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TURNING 65

What's Next?

At age 65, you may be eligible for Medicare. If you’re not receiving Social Security or disability benefits, you’ll need to apply for Medicare during your Initial Enrollment Period (IEP). The IEP is the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month your turn 65.  You can do this online through ssa.gov , over the phone at 1-800-772-1213 (TTY: 1-800-325-0778), in person at your local Social Security Office. If you’re already receiving benefits, most people are automatically signed up and eligible for coverage on the first day of the month they turn 65. ​Once your Medicare is effective, you can decide which Medicare option works for your situation. 

 

What if I plan to keep working?

Some people choose to continue working at age 65. If you have employer coverage, and it is creditable (at least as good as Medicare) you may "delay" your Medicare by contacting Social Security. If your coverage is creditable, there will not be any penalties in your decision to delay.  It is important that you look at the "cost" of your employer insurance and the amount you will be out of pocket for deductibles and coinsurance when you receive medical services.  Once you understand the costs, compare them to the cost of Medicare to see what will be the most effective decision financially. Our team can help you with these types of decisions.  Our goal is to simply help outline the comparisons.

What does Medicare Cost?

Part A (hospital insurance) has a $0 premium for most. It depends if you or your spouse paid Medicare taxes while working for a certain amount of time. It helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Each time you’re hospitalized for 1 to 60 days, you pay a $1,632 deductible (rate is for 2024, rates are updated annually). Medicare then pays most confinement costs after the required Medicare deductible. Starting with day 61, patient pays a per-day copayment. The copay per day changes on day 91 and day 151. Skilled nursing confinement following an inpatient hospital stay has a per-day copayment starting on day 21. One thing to remember, there’s no limit on yearly out-of-pocket costs.

 

Part B monthly premium is determined by your modified adjusted gross income reported on your IRS tax return from two years prior. The standard monthly premium for 2024 is $174.70. (amounts are updated annually) If your reported income is above a certain amount, you pay a higher rate. For more information visit www.medicare.gov and search for IRMAA (modified adjusted gross income). Part B helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment), and many preventive services like screenings, shots, vaccines, and yearly “wellness” visits. For Part B covered services, you usually pay 20% of the Medicare-approved amount after meeting your deductible. Original Medicare (Parts A & B) has no yearly limit on what you pay out-of-pocket, unless you have supplemental insurance — like Medicare Supplement Insurance, also called Medigap. More on Medigap is explained below.

Now, how about prescription drug coverage?

Medicare Part D is prescription drug coverage. It’s managed and offered by Medicare-approved private insurance companies that must follow rules set by Medicare. Your drug costs will vary based on the plan you choose. Plan coverage and costs can change each year. And you may have to pay a premium, deductible, copayments, or coinsurance throughout the year.  

What do you need to know?

IF If you don’t sign up for Parts B and D when you’re first eligible and don’t have creditable coverage under another health insurance, you may pay a penalty for each month you could have had the coverage but didn’t. These late enrollment penalties can be costly. Generally, you’ll pay the penalties for as long as you have Medicare coverage.

 

What are my Options?

Original Medicare

​​Original Medicare (Parts A & B) pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance policies, also called Medigap, are sold by private companies. They help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles that Original Medicare doesn’t cover. Monthly premiums are calculated based on your zip code, age, tobacco usage, and your health. Monthly premiums can go up each year with the average increase for some are around 3%. The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. After this enrollment period, you may not be able to buy Medigap. If you’re able to buy a policy, it may cost more. Medigap policies can only be used with Original Medicare.

Medicare Advantage

Medicare Advantage (MA or Part C) is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D. Members must continue paying the monthly Part B premium and may also have to pay a plan’s monthly premium if there is one.  Members may pay additional deductibles for certain services, but all plans have a yearly limit on what members pay out-of-pocket for services Medicare Part A and Part B cover. In many cases, members can only use doctors and other providers who are in the plan’s network and service area for non-emergency care. Members may also need a referral to see specialists. Plans may also offer some additional benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services. Both HMO and PPO plan types are available. When joining a Medicare Advantage plan, members still have Medicare, but they get most of their Part A and Part B coverage from their Medicare Advantage plan, not Original Medicare.

 

If you are eligible for state assistance, it is possible your Part B premium and copays can be eliminated and you may qualify for Extra Help with your prescriptions.

For more information, https://www.ssa.gov/medicare/part-d-extra-help

How do you decide what to do?

There are pros and cons of Original Medicare and Medicare Advantage plans.  We believe it is important that you understand them in order to make a good decision for your future healthcare needs. 

CALL TODAY  We can explore your insurance needs over the phone, online, or in-person. We schedule at YOUR convenience with NO OBLIGATION to enroll.”

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