What to Look for When Signing Up for Medicare
By Sam Matthews I the executive director of the Shepherd’s Center of Winston-Salem.
It is very important for everyone becoming eligible for Medicare to get accurate information. Several months before turning 65 you should learn about Medicare and how it relates to your circumstances. For example: If you or your spouse have paid into the Social Security System for 10 or more years, you are eligible for premium-free Medicare Part A (hospital insurance) at age 65. If you have paid in fewer than 10 years, you can buy Medicare Part A coverage. Everyone pays a premium for Medicare Part B (Medical Insurance). Learn more about what Medicare will and will not cover. Get a copy of the Medicare & You Handbook or The Guide to Health Insurance for People with Medicare from Medicare or from Social Security. Understanding what Medicare covers and does not cover will give you some idea of the health care costs you may incur.
Initial Enrollment. You have a seven-month window which begins three months prior to your 65th birthday in which to enroll in Medicare without incurring a penalty. You can enroll online at SocialSecurity.gov, or visit the nearest Social Security office to enroll in Medicare Part A and Medicare Part B.
The Seniors’ Health Insurance Information Program (SHIIP), a division of the North Carolina Department of Insurance, is available for guidance and information. Contact SHIIP at 855-408-1212 or firstname.lastname@example.org. The SHIIP coordinating site in Forsyth County is the Shepherd’s Center of Greater Winston-Salem (336-748-0217) and offers monthly Welcome to Medicare workshops, individual counseling and assistance during Medicare Open Enrollment. Find more at NCshiip.com.
During this Period, you will also have the option to enroll in a Medicare Prescription Drug Plan (PDP) available under Medicare Part D or a Medicare Advantage Plan. These plans are offered by private insurance companies approved by Medicare. If you fail to enroll in a Medicare PDP (or Medicare Advantage with a drug plan) during your Initial Enrollment Period and you do not have equal or better coverage through an employer group plan, you will incur a one percent penalty for each month that you are late enrolling, and you will only be allowed to enroll during the Oct. 15 through Dec. 7 Open Enrollment Period for Medicare Advantage and Medicare Part D.
Working Past 65 (Special Enrollment). If you or your spouse are actively working at age 65, are covered by an Employer’s Group Health Plan (EGHP) and the company has 20 or more employees, you may be able to delay Medicare Part B coverage without penalty.
Supplemental Coverage. Medicare is a major federally-funded medical plan that provides a basic foundation of benefits. It does not pay 100 percent of all medical bills. Beneficiaries are responsible for premiums, deductibles, and coinsurance. Amounts can be significant. Because of these costs, most beneficiaries need some kind of plan, policy or program to fill in the “gaps.”
Medicare Supplement Insurance. Medicare supplement plans are one health insurance option that are designed to fill the gaps left by Original Medicare (Parts A and B). Individual policies are sold by private insurance companies and regulated by the department of Insurance. After age 65 and for the first six months of eligibility for Medicare Part B, beneficiaries have an Open Enrollment Period and are guaranteed the ability to buy any of these plans from any company that sells them. Companies cannot deny coverage or charge more for current or past health problems. If you fail to apply for a Medicare supplement within your Open Enrollment Period, you may lose the right to purchase a Medicare supplement policy without regard to your health.
Medicare Advantage (Medicare Part C). Medicare Advantage plans (HMOs, PPOs, SNPs and/or PFFS) provide all Medicare Part A and Part B benefits and possibly some extra benefits. Members may be required to utilize a network or group of preferred providers. Check with your health care providers to see if they accept the insurance plan you are considering.
If you join a Medicare Advantage Plan, you are still in the Medicare Program but you receive your Medicare benefits from the private carrier. You may enroll in a Medicare Advantage plan during your Initial Enrollment Period or during the Open Enrollment Period for Medicare Advantage and Medicare Part D from Oct. 15 through Dec. 7.
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