What is Medicare?

 If you are just turning 65, you may be wondering, what is Medicare and how do I get my Medicare? Medicare is a national health insurance program under the Social Security Administration that provides low-cost health insurance for Americans 65 and older and for some younger people with disabilities.

Roughly 60 million people qualify for Medicare and that number continues to grow as Baby Boomers age.

The 3 Things to Know About Medicare

The first thing anyone turning 65 should know about Medicare is how critical it is to sign up for the plans that work best for you. Failing to do so can lock you into the wrong insurance for a year or more and cost you hundreds, maybe even thousands of dollars.

The second thing to know is that Medicare plans have a lot of complicated rules, benefits and drawbacks. It is difficult to sort through all the legal language and all the pros and cons yourself. That is why I always advise people turning 65 to contact me to serve as their guide and advocate.

My services are free to you. I earn a commission from the insurance company for helping you enroll. I make a living, and derive pleasure and fulfillment, by helping people choose the plans that match their needs.

The third thing to understand about Medicare is the alphabet soup of coverage. Let’s break it down simply:

Medicare Parts A & B – these are the original Medicare plans. Part A helps pay for hospital stays. Part B helps pay for doctor visits and other medical services. Part A is free. Part B has set premiums, deductibles and co-pays, usually less expensive than employer-provided health insurance, but not always.

Medicare Part C – also called Medicare Advantage. This combines Parts A & B and often adds other benefits, like dental, hearing, prescription drug and vision.  There is typically no added cost for this plan, so let’s talk and I’ll help you determine how it helps you.

Medicare Part D – prescription drug coverage was added in 2006.

Dual Special Needs Plan D-SNP – there is special Medicare coverage for individuals with disabilities and/or modest incomes. Special needs plans offer benefits and feature beyond original Medicare, such as transportation assistance and drug coverage without paying for Part D. If you qualify for a Special Needs Plan, you should claim it. What qualifies as a disability or modest income? The rules are complex, so let’s talk.

Medicare Supplement Insurance Plan – also called Medigap, it fills in the cracks where Medicare doesn’t provide coverage. Medigap can pay for coinsurance, co-payments and deductibles. Some policies cover health costs outside the U.S.  Medigap policies come with a premium, and they do not include vision, dental, hearing or over-the-counter products, transportation, personal emergency response systems and other benefits typically included in Medicare Advantage plans.

Consequently, the decision whether to purchase it depends on how and how much you use health care. I can help you determine whether this policy is useful to you.

Sifting Through the Many Options of Medicare

While each plan separately is complicated, the interplay among the plans is even more confusing. For example, a full Medicare Advantage Plan includes a prescription drug benefit. If you purchase a Medicare Advantage policy, you don’t need Part D, the prescription drug coverage.

Which is a better option – Medicare Part D alone or the more expensive Medicare Advantage Plan? That depends. Contact me and I’ll walk you through all your options.

Failing to sign up on time for Medicare can raise its cost to you. The window to enroll is three months before you turn 65 until three months after you turn 65. Failing to sign up in time can add an extra 10% to your Part B premium for each year-long period you go without coverage.

If you’re still working at 65, and you have coverage under a group health plan through an employer with 20 employees or more, you don’t have to enroll in Medicare right away. Nonetheless, I generally advise clients to at least enroll in Part A – hospital coverage – which is free. It can help pay for hospital costs that employer-provided health insurance may not.

People sometimes ask me, “can’t I just look up all my options online?” I wish them good luck with that. You certainly can try to do this yourself, if you have ample free time to sort thorough the many choices and considerations before you. Why bother when I can save you the headache and I don’t cost you an extra penny? It is very difficult to describe in one simple document all the complicated rules, each with exceptions, and the different pros and cons of literally hundreds of insurance plans from which you must choose.