Turning 65?

Five things to know about Medicare...

1. You are eligible for Medicare at age 65 even if you are not collecting Social Security or still working.

2. There are many parts of Medicare including A, B, C and D. They affect you differently.

3. There may be penalties if you miss the enrollment deadlines.

4. Medicare only covers about 80% of your medical costs. What about the other 20%?

5. You may need additional coverage to help pay for your prescription drugs.

Medicare eligibility

1) Are you eligible for Medicare?

At age 65, you are eligible for Part A, B, C and D of Medicare, even if you are not collecting Social Security or still working. In many situations, there may be penalties if you fail to enroll in Medicare.

Enrolling in Medicare does not affect your Social Security benefits. You can be enrolled and using Medicare benefits before you start Social Security. For more information, go to socialsecurity.gov or call Social Security at 800-772-1213.  You can also find information on medicare.gov or call Medicare at 1-800-633-4227.

If you are still working and using your employer's benefits, you should look into your Medicare options, because they may have better coverage and benefits at a lower cost. Medicare and the additional Medicare coverages were created with seniors in mind.

If you have been on Social Security disability for a minimum of 24 months, you may be eligible for Medicare, even if you are not 65. To see if you qualify, check with Social Security by calling 1-800-772-1213.

Parts of Medicare

2) There are four different parts to Medicare including A, B, C and D. The two major parts of Original Medicare are Part A and Part B.

Part A is for your hospitalization coverage when you are an inpatient at a hospital.  This includes room and board and tests administered by the hospital, and up to 100 days at a nursing home for a temporary stay. There are deductibles and co-insurance associated with Part A, so make sure you are familiar with these.  Usually, there isn't a monthly premium charge for Part A, because you or your spouse already paid payroll taxes for Medicare while you worked.

Part B helps cover doctor's visits and outpatient care. It also helps pay for services Part A doesn't cover including occupational and physical therapy and some healthcare services. Preventative exams, testing and medical equipment are examples of Part B coverage. Typically, there is a monthly premium for Part B.  This can change annually and can be affected by income. There are deductibles with Part B, and usually your responsibility can be from 20 to 50%. You can offset these costs with a supplemental Medicare health plan.

Part C is offered through private insurance companies and is better known as Medicare Advantage Plans. These plans would become your primary insurance before Original Medicare and would pay the doctors and hospitals directly. Under a Part C plan, one company covers doctors, hospitals and can cover prescription drugs. In most cases you pay co-pays for services that you receive instead of deductibles and co-insurances. You pay an additional premium for these plans.

Part D is for prescription drug coverage. Part D plans are offered by private insurance companies but regulated by the rules of Medicare.

Enrollment Deadlines

3) There are enrollment deadlines that you must meet when enrolling into Medicare, or there may be penalties. You usually are enrolled in Medicare Part A when you are first eligible at age 65.

If you want to enroll in Part B when you are first eligible, you can enroll online or call or visit your Social Security office. The eligibility timeframe for someone turning 65 covers seven months. It starts three months prior to your 65th birthday, the month of your birthday and during the three months after your 65th birthday.

The other insurance that you may want to enroll in is Part D, which is governed by Medicare and sold through private insurance carriers. It is in your best interests to understand the rules about enrollment deadlines to avoid potential penalties.

Medicare only covers about 80% of your medical costs.

4) Medicare was never intended to cover 100% of medical costs. In general, Original Medicare covers about 80% so there are some ways to help you with the other 20%.

If Original Medicare has 80% coverage, why do you need more insurance coverage than that? If you had an accident or major illness that costs $100,000, $300,000, or $500,000, paying the 20% would be your responsibility. With a Medicare Supplement, Advantage, or Cost Plan, that 20% could be eliminated or minimized.

The following types of Medicare health Plans can help you pay the bills that are not paid by Medicare.

Medicare Supplements – These type of plans will pay all or part of your deductibles and co-insurances in conjunction with Medicare.

Medicare Cost Plans– Available in Minnesota, these plans will pay all or part of your deductibles and co-insurance in conjunction with Medicare.

Medicare Advantage Plans – Available in Minnesota, these plans will pay part of your deductibles and co-insurance in place of Medicare.

Prescription Drug coverage, is also known as Part D.
This will help cover the cost of your prescription drugs.

5) Under Original Medicare, there is no prescription drug coverage. If you want insurance coverage to help pay for prescription drug costs, you will need a Part D plan.

Medicare writes the rules for Part D, and the private insurance companies follow those rules. It is important to review the Part D plans available that best fits your needs. Our agents can help assist you select your plan. It is in your best interests to understand the rules about enrollment deadlines to avoid potential penalties.