Medicare
Medicare is a federal health insurance. Generally speaking, it is for:
People 65 or older
If you meet the criteria for a disability
End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)
ALS (also called Lou Gehrig’s disease).
A Little FYI
Medicare is broken down into 4 Parts, that covers different categories
(Parts A, B, C, D)
Part A
Check out your paycheck. You have already started paying the Medicare tax for Part A (basically for hospital, skilled nursing facility, hospice and some home health).
Click below for the details
Part B
Part B (basically covers doctors’ services, outpatient care, medical supplies & preventive services). Preventive services, including annual check-ups, mammogram, colonoscopy… are those services meant to “keep you out of trouble”.
Once eligible for Medicare, you pay a premium.
If you have social security, that premium, is usually deducted from your social security check, otherwise you can arrange to have payments deducted from elsewhere.
Yep, still paying after years of deductions from your paycheck. But remember, that was for Part A.
Part C
Once eligible, Medicare basically covers 80%. This is where a lot of insurance companies come in, to manage how your Medicare dollars are spent. They may help cover the rest (including premiums, copays… dependent on the plan you chose). Additional coverage may be at an additional cost. Once they start managing your Medicare they call the shots aka authorize payment for services. It may be worth it, dependent on your medical needs, or not. Do your “end of the year pick an insurance” homework.
For the most part, when first eligible for Medicare and at the end of the year, is when you get to pick which insurance company you want to manage your Medicare. There are exceptions when you can change your manage care insurance company or get rid of them altogether. When the insurance company starts managing your Medicare is when your coverage becomes
Medicare Part C = Medicare Advantage = Manage Medicare
Stay with me … one more
Part D
Then there’s Part D; additional coverage for medications. You can have this or have medications covered within your Part C ^ (Medicare Advantage Plan). Likely an additional cost.
For those who like visuals…
Medicare and You Handbook as mentioned in the video
Shortly before you are eligible for Medicare, go through this book. Make sure it is the most updated version.
Below and in the book are dates you should be aware of to make sure you are timely with enrollment and to avoid penalties (see below).
Important Medicare Dates
October 1st: start reviewing coverage and options
October 15 to Dec 7: pick or make changes to your plan
January 1 : your plan starts
January 1 - March 31: if in a Medicare Advantage plan, you can make changes or drop
Avoid penalties of late enrollment!
Important because… it is not a one time penalty and usually is an added charge to your monthly premium, forever.
Learn more late enrollment penalties
Until it makes sense!
Clarify with your payor & ask questions until it makes sense.
If you are not receiving clear and concise information to sort out a medical event, contact me.