
If you sign up for Medicare online or by phone, you may need to submit additional information. Social Security will let you know if you need to do this and what that information might be.
Learn more:
Applying For Medicare By Phone
Just like applying online, applying for Medicare by phone is easy. You can contact a representative at 1-800-772-1213.
Depending on the volume of calls, there might be a wait time. If the wait time is above average, you can schedule an appointment to have a representative call you.
The only downfall with applying for Medicare by phone is that it can take longer compared to online. If youre ahead of the game and start well before your birthday, then applying by phone shouldnt cause any issues. If you do not wish to apply online or by phone, you can choose to do so in person.
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You Can Supplement Medicare With A Medigap Policy
If you can afford it, it is possible to supplement Medicare with a Medicare Supplement Plan, or Medigap Policy. These plans will help cover expenses like:
- Coinsurance
- Co-payments
- Deductibles
What else do you want to know about Medicare? What has the Medicare application process been like for you? Wed like to hear your experiences in the comments below.
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There’s Medicare Part A Part B Part D Medigap Plans Medicare Advantage Plans And So On We Sort Out The Confusion About Signing Up For Medicare
Heading into retirement brings a slew of new topics to grapple with, and one of the most maddening may be Medicare. Figuring out when to enroll in Medicare and which parts to enroll in can be daunting even for the savviest retirees. There’s Part A, Part B, Part D, medigap plans, Medicare Advantage plans and so on. And what the heck is a doughnut hole, anyway?
To help you wade into the waters of this complicated federal health insurance program for retirement-age Americans, here are 11 essential things you must know about Medicare.
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How To Enroll In Medicare Online
To be clear, you dont have to sign up for Medicare online. You can do so over the phone or in person, but if youre looking to save time, completing an online application is probably the best way to go.
The first step in enrolling in Medicare online is creating an account on the Social Security Administrations web site. You do not need to sign up for Social Security at the same time as Medicare, so if thats not your plan, worry not. Youll be asked whether you wish to enroll in one program or both during the signup process.
Next, youll need to provide some basic information like your name, address, and telephone number, and youll also need your Social Security number to complete your application. In addition, youll need information that helps identify you, such as your birth certificate, drivers license, or proof of U.S. citizenship if you werent born in the U.S. If youre not a citizen, youll need your permanent resident card number.
When Do I Sign Up For Medicare Advantage
Before you sign up for Medicare Advantage, make sure you weigh the pros and cons of Medicare Advantage vs. Medicare Supplements. If you choose to sign up for Medicare Advantage, you can do so during your IEP.
If you missed your IEP, you can join during the Medicare Annual Enrollment Period. For those currently enrolled in a Medicare Advantage plan, you also have another opportunity to make changes during the Medicare Advantage Open Enrollment Period.
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How To Get The Care You Need At The Lowest Cost
by Dena Bunis, AARP, October 9, 2019
En español | There’s no getting around it. Medicare is a complicated program and every decision you make will have consequences for your health and your wallet. To help you get the most out of your benefits whether you are signing up for the first time or taking stock of your choices during open enrollment AARP interviewed experts for their advice on how to get the most out of Medicare.
Medicare Advantage Can Bundle Your Health Care
Medicare Advantage plans, also known as Medicare Part C, are Medicare-approved plans from private insurance companies that bundle your Part A and Part B coverage with other benefits. This is usually prescription drug coverage, but Medicare Advantage plans can also include many vision, hearing and dental benefits that Original Medicare does not.
Medicare Advantage plans are all-in-one, more like traditional insurance, but they come with less flexibility. You may pay lower out-of-pocket costs for most services, but higher fees if you want to see a specialist out of your network. Depending on your location and individual health care needs, this may be a good option.
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Sign Up: Within 8 Months After You Or Your Spouse Stopped Working
Your current coverage might not pay for health services if you dont have both Part A and Part B .
Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
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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How To Apply For Medicare
Medicare enrollment is easier than ever. Once you meet eligibility requirements, you are ready to choose from a variety of plans in which to enroll. As we mentioned earlier, some beneficiaries can receive automatic enrollment, and some have to apply manually.
There are three ways to apply for Medicare Part A and Part B:
If you have previously been a railroad employee, you can enroll in Medicare by contacting the Railroad Retirement Board, Monday Friday, from 9:00 AM 3:30 PM at 1-877-772-5772.
Medicare applications generally take between 30-60 days to obtain approval.
Dont Register For Medicare Alone
If youre uncomfortable with applying for Medicare alone, we can help! Our services are completely free for you. If you would like an agent by your side when applying, contact us. We can walk you through setting up all your coverage, including Medicare, Medigap, Part D, and more.
Plus, when you use us to apply, you get unlimited support from our Client Service Team. That means if you have any issues with claims or appeals, we can help at no additional cost. You can compare rates online or give us a call today at the number above.
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High Incomers Pay More For Medicare
If your income is above a certain threshold, you’ll pay more for Parts B and D. These surcharges are based on your adjusted gross income from two years earlier. In 2021, single filers who made more than $88,000 paid a premium ranging from $207.90 to $504.90 per month depending on their income. The standard premium in 2021 was $148.50. The income thresholds, the standard premium and the surcharges haven’t been set yet for 2022.
For Part D coverage in 2021, single filers who made more than $88,000 paid an extra $12.30 to $77.10 per month, depending on their income.
Everything You Need To Know About Medicare
Medicare is a critical component of healthcare, and its an essential piece of millions of peoples lives. With 44 million Americans currently on Medicare and more signing up each year this health insurance program funds many health and medical needs¹.
But Medicare can be confusing. With coverage broken down into different parts and plans, and available supplemental coverage options, its tough to understand what, exactly, Medicare covers. If youre wondering what you need to know about Medicare, there are a number of important aspects.
Medicare is something of a mix-and-match health insurance program. Subscribers must choose between Original Medicare and Medicare Advantage plans, but you can also opt in to other types of coverage. Heres an overview of the different pieces of Medicare, and what they entail.
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You Automatically Get Medicare
- You should already have Part A and Part B , because you have ALS and youre already getting disability benefits.
- We mailed you a welcome package with your Medicare card.
Sign up for Part B if you live in Puerto Rico or outside the U.S.
- 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 after your Part A starts, you might have to wait to sign up and pay a monthly late enrollment penalty.
- 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.
