The A B C’s…and D of Medicare
Written by Julie Corcoran
Ask a senior what’s important to them, and somewhere at the top of their list is having reliable and affordable health coverage. They may be facing worsening health issues, visits to specialists and increased medications. This can add up to considerable expenses, and usually at a time when they are on a fixed income or wondering if their retirement savings will last. Most seniors understand that turning 65 equates to eligibility for Medicare, and as their 65th birthday approaches, they experience a constant barrage of Medicare mail, commercials and phone calls that leave them with a sense of urgency, but also with a great deal of confusion on how to make sense of it all.
At its core, Medicare was designed to help seniors access medical care while also helping to control their costs. It covers individuals aged 65 and over, individuals under 65 with certain disabilities, and individuals of all ages with end-stage renal disease. If you are confused about how Medicare works, you are not alone. Figuring out when to enroll in Medicare and which parts to enroll in can be intimidating for even the savviest retirees – but there is help.
First you need to understand the ABCs – and Ds – of Medicare. Think of these as building blocks of Medicare. At the foundation is original Medicare, which consists of Parts A and B.
Part A: Helps pay for hospital stays and inpatient care.
Part B: Helps pay for doctor visits and outpatient care.
Supplement (Medigap): Helps fill in the costs not covered by Parts A and B.
Neither of those cover prescription drugs. That’s where Part D comes in.
Part D: Helps cover prescription drugs.
Another option is Part C, commonly known as Medicare Advantage Plans. These plans are offered by private insurers and cover all the services of Medicare Parts A and B, but many also include prescription drugs and some limited dental, vision and hearing services.
Part C: Helps cover services of Medicare Parts A and B (you must still be enrolled in Part A and pay for Part B). For many, a Part C or Medicare Advantage Plan resembles group coverage similar to what they may have experienced during their working years.
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It’s certainly not an easy program to understand, but even in its complexity, Medicare successfully serves the needs of more than 60 million people, and that number is growing. The trick is understanding how to customize the program so that it fits your needs. At the heart of the Medicare challenge is understanding that Medicare is tailored to an individual. What may be the right coverage for your friend or family member may not be the right coverage for you. To help you make that determination, there are a few things to keep in mind.
Assess your medical needs. Think about your medical needs, the number of doctors you see and the medications you take. Are you relatively healthy, or do you have a chronic illness that has you visiting several specialists each year and undergoing multiple tests and procedures on a regular basis? Do you spend several weeks or months in another state? Your answers can help evaluate which Medicare options will service your needs.
Keep an eye on the calendar. Timing of Medicare enrollment is crucial. The enrollment window generally opens three months before the month of your 65th birthday and closes seven months later. There are exceptions to enrolling when you are 65, especially if you plan to keep working and have credible group coverage, but if you don’t understand this exception, missing the enrollment window can be costly. There is also an Annual Enrollment Period from October 15 to December 7, when Medicare recipients can make changes to their Medicare coverage that are effective for the coming January. In addition, you may switch Medicare coverage at any time due to special circumstances (such as moving to a different service area, receiving Medicaid assistance or loss of retiree health coverage).
Understand the costs. Medicare is not free, and recipients should expect to pay a monthly premium, deductibles and copays depending on the parts of Medicare selected. As mentioned above, even though Part A is free to most, the cost for Part B premiums is tied to taxable income. The higher your modified adjusted gross income, the higher your Part B premium. The same goes for your Part D premium.
Be wary of unsolicited phone calls. Unsolicited calls may result in your enrollment into a Medicare plan that you did not intend. Be careful when talking with a caller. If you did not ask them to contact you, you should end the call. Just as you would not give out your Social Security number, do not give out your Medicare number.
Work with an experienced Medicare agent. Working with a trusted and knowledgeable agent can save you time and money. A good agent listens to what is important to you, educates you on your options, and helps you select a plan that fits your needs. They can also help customize your options as your medical needs and financial resources change in the years ahead.
One such local agency is Easy Street Insurance. Specializing in Medicare for more than 25 years, their agents help you customize a Medicare plan that suits your needs. Meeting with their agents comes at no cost or pressure to you. In the process, you will gain an advocate that can partner with you in the years ahead, and help you navigate the ever-changing Medicare system.
For more on Easy Street Insurance, visit easystreetins.com.