By Tina Fader
It’s hard to believe there are 10,000 Baby Boomers turning 65 every day right now. Know someone? Here are some basic facts about Medicare, and a few things that are new.
Who is Covered:
If turning 65, one may apply for Medicare Part A and Part B, 3 months before or after one’s 65th birthday. One may qualify for Medicare Part A and Part B even if one chooses not to take Full Retirement Benefits (i.e. Social Security). Signing up late can affect costs, for example, penalties exist for signing up late for Part B or Part D (Prescription Drug coverage). Even if one doesn’t take any prescription drugs now, one should still sign up for Part D because there are late penalty fees to sign up later. In many cases, there are no premiums for Part D coverage.
What is Covered:
Medicare Part A is hospital insurance that helps cover hospital, skilled nursing, home health and hospice care. Medicare Part B is medical insurance that helps cover doctor visits, outpatient care and preventative services. It also helps to pay for services Part A does not cover, like occupational and physical therapy.
Part A and Part B covers much of the medical care, but not all, and one typically pays a deductible and coinsurance when it’s used. That is why many people buy coverage with benefits beyond those included in Medicare.
Medicare Part C is a Medicare Advantage Plan that covers everything that Parts A and B cover and often includes services at no additional cost and may include Prescription Drug coverage. You must have both Medicare Part A and B to join a Medicare Advantage Plan. Medicare Advantage Plans usually include extra benefits and services like fitness programs and gym memberships, mail delivery pharmacy access, health education programs, and a 24-hour nurse advice line, and may lower out-of-pocket costs. Also, one may be able to customize
the plan to meet needs with optional supplemental benefits such as dental and vision coverage, for an added cost.
Medicare Advantage Plan Types:
Health Maintenance Organization (HMO). A primary care physician arranges healthcare in the plan’s network.
Preferred Provider Organization (PPO). One can choose any provider, although may pay more for out-of-network providers.
Private Fee-For-Service (PFFS). More freedom to choose providers may be available, however, a network arrangement may still apply. Medicare Supplement plans can be purchased to go with original Medicare to help with some costs Part A and B don’t pay, like coinsurance and deductibles.
Special Needs Plans (SNPs). Medicare Special Needs Plans are available only to people with specific diseases or circumstances. These plans include tailored benefits, providers and drug Lists to meet the needs of members.
How the Plan Choices affect Costs:
Whether one chooses original Medicare or Medicare Advantage, one must pay Part A and B premiums. Medicare Advantage, Medicare Part D prescription drug coverage, and Medicare Supplemental Insurance may have additional premiums. The cost depends on the coverage chosen. The cost for a Medicare Advantage plan depends on whether the plan charges a monthly premium and pays any of the monthly Part B premium. Original Medicare and Medicare Advantage plans both cover routine services. Medicare Advantage Plans are required to cover everything that original Medicare covers, including coverage for services that Medicare considers medically necessary.
If one chooses a Medicare Advantage plan, one still has Medicare coverage. One simply chooses to receive Medicare benefits through a private insurance company. One may pay an additional premium for the extra services and benefits of a Medicare Advantage plan.
Annual Enrollment Period Begins October 1st
This is a special election period when Medicare beneficiaries can change plans for the following calendar year, between October 15th and December 7th, to become effective January 1, 2020. There are exceptions that may allow one to enroll outside of this period. Call with any questions, as the best time to make a change to the existing plan is coming soon, October 1st, 2019.
Tina Fader is a Licensed Health and Life Insurance Professional offering Medicare Advantage Plans, Medicare Supplemental Plans, Vision and Dental Plans for all ages, and Life Insurance. Tina Fader has been a local resident for 20 years serving the community and looks forward to helping anyone needing personal service or has questions needing answers. You can reach Tina for a confidential assessment at 850-368-8007 or e-mail at email@example.com.