With over 10,000 Americans turning 65 in the U.S. every day, the number eligible for Medicare coverage continues to grow at a rapid pace. There will be 88 million folks 65 and up by 2050 – and they will make up over 20 percent of the nation’s population.
In 2019, the most recent year for which statistics are available, over 61 million people enrolled in Medicare, a national healthcare program primarily for seniors. Close to 53 million qualified because of their age. The others became beneficiaries due to certain disabilities the program covers for those younger than 65.
If you’re a first-year Medicare beneficiary, here’s vital information you need to make the best possible coverage decisions.
Medicare doesn’t always start automatically
While Medicare does begin for some without them having to sign up, that’s not the case for others. For example, you’ll have to sign up yourself if you are close to or already 65, and you don’t collect Social Security benefits.
Helpful facts for newbies include:
- You can sign up or change coverage at certain times during the year.
- You can avoid a penalty by signing up for Medicare Part B immediately after you become eligible.
- You get to choose how you get coverage.
- You could be eligible for help paying for your Medicare coverage.
Turning 65 this year?
If your 65th birthday is coming up within the next three months and you aren’t receiving Social Security, you must sign up for Medicare Part A (hospital insurance) and Part B (medical insurance). You can apply online at Social Security, or by visiting your local Social Security office. And if you’ve already signed up for Part A but not Part B, you can complete a Part B enrollment application. They are available in English and Spanish.
As a new Medicare beneficiary, once you sign up, you’ll receive an information packet from Medicare. This will include a red, white and blue Medicare card.
And while there are additional steps you’ll need to take; you’ll never have to re-enroll in Medicare again. (You will have the option each year to change plans if you want. That’s why we are here. Contact us anytime with questions and to review options.)
First-year Medicare beneficiary coverage
Welcome to Medicare! It can be confusing, but there are actions you can take to understand your options and make the right choices.
If someone will be speaking to a Medicare representative on your behalf, there is an authorization form you’ll need to complete in order for them to be allowed to give another person health information about you.
Next, schedule a preventative care visit with your physician. Be sure the doctor accepts Medicare before you do this. That way, you will only have to pay any deductible or copayment, not bear the entire cost of the visit. However, a Part B deductible may apply if your provider performs additional tests or services during that visit, or if preventative service benefits don’t cover them.
What’s a preventative visit?
This is a time to review your medical history and current health. Your doctor will typically measure your height, weight, and blood pressure. You may undergo some screenings, get vaccinations as appropriate, and be assessed for depression and your physical safety.
Medicare & other coverage
You may have other health coverage in addition to Medicare. If so, there are guidelines about which one pays before the other. If Medicare is your primary, it will cover what it has agreed to pay. Any outstanding costs are forwarded to the second insurer.
Depending on your secondary health insurance, they may pay the remaining costs, or they may not.
If you have insurance through an employer, it is possible you’ll have to sign up for Medicare Part B before your insurance company will pay. Give us a call to discuss if you have questions.
Costs of Medicare Parts A and B
As we’ve already noted, this can be confusing for first-year Medicare beneficiaries.
If you chose Original Medicare, which comprises Part A and Part B, you may or may not have to pay a Part A premium. (Many people don’t because they paid a certain amount of Medicaid taxes during their working years.)
Most Medicare beneficiaries pay a Part B premium. It’s important to sign up for it as soon as you’re eligible, or a late penalty may be imposed. There are some exceptions, so be sure you understand if you meet certain conditions that allow you to wait.
Medicare Supplement Plans
Are you concerned about the costs that Medicare does not cover? Many people are. That’s why most Medicare recipients select a Medicare Supplement plan, also known as Medigap insurance, to help cover the “gap” between what Original Medicare pays and what you are expected to pay out of your own pocket.
It is sold by private insurance companies. Remember, Original Medicare (Part A and Part B) provide insurance coverage for health-related expenses, but they do not cover all of the health care costs you may have. They cover about 80% of the cost.
Medigap plans, depending on the level of coverage selected, can cover some or all of your out-of-pocket expenses. Medigap plans have NO NETWORKS and require NO REFERRALS. Supplement Plan F provides the most comprehensive coverage of any of the Supplement plans on the market.
Medicare Advantage Plans
You may decide against Original Medicare in favor of Medicare Part C, or Medicare Advantage (MA). These are private plans offering combined Part A and Part B benefits (minus hospice) and usually, Part D (prescription drug coverage).
All MA plans have contracts with Medicare. Some have premiums, while others do not. Some pay a portion of, or all of, your Part B premium. Some have yearly deductibles. How much you kick in for copayments or coinsurance vary.
There’s more to MA plan costs. For instance, different plans charge differently for in-network and out of network providers; annual limits on out of pocket costs, and what kind of health care services you seek – and their frequency. It can be confusing, so don’t hesitate to email us with questions.
Let us help you sort it out
Hopefully, this guide has offered you valuable insight into Medicare and why you should sign up for the various components at certain times.
It’s so important to understand how Medicare works, so you receive the best possible healthcare at an affordable price. (There is assistance available for those with limited income, and who meet other criteria.)
As Medicare experts, we’re standing by to walk first-year Medicare beneficiaries through the process and ensure you get maximum value from the program.