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MEDICARE

Before choosing a plan we want to be sure you know the difference between your many options.

Medicare Supplement

A Medicare Supplement is used with original Medicare. Any caregiver that accepts Medicare will take a Supplement because they only need to bill Medicare. Medicare pays their part (generally 80% of Medicare covered benefits) and sends the remainder of the bill to the Supplement which pays their part (generally 20%). It is important to note that Supplements do NOT include Prescription Drug Coverage (Part D, PDP) and for those that do not get a PDP when first eligible there will be a penalty when they do get a PDP. (there are exceptions to this) A Medicare Supplement does not change year to year (although the cost does generally go up the coverage does not change).

Medicare Advantage

A Medicare Advantage plan works differently than a Supplement. With a Medicare Advantage Plan a private company TAKES OVER for Medicare (you remain in the Medicare system but Medicare is no longer responsible for your bills). These plans follow the same type of module as many group plans such as HMO or PPO. With this type of plan it is important to remember several things. First, most Advantage Plans have Networks so you want to make sure your Doctor, Hospital, and auxiliary care are within the network. (otherwise you will be paying higher costs and in some cases are responsible for 100% of care outside the network) Second, Advantage Plans have co-pays associated with them. It is important to be aware of these because they can add up to be quite a bit of money. Third, most Advantage Plans have the Part D “built in” which is a nice bonus but you must be aware that when switching to a Supplement from an Advantage Plan you will also need to add a Part D. (there are several types of Advantage Plans that do NOT have the Part D built in so this is something you need to keep in mind when choosing any plan). Lastly, Advantage Plans typically have value added benefits. These benefits vary between plans but typical benefits include Health Club membership, limited dental, eye and/or vision.

Also, not all Plan D’s are the same. Although they are required to be at least as good as the Medicare model they can vary greatly in costs, co pays and specific drugs that are covered. It is important to check which one suits you and continue to check each year because they (like Advantage Plans) do change every year.

Are you Eligible? 

If you’re turning 65, you have an opportunity to enroll in a Medicare plan. You can enroll three months before the month you turn 65, the month of your birthday and three months after. If you wait to enroll in a plan, there is a chance you’ll have fewer plan choices, and you may have to pay more.

You are eligible for Medicare if:

  1. You’re 65 or older, or have a qualified disability.

  2. You’re a U.S. citizen or legal resident for five consecutive years.

Medicare Facts & Things to Know

If your health care needs change over time. So will the health plans you want to choose. You’re not locked into one plan permanently. You’ll have an opportunity to change plans at least once a year.
 

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

  • Even if you’re already collecting Social Security, you must wait until you’re 65.

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

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

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.

Your plan choices don’t have to be permanent.

Who does the paperwork?

The Social Security Administration handles most of the paperwork for joining Medicare. The first letter you get in the mail about Medicare will probably come from Social Security.

 

If you’re drawing Social Security benefits when you turn 65, Social Security will automatically enroll you in Medicare Part A and Part B.

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

What happens to the health coverage I have now?

As you make your decisions about Medicare, keep your current health coverage in mind. This could be retiree health coverage from your former employer or your union, if you’ve retired.

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 than the standard choices described in this guide.

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.

Medicare Resources