Medicare Resources

Medicare Part A pays medical costs when you are admitted to a hospital. Medicare Part B pays outpatient costs such as doctor visits, labs, x-rays, outpatient surgery and more. Between A and B, Medicare helps you get much of the medical coverage you need. However, you will find gaps in Medicare’s coverage. You will owe deductibles and coinsurance. This is why many Medicare beneficiaries enroll in some sort of Medicare-related insurance.

• Medicare Supplement Insurance plans help cover the costs that Medicare Parts A and B don’t cover.
• Medicare Part D plans help with the cost of prescription medications.
• Medicare Advantage Plans (Part C) replace Original Medicare A and B. They cover all services that are covered with Medicare A and B and usually include prescription coverage (Part D). They also generally add some additional benefits like a health club membership, discounts on glasses and/or hearing aids, some dental coverage, ect.

You cannot enroll in both a Supplement and an Advantage Plan. Choose one or the other, depending on your individual needs.

You’re eligible for Medicare if you are 65 or older, or have a qualifying disability. You must be a U.S. Citizen or a Legal Resident for at least five years. You can enroll three months before the month you turn 65, the month of your birthday, and three months after your birthday month.

Here are some things to know about the “age 65” rule:

1. Even if you’re already collecting Social Security, you must wait until you’re 65 to receive Medicare.

2. You must be 65. Your spouse’s age doesn’t count.

3. Even if you’re not collecting Social Security yet, you’re eligible for Medicare at age 65.

1. 4. If you are covered by Employer Group Coverage you may be able to delay enrollment into Medicare until you lose your group coverage.

If you have questions about when you will be eligible for Medicare, visit www.medicare.gov, or call your local Social Security Administration office for more information.

The Social Security Administration handles most of the paperwork for joining Medicare. If you are collecting Social Security retirement benefits for at least four months before turning 65, your Medicare card comes in the mail.

Social Security can also help you find out if you’re eligible for extra help with the cost of Medicare coverage.

When you enroll in Medicare you have an opportunity to enroll in insurance.

• Eligibility to enroll in an Advantage Plan (Part C) and Prescription Coverage (Part D) ends three months after you enroll in Medicare. After that, you will have to wait until the Annual Enrollment Period (AEP), October 15 through December 7. Coverage begins the following January.
• Eligibility to enroll in a Medicare Supplement with guaranteed coverage ends six months after you enroll in Medicare. Delay can mean you have fewer choices or pay more.

Health care needs, and your budget, may change over time. Each year during Medicare’s Annual Enrollment Period (AEP), October 15 through December 7, you can change your Part C Advantage Plan or your Part D Prescription Coverage Plan. The new plan goes into effect on January 1^st.

AEP does NOT apply to Medicare Supplement Plans. You can drop a Supplement and enroll in an Advantage Plan during AEP, but if you want to switch from one Medicare Supplement to a different one, coverage is not guaranteed. You will need to pass health care questions.

That depends. As you make your decisions about Medicare, keep your current health coverage in mind. If you are currently retired,  this could be retiree health coverage from your former employer or your union. If you’re still working, you may have health coverage from your current job. Or you may have purchased your own health insurance. You’ll need to find out whether you can keep any coverage you currently have, and what your costs might be. You may have more choices available to you.

Explore your options with someone who’s familiar with the details of the coverage you have now. If it’s coverage from an employer or a union, you can start with a human resources manager or a benefits specialist. Or talk to customer service at the insurance company that provides the plan. Do your research well. In some cases, if you keep your current coverage and wait until later to join Medicare, you may have fewer choices and pay more.

If you have coverage through the Federal Marketplace, you will need to cancel your plan and enroll in Medicare. You can ask Next Step for assistance.