Getting older can be a challenging experience.  The healthcare options available to you may seem confusing or unnecessary.  The inexperience you have in this new chapter coupled by ongoing health concerns create a recipe for disaster.  The best way to combat these fears is to know what your options are and how to sign up for them.   With age comes wisdom and knowing how to navigate the system will demonstrate your wisdom all the more.  Getting the coverage and protection that you need is much easier than it seems.  Here are 3 important parts of enrolling in Medicare that will help guide you through the process.

Timing- The biggest mistake seniors make when enrolling in Medicare is timing.  There is a small window in which enrollment is open.  This window is limited to the three months leading up to your 65th birthday, the month of your birthday, and the three months following your birthday.  Failure to enroll in the specified time frame can lead to penalties.  To avoid those fees, being proactive with the enrollment is the best way to get started.  This time is called the “First Enrollment Period,” which is self-explanatory.  Getting ahead of the enrollment period allows plenty of time to ensure that you feel comfortable with your coverage's prior to utilizing them.

Knowledge- Many seniors end up making a mistake because they feel vulnerable and don’t want to be taken advantage of.  The best way to combat this is through educating yourself on your options.  There are two parts to the enrollment.  The first part is Part A which is for long term care, hospice, and hospital stays.  The second part is Part B is for specific doctor’s appointments, outpatient visits, and medical supplies.  The two parts work together to keep you covered for the spectrum of situations.  There is a Part C which is an elective portion that supplements both A and B.  Think of Part C as the component that expands your options.  With Part A and Part B, you may find yourself limited in terms of physicians that accept Medicare.  Part C is through a separate private company that offers more options and a more thorough coverage portfolio.  Part B is a paid coverage meaning that you can decide you do not want that coverage but it does cause you to lose out on the benefits. Considering the benefit of having additional coverage in the event of an onset illness or accident is something to do by consulting with a reputable Medicare Part C affiliate. They can educate you on the benefit of having the additional protection that can ensure that your out of pocket expenses will be minimal when the time comes. There’s more that can be done than just crossing your fingers and hoping for the best. Keeping in mind the value that comes by having a small monthly premium to improve the quality and accessibility of care when needed will be impactful later on.   

Enrollment- Enrollment options vary but regardless, there’s an option for everyone.  The easiest way is attempting to enroll online.  If you have access to the internet on your phone, desktop, or laptop, you will be able to access the website to enroll in care.  On medicare.gov the process is outlined and the application can be filled out there.  The system on the government website is very user friendly and allows for a guided question and answer completion.  You can even check the status of your application after its been submitted through the website.  This avenue does help prevent unnecessary trips to the Social Security office and you can make corrections to the application online.  To ensure that it is completed, you can also track the status of your application for Medicare to verify what stage it is at and if there are any processing issues. This allows you the opportunity to often get ahead of anything that may come up should they require additional information or documentation from you.  If you do prefer to avoid the Social Security office but don’t feel confident about applying through their website, you can also apply by phone.  The Medicare Registration can be reached at 1-800-772-1213.  The office has hours of 7am to 7pm and service they provide will walk you through an application process.  Of course, you can take the old-fashioned way and head to the Social Security office and wait in line.  These processes all vary in the amount of time they can consume but the fastest process is generally over the phone or website.

 Preparation is key.  Now that you have a good understanding on the options you will need to select from, you will want to weigh these decisions out.  There are pros and cons to the coverage choices and realistically you want to pick out the one that fits best for you.  However, something to consider is that with age, comes additional health risks.  Rejecting valuable coverage can leave someone in financial ruin without insurance to pay the difference in cost.  By utilizing your knowledge of your needs, and with being proactive in your approach, you will be able to feel confident and empowered in your decisions.  Seeing your friends or family members impacted by a terminal condition or an ongoing health issue may have already led you to see this.  It is all the more important for you to consider your options.  Another benefit of Medicare is that each year you can adjust the coverage's from those you have selected the year prior.  Regardless of this opportunity, be careful to say, “maybe next year I’ll add Part C,” as the year passes, emergencies can arise. At this important juncture in your life, it is important that you feel poised to handle your own Medicare benefits without the fear of being taken advantage of.  The more you know, the better you can protect yourself.  Knowledge is power, and with age comes wisdom, so you’re likely to make the right decision with all that you’ve learned.

 

GETTING STARTED WITH MEDICARE

As you get started with Medicare, you have a choice in how you get your Medicare coverage. And there are some important decisions for you to make. Follow these 3 steps to help you get started:

1. Sign Up For Medicare Through Social Security

ENROLLING IN MEDICARE 

PARTS OF MEDICARE

Social Security enrolls you in Original Medicare (Part A and Part B).

• Medicare Part A (Hospital Insurance) helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care.
• Medicare Part B (Medical Insurance) helps pay for services from Doctors Visits and other Health Care Providers, Laboratory Costs, Medical Imaging (MRI's, CT scans & X-Rays), Outpatient Care, Home Health care, Durable Medical Equipment, and some preventive services such as Screenings.

Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.

• Supplemental (Medigap) policies help pay Medicare out-of-pocket co-payment, coinsurance, and deductible expenses.
• Medicare Advantage Plan (previously known as Part C) includes all benefits and services covered under Part A and Part B — prescription drugs and additional benefits such as vision, hearing, and dental — bundled together in one plan.
• Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs.

Most people aged 65 or older are eligible for free medical hospital insurance (Part A) if they have worked and paid Medicare taxes long enough. You can enroll in Medicare Medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read:

 

Medicare Premiums: Rules For Higher-Income Beneficiaries.

 

SHOULD I SIGN UP FOR MEDICARE PART B?

If you’re eligible at age 65, your initial enrollment period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday.

 There are a lot of things to understand and consider when it comes time to enroll in Medicare. For everyone, enrolling in Medicare Part A (Hospital Insurance) is no brainier.  It is free to 99% of those enrolling who have worked or had a spouse that worked at least 10 years.  Enrolling in Part B depends on your current Work situation and also believe it or not what type of Health Insurance you currently have.  Why does that matter?  Because Medicare views having Health Coverage from a company with more than 20 employees to be "Credible" coverage.  All other Health Care coverage is viewed as being non-credible by Medicare. Even if you have ACA/Obama Care Insurance it is not deemed as "Credible" by Medicare. So, at age 65, unless you are insured under you or your spouse's Employer Health Plan, you need to enroll in Medicare Parts A & B at age 65 to avoid any penalties.

If you choose not to enroll in Medicare Part B initially and then decide to do so later, your coverage could be delayed and you may have to pay a higher monthly premium for as long as you have Part B. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didn’t sign up for it, unless you qualify for a "Special Enrollment Period" (SEP).

If you don’t enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a “general enrollment period” from January 1 through March 31. Your coverage begins on July 1 of the year you enroll. 

If you have a Health Savings Account (HSA) or health insurance based on current employment, you may want to ask your personnel office or insurance company how signing up for Medicare will affect you.

 

SPECIAL ENROLLMENT PERIODS (SEP)

If you have medical insurance coverage under a group health plan based on your or your spouse's current employment, you may not need to apply for Medicare Part B at age 65. You may qualify for a "Special Enrollment Period" (SEP) that will let you sign up for Part B during:

• Any month you remain covered under the group health plan and you, or your spouse's, employment continues.
• The 8-month period that begins with the month after your group health plan coverage or the employment it is based on ends, whichever comes first.

 

HOW TO APPLY FOR JUST MEDICARE

If you are within three months of age 65 or older and not ready to start your monthly Social Security benefits yet, you can use our online retirement application to sign up just for Medicare and wait to apply for your retirement or spouses benefits later. It takes less than 10 minutes, and there are no forms to sign and usually no documentation is required.

 

MEDICARE CARDS

To help protect your identity, your Medicare card has a Medicare number that’s unique to you. If you did not receive your red, white, and blue Medicare card, there may be something that needs to be corrected, like your mailing address. You can update your mailing address by signing in to or creating your personal my Social Security account. Learn more about your Medicare card.

 

ARE YOU ALREADY ENROLLED IN MEDICARE?

If you already have Medicare, you can get information and services online. Find out how to manage your benefits.

If you are already enrolled in Medicare Part A and you want to enroll in Part B, please complete form CMS-40B, Application for Enrollment in Medicare – Part B (medical insurance). If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.

You have three options to submit your enrollment request under the Special Enrollment Period. You can do one of the following:

1. Go to “Apply Online for Medicare Part B During a Special Enrollment Period” and complete CMS-40B and CMS-L564. Then upload your evidence of Group Health Plan or Large Group Health Plan.
2. Fax your CMS-40B and employer-signed CMS-L564 to 1-833-914-2016.
3. Mail your CMS-40B and employer-signed CMS-L564 to your local Social      Security office.

 

Note: When completing the CMS-L564

• State on the form “I want Part B coverage to begin (MM/YY)” in the remarks section of the CMS-40B form or online application.
• If possible, your employer should complete Section B.
• If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employer’s signature and submit one of the following forms of      secondary evidence:
  • Income tax form that shows health insurance premiums paid.
  • W-2s reflecting pre-tax medical contributions.
  • pay stubs that reflect health insurance premium deductions.
  • health insurance cards with a policy effective date.
  • explanations of benefits paid by the GHP or LGHP; or
  • statements or receipts that reflect payment of health Insurance premiums.

You’ll have Original Medicare (Part A and Part B) unless you make another choice. You can decide to add a drug plan (Part D) or buy a Medigap policy to help pay for costs that Original Medicare doesn’t cover. You can choose to join a Medicare Advantage Plan (Part C) and get all your Medicare coverage (including drugs and extra benefits like vision, hearing, dental, and more) bundled together in one plan.

 Some people with limited resources and income may also be able to get Extra Help to pay for Part D drug costs.

 

WHAT HAPPENS AFTER I APPLY?

The Centers for Medicare & Medicaid Services CMS) manages Medicare. After you are enrolled, they will send you a Welcome to Medicare packet in the mail with your Medicare card. You will also receive the Medicare & You handbook, with important information about your Medicare coverage choices.
 

2. People get Medicare coverage in different ways. You'll   get lots of information to help you make a decision about how to get your Medicare coverage:

• An official "Welcome to Medicare" packet with important information about your coverage options.
• Your official "Medicare & You" handbook once you're enrolled and every year each fall.
• Mail from private insurance companies, agents and brokers, marketing the Medicare plans they offer.

 

THE TWO MAIN WAYS TO GET MEDICARE COVERAGE

Original Medicare – Includes Part A and Part B. You can use any doctor or hospital that takes Medicare, anywhere in the U.S.

• If you want drug coverage, you can join a separate Medicare Prescription Drug Plan (Part D).
• To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage like a Medicare Supplement Insurance Plan or Medigap policy.

 

If you don't get Part D or a Medigap policy when you're first eligible, you may have to pay more to get this coverage later. For Part D, this could mean a lifetime premium penalty.

Medicare Advantage – An "all in one" alternative to Original Medicare. These "bundled" plans include Part A, Part B, and usually Part D. Most plans offer extra benefits that Original Medicare doesn't cover – like vision, hearing, dental, and more.

• Plans may have lower out-of-pocket costs than Original Medicare.
• In most cases, you'll need to use doctors who are in the plan's network.

If you have Medicare and other health insurance or coverage, each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decides which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" to pay. In some cases, there may also be a third payer.

 

• The insurance that pays first (primary payer) pays up to the limits of its coverage.
• The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover.
• The secondary payer (which may be Medicare) may not pay all the uncovered costs.
• If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.

If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should've made.

 

If your questions about who pays first, or if your coverage changes, call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY: 1-855-797-2627). Tell your doctor and other health care provider about any changes in your insurance or coverage when you get care.

 

Medicare is very strict about when you can and need to enroll in or change your Medicare Coverage.  If you have Employer Coverage for example, you're fine as it is considered Credible Coverage.

• Unless you are enrolled in Medicare Part B during your IEP, you will most likely be subjected to paying a late enrollment penalty. This can hurt because all late enrollment penalties continue as long as you have Medicare Coverage.  The Late Penalty is 10% for each year that you should have had Part B coverage but didn't. The standard premium for Part B is $148.50 in 2021, which means you’ll pay an extra $14.85 every month. This will increase if the standard Part B premium goes up next year, which it likely will. You’ll pay this penalty even if you ultimately choose to enroll in a Medicare Advantage Plan.
• You might have to continue with no Part B for a long period of time. If you fail to enroll in Medicare Part B during your IEP, you will not be able to enroll until the General Enrollment Period, or GEP. This means your coverage won’t start until July 1 that year.
• If you don’t have creditable Part D prescription drug coverage and miss your IEP, you’ll pay a penalty with your Part D premium—again, as long as you have the coverage. The penalty is 1% per consecutive month that you went without coverage for prescription drugs. The national base premium is currently about $36 per month, so if you go without coverage for a year, you’ll pay an extra $4.30 a month, and probably will even pay a little more if the Part D base premium increases. And this penalty will be in force as long as you have Part D coverage.

 

Most Medicare beneficiaries who are still working have group coverage through an employer or an employer's union plan.  This allows you to delay enrollment in Part A and/or B without penalties.  When you retire, you can sign up for those Parts during a Special Enrollment Period (SEP). Medicare credits you for having employer group coverage at any large employer (20+ employees.)
Later when you retire, you will be eligible for a 63-day Special Enrollment period to sign up for Parts A and/or B with no late enrollment penalties.
The Medicare Special Enrollment Period is an eight-month period that begins either the month you or your spouse quits working or the month your group coverage ends, whichever comes first.

 

If for some reason you missed or forgot to enroll in your Initial Enrollment Period (IEP) you will have to wait to enroll in the General Enrollment Period (GEP). This runs from January 1 through March 31 each year.
Even though you can enroll in Original Medicare during this time, you are still subject to the late enrollment penalties. However, in most cases your new Medicare coverage will not go into effect until July 1st, meaning you might have an extended period with no Insurance.
Keep in mind that the General Enrollment Period only applies to Original Medicare. If you want a Medicare Advantage plan or Medicare Part D coverage for prescription drugs, you’ll have to wait for the Annual Enrollment Period. From October 15 through December 7th.

Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

• Co-Payments
• Coinsurance
• Deductibles

Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care whenever you travel outside of the US. If you have Original Medicare and you buy a Medigap policy, here's what happens:

• Medicare will pay its share of the Medicare Approved Amount for covered health care costs.
• Then, your Medigap policy pays its share.

 

8 THINGS YOU NEED TO KNOW REGARDING MEDIGAP/MEDICARE SUPPLEMENTS

1. You must have Medicare Part A and Medicare Part B.
2. A Medigap policy is different from a Medicare Advantage Plan.  Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
3. You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
5. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.
7. Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006, aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Part D (Prescription Drug Plan).
8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you're switching back to Original Medicare.
9.  

Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

 

Some types of insurance aren't Medigap plans, they include:

• Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
• Medicare Prescription Drug Plans
• Medicaid
• Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
• Tri-Care
• Veterans' benefits
• Long-term care insurance policies
• Indian Health Service, Tribal, and Urban Indian Health plans

 

You may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage). Or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage. If you decide to drop your entire Medigap policy, you need to be careful about the timing. When you join a new Medicare drug plan, you pay a late enrollment penalty if one of these applies:

• You drop your entire Medigap policy, and the drug coverage wasn't credible prescription drug coverage
• You go 63 days or more in a row before your new Medicare drug coverage begins

 

Medicare doesn't pay any of the costs for you to get a Medigap policy. You have to pay the premiums for a Medigap policy.

 

In most Medigap policies, the Medigap insurance company will get your Part B claim information directly from Medicare. Then, they pay the doctor directly. Some Medigap insurance companies also provide this service for Part A claims.
If your Medigap insurance company doesn't provide this service, ask your doctors if they "participate" in Medicare. This means that they "accept assignment" for all Medicare patients. If your doctor participates, the Medigap insurance company is required to pay the doctor directly if you request it.

 

Insurance companies may charge different premiums for the same exact policy. As you shop for a policy, be sure you're comparing the same policy. For example, compare Plan A from one company with Plan A from another company. In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. If you buy a Medicare SELECT policy, you have the right to change your mind within 12 months and switch to a standard Medigap policy. The Medicare Advantage Open Enrollment Period

 

Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Your Medicare services aren’t paid for by Original Medicare. Below are the most common types of Medicare Advantage Plans. 

• Health Maintenance Organization or HMO Plans
• Preferred Maintenance Organizations or PPO Plans
• Private Fee for Service Plans or PFFS Plans
• Special Needs Plans or SNP's and Dual Special Needs Plans or D SNP's

 

The late enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:

• A Medicare Prescription Drug Plan (Part D)
• A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage
• Credible prescription drug coverage.

 

1. Join A Medicare Drug Plan When You're First Eligible.
You won't have to pay a Part D late enrollment penalty, even if you've never had prescription drug coverage before.

2. Don't Go 63 days Or More In A Row Without Medicare Prescription Drug Coverage Or Other Creditable Drug Coverage.
Credible prescription drug coverage could include drug coverage from a current or former union employee, TRICARE, Indian Health Service, the Department of Veteran's Affairs, CHAMP VA, or health insurance coverage. Your prescription drug plan must tell you each year if your drug coverage is creditable coverage. They may send you this information in a letter, or draw your attention to it in a newsletter or other piece of correspondence. Keep this information because you may need it if you join a Medicare drug plan later and want to avoid the Part D late enrollment penalty.

3. Keep Records Showing When You Had Creditable Drug Coverage, And Tell Your Plan About It.
When you join a Medicare drug plan, the plan will check to see if you had creditable drug coverage for 63 days or more in a row. If the plan believes you didn't, it will send you a letter with a form asking about any drug coverage you had. To avoid a Part D penalty, complete the form and return it to your drug plan by the deadline in the letter. If you don't tell the plan about your creditable drug coverage, you may have to pay a Medicare Part D late enrollment penalty. Are there company policies that are particularly important to your business? Perhaps your unlimited paternity/maternity leave policy has endeared you to employees across the company. This is a good place to talk about that.