Turning 65 shouldn’t be stressful.
Having the right Medicare information will help ease your transition into a wildly different health insurance system. The Medicare system has it’s own set of rules and regulations. From enrollment periods and mandatory coverage rules, to acronyms that will drive you crazy, Medicare isn’t the easiest thing to understand.
Follow A Simple Game Plan For A Smooth Transition
Working with a broker like myself will make your life much easier. I do this for a living and have helped 1,000’s of seniors since 2011. If you follow a simple game plan, you’ll be into a Medicare plan without any hassles, penalties or delayed coverage. Just keep these 4 steps in mind:
1 – Make Sure Medicare Is The Top Choice
Turning 65 typically means that Medicare insurance is your only choice. But for some seniors, staying with your employer’s plan may be more beneficial. First, make sure your employer or Union will allow you to stay on their plan past age 65. Secondly, make sure they won’t charge you more than $200 per month for their plan, if they do, it is simply not worth staying on their plan. Lastly, try to figure out if your monthly premiums will rise dramatically in the first few years. Some teacher’s unions only subsidize 65+ health insurance for the first two years, in year three, the monthly premium nearly triples, making Original Medicare a much better option.
If you or your spouse served in the Military, you may be entitled to Military insurance benefits either through the Veteran’s Health Care system (VA) or through Tricare For Life. You are allowed to have both VA Benefits and a Medicare insurance plan. These dual-benefits work together to offer the veteran additional network options, either with care provided by the VA or with care provided by a provider outside of the VA system. However, if you qualify for Tricare For Life (typically after 20 years of military service) then you do not need additional Medicare coverage. In fact, adding any Medicare plans on top of what Original Medicare offers will actually disrupt your Tricare benefits.
2 – Determine If You Need To Apply For Medicare Part B
Medicare is made up of two basic parts, Medicare Part A covers Hospital Benefits and Medicare Part B covers outpatient services. Here’s the issue, if you have not yet turned 65 and are already collecting Social Security benefits, then you don’t need to apply for Medicare A or B, the Social Security Administration (SSA) will automatically enroll you into both A & B.
If you have not yet turned 65 and are not taking your Social Security benefits yet, and you want to start Medicare when you turn 65, you will need to apply to be enrolled into Medicare Part B (the Social Security Administration will automatically send you Part A up to 90 days prior to your 65th birth month regardless of your status).
Turning 65 will automatically trigger you being enrolled into Medicare Part A. Your enrollment into Part B is determined by your current SSA benefits status. To enroll into Medicare Part B, you can sign up for Medicare online, or you can arrange an appointment by finding a local SSA office and meeting them in person, or you can download OMB No. 0938-1230 which is an APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE). You will need to drop this off at your local SSA office or mail it to them, which should be sent with a tracking number and some way to prove it was received. Enrollment takes at least 10 to 14 days and longer during busy times, so be sure you plan accordingly. You can apply for Medicare Part B enrollment up to 3 months prior to your 65th birth month.
3 – Don’t Miss Vital Medicare Deadlines
There are many deadlines that must be followed when entering Medicare. Here are some of the most important ones:
- Part B 90 Day Rule – File for Medicare B up to 90 days prior to your 65 birth month and up to 90 days after. If you miss this 7 month window, your coverage will be delayed by as much as a full year, including financial penalties. If you have sufficient credible coverage from an employer, you may not need to apply for Part B.
- Part D Mandatory Coverage – Obtain Medicare Part D (prescription drug plans) within 63 days of your Medicare Part B becoming effective. If you don’t have credible coverage or sign up for a PDP plan, then you will start incurring penalties and your coverage will be delayed.
- Loss Of Employer Coverage – Prior to losing your employer’s coverage, you should apply for Medicare Part B. However, once Part B starts, you’ll only have 63 days to enroll into a Part D drug plan or Part C Advantage Plan and up to 6 months to enroll into a Medicare Supplement Medigap Plan. Do not miss these guaranteed enrollment periods so you don’t have to answer any health questions.
4 – Understand Your Optional Medicare Insurance Plans
As you know, Medicare by itself doesn’t cover 100%. Original Medicare only covers about 80% of the Medicare allowed billable rates. So if that procedure costs $1,000 and you don’t have any other insurance to help pay for it, you may be billed up to $200 for that procedure. And since there are no spending limits (called Max-Out-Of-Pocket), if you end up in the hospital, the costs could skyrocket past your financial means. This is why it’s important to understand what options are available to you when you turn 65.
Turning 65 triggers several “additional” options for Medicare insurance such as Supplemental Gap Plans, Medicare Advantage Part C plans and Prescription Drug Plans (PDP). All of these have their pros and cons.
While I won’t go into great detail in this article about your Medicare gap insurance options, I will say that it’s best to call me for a free Medicare consultation. These plans offer something for everyone, and can be pretty robust in their benefits.
I can explain in simple terms what all your options are so you understand the scope of offerings. I’m licensed and authorized to sell all the different types of plans in Maryland and the surrounding states. I can be contacted directly at (410) 896-1212.
