Making Medicare Easy

Turning 65

I’m turning 65, what are my options?

 

Stay on your employer’s plan.

Increasingly, many seniors work past their 65th birthday, when they first become eligible for Medicare. If you or your spouse is actively working at a company with at least 20 or more full-time workers AND you get health insurance through them, you can delay enrollment in Part B & D and get it later on when you retire or if you lose your job related insurance. Make sure you and your employer agree that you meet these terms. Check with your office HR department to make sure the coverage is considered suitable for Medicare.


Original Medicare

Medicare Part A and Medicare Part B are often referred to as Original Medicare. Original Medicare is managed by the federal government and provides Medicare eligible individuals with coverage for and access to doctors, hospitals, or other health care providers who accepts Medicare. It is a fee-for-service plan, meaning that the person with Medicare usually pays a fee for each service. Medicare pays its share of an approved amount up to certain limits, and the person with Medicare pays the rest.

  • For Part A – you will pay a deductible if hospitalized, currently $1,316 per benefit period.

  • For Part B - you will pay a Monthly premium of $135 (can vary based on income), as well as a $183 deductible per year

  • Once deductibles have been met Medicare will then pay 80% and you will pay 20%.

  • There is no cap or limit on what you could be responsible for paying each year when you choose original Medicare.

  • You will have to purchase a Part D prescription Plan.


Medicare Supplement Plan (Medigap)

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There are 10 different Medigap policies, all designated with letters—A, B, C, D, F, G, K, L, M, and N. (Keep in mind that the letter of these Medigap plans are in no related to Parts A,B,C, and D of Medicare). Plan F is the most complete and most popular Medigap plan. In 2014, 56% of Medicare beneficiaries were enrolled in Medgap Plan F.1 Plan F covers nearly all the costs someone enrolled in Original Medicare might be responsible for, including Medicare Part B excess charges. Plan F also tends to be the most expensive because of the amount of coverage it provides. Along with a Medigap plan you will still be required to pay the Part B premium of $135/m. You will also have to enroll in a Part D prescription plan (national average premium of $33/m.

What does it not cover?

Even though it’s the most comprehensive Medigap plan available, there are still a few things that Plan F doesn’t cover:

  • Hearing aids and related services

  • Eyeglasses and related services

  • Dental care

  • Private nursing

  • Long-term custodial care

  • Part D - Prescriptions

These health care services are not covered by any Medigap plan because they are not covered by Original Medicare. If you need coverage for one or more of these, you can purchase additional private insurance or switch to a Medicare Advantage plan that offers coverage for them. Medicare Advantage plans are offered by only private insurance companies, and they combine Medicare Part A and Part B with additional benefits and coverage, such as dental or vision coverage.


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Medicare Advantage (Part C)

If you currently are enrolled in Original Medicare, Part A and Part B, you can choose to enroll in Medicare Part C, more commonly known as Medicare Advantage. Medicare Advantage plans are offered by private health insurance companies to provide and coordinate Medicare Part A and Part B benefits (hospital and medical) for beneficiaries. They are referred to as “all in one” Medicare coverage

  • Includes Parts A, B, and most of the time D

  • May include additional benefits such as vision or dental

  • There may be a monthly premium in addition to the part B premium ($134/m)

  • Advantages

    • Offered only by private insurance companies that have contracts with Medicare to provide these services.

    • There is a yearly limit on what you could pay out-of-pocket.

    • Protected in the event that you are a significant health situation

    • You avoid the added cost of a Medicare Supplement Plan.

Medicare advantage plans Increased in popularity by 33% since 2017, with over 19 million people in US are enrolled in Medicare advantage plans. They have become popular because the out-of-pocket costs are typically lower in a Medicare Advantage plan. So, this option may be more cost effective for you, especially when you consider that there are $0 premium plans.


Which plan is right for you?