Turning 65 in Maryland entitles you to opt into Medicare insurance and most of the time it is beneficial to do so. However, Medicare can be extremely confusing and most information you find is outdated or very misleading at best.
There are several steps you need to take when considering joining a Medicare plan when you turn 65. Here are a few of the most important things to consider when turning 65 and looking to enroll into a Medicare plan.
Current Coverage From An Employer, Union, Spouse, Government Plan
You may not need to enroll into Medicare (or Medicare Part B) if you have coverage from your current employer, spouse, government or union plan that will allow you to continue coverage after you turn 65.
Most companies realize that your cost of insurance skyrockets after you turn 65, so they will not offer any continuation of coverage. However, there are plans out there and companies that will allow you to continue your coverage well past your 65th birthday and the cost of this coverage might be worth you staying where you are.
A general rule of thumb is the $300 mark. If you will spend more than $300 per month with your current employer, spouse, government, union plan, then you should consider entering the Medicare market and taking full advantage of the fact that will have much coverage and benefits for less money each month. Consult with the human resources department to determine what your costs will be if you stay put after you turn 65.
When I work with clients the average price to have full Medicare coverage is around $300 per month. This includes all major medical including doctor and hospital visits as well as worldwide emergency and urgent care visits. It also includes coverage for your prescription drugs. However there are cases in which your Medicare cost could be slightly higher due to the fact that you are a high income earner. You can reference the chart below to see if you would trigger any Medicare high income earner penalties inside of the Medicare system.
Doctor And Specialist Preferences And Freedom Of Choice
There are many options when selecting a Medicare plan but first you really need to determine what type of selection and freedom you want.
Determining this prior to meeting with a broker is extremely helpful in deciding what type of plan you will actually enroll in.
Because Medicare is a completely separate system of healthcare there are many rules that do not apply to what you are normally used to, and there are many rules that you now need to understand and follow to get the most out of your Medicare insurance.
Determining if you like staying within a specific network of doctors or if you like the freedom to choose anyone at any time is a major factor in determining which type of plan you will ultimately purchase.
You should discuss this with your broker as they can give you multiple different options with either choice.
Typically the general rule of thumb is if you enjoy a certain group of doctors within the same system, such as the University of Maryland or Johns Hopkins, then you may consider a Medicare advantage plan. If your doctors are spread out amongst various different doctor networks and you really like to choose your doctors in any doctor network at any time without a referral required, then you will probably enjoy a Maryland Medicare supplement plan. They both have their pros and cons and there is usually something for everybody.
Maryland offers many different Medicare insurance plans when turning 65 and using an experienced broker will help guide you to the best plan possible.
Prescription Drug Costs - Do You Really Need Coverage?
When you turn 65 Medicare insurance brings with it a whole different set of rules for both your medical coverage as well as your Medicare prescription drug coverage. These rules are universal regardless of which plan you select.
Providing your broker with a complete list of your current prescription medications is the best way to determine which plan will save you the most money for the remainder of the calendar year.
It’s quite shocking to see the price differences on the same medications from one plane to the next. Even when you compare Medicare advantage plans to standalone Medicare prescription drug plans, you will notice a significant price difference from one plane to the next.
These price discrepancies are further complicated by selecting various types of pharmacies from your local pharmacies to the big chain stores even to Costco Pharmacy or Sam’s Club. The price differences can be enough that they may sway your decision on which specific plan to select.
This complexity is exactly why you should work with a certified Medicare insurance broker that offers at least 10 different plans to ensure you are being offered the lowest priced plan with the most benefits as possible.
Each year Medicare changes the coverage limits and the deductibles in regards to prescription drug coverage. Currently the drug coverage deductible is $435 (for 2020). This deductible will reset on the first of every year and typically goes up year after year. This is why you should always have your broker shop for your Medicare insurance prescription drug plans every October or November to determine if it is smart to switch plans for the ensuing year.
Because the drug prices can be so different from one plane to the next and from one pharmacy to the next, do not rush into selecting a Medicare plan without fully discussing your prescription drug requirements with your Medicare insurance broker first.
And just remember that even though you may not be currently taking any medications, you are obligated to purchase and carry Medicare prescription drug insurance (Part D). There are some penalties if you fail to obtain coverage within 63 days of turning 65 or within 63 days of your Medicare part B Becoming active.
Some people may not be required to have Medicare prescription drug coverage due to what we call “ credible coverage“ from an existing employer, union, government plan or veterans administration benefits.
Those that receive state assistance from Maryland’s Medicaid program (HealthChoice) are required to obtain coverage, however, the monthly premiums are typically covered 100% by the state. Those on Medicaid typically receive lower prescription drug prices at set rates regardless of how expensive your medications actually are. There are no late enrollment penalty’s for people that are Medicaid qualified.
Medicare prescription drug plans can be complicated and have a lot of different rules surrounding them. This is why it’s critical that you work with an experienced Medicare insurance broker that offers a variety of different Maryland insurance plans.
Lifestyle, Budgets And Medical Requirements
The last thing we look at typically is one’s lifestyle, their budget and of course their medical requirements.
While most plans cover every major medical procedure you can comprehend, there are plans designed specifically to address certain elements such as COPD, ESRD, or those confined to a nursing home. These are typically Maryland Medicare Advantage Part C Plans.
Saving money is always the goal of most of my clients, so working within your budget is important. I typically tell my clients that they should budget about $300 per month to cover their basic Medicare insurance plans.
Is $300 can be broken down relatively easily in the following manner;
- $145 per month for Medicare part B premiums, this is paid directly to CMS and normally withdrawn directly from your Social Security benefits. If you are not collecting Social Security, then CMS will bill you on a quarterly basis for these monthly recurring premiums. Medicare part B premiums could be higher if you are a high income earner please see the chart here. Medicare part B premiums could be as low as zero dollars depending on your income and if you qualify for Medicaid.
- $20 per month for a Medicare prescription drug plan in the state of Maryland. This of course can vary greatly depending on what type of medications you take and which plan may ultimately be the least expensive. You do not need to pay this premium if you have credible coverage elsewhere, are on Medicaid, or if you join a Medicare advantage plan that has Medicare prescription drug coverage built into it.
- $150 per month is typically the monthy rate for a non-smoker in Maryland for Medicare supplement plan G. There are many other plans available but plan G is typically the most popular plan if you are born after January 1, 1955.
You can eliminate bullet points number two and three if you enroll into a Medicare Advantage Plan. The monthly premium for Medicare advantage plans in Maryland start at $0 dollars per month and can range upwards of $150 per month depending on the county and the type of coverage you desire.
If you are in great health and have the financial means to support a $6000 deductible, which you would only pay if you used a lot of medical services throughout the year, then there is one plan that will actually pay you approximately $3500 per year to be in their plan. It is a MSA Medicare savings account design for those looking to invest their money through Medicare savings account and are infrequent users of medical services.
As you can see your lifestyle, budget and medical requirements will really determine your overall price structure for your Medicare Plan in the state of Maryland. Use a Broker for best results.
Turning 65 allows you to access Medicare, but don’t get confused by all the miss information found online and on TV ads. Be sure you work with a local, knowledgeable licensed broker that works independently and is not associated with any one particular insurance carrier.
Avoid sales people that call you without you giving them permission first. They could be from a different state without the intricate knowledge of Maryland insurance plans, or they could be calling from out of country with a very limited set of certifications or permissions to sell you insurance.
There are tons of options in Maryland for your Medicare insurance options, working with a knowledgeable broker will help you find the best plan to fit your needs in the most efficient way possible.
If you’d like a free consultation or quote over the phone or in person please contact me directly at peterpalmiotto@gmail.com or call me direct at 410-896-1212.
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