Ask the Medicare Specialist
Question: I’m going to be turning 65 in May. What do I need to do to enroll in Medicare?
If you’re already collecting Social Security, you don’t need to do anything. You will be automatically enrolled and receive your Medicare card about 100 days prior to the month you turn 65. If you’re not yet collecting, you need to enroll in Medicare via Social Security. That can be done online at socialsecurity.gov or at your local office. You can apply for Medicare 90 days prior to the first day of the month you turn 65. I suggest starting that process as soon as possible to avoid delays in getting your card. Once it arrives, you can then choose a plan.
There are a couple of important scenarios people turning 65 need to be aware of. If you or your spouse are working and have the option of getting health insurance through an employer, you can opt out of Part B if that makes more sense financially. You’ll want to evaluate that, taking into consideration the cost of Medicare Part B, $144.60 per month in 2020, and the premiums for a Supplement or Advantage plan compared to what is being deducted from your paycheck for insurance. Many people don’t know what they’re paying for employer coverage. That’s a mistake. If you aren’t sure, ask your HR rep or whoever handles company benefits. It is also common for it to make sense for the employee to remain on the plan at work, but the spouse to come off. That’s because many employers are willing to cover more of the premium for the employee and less for the spouse.
There are more parts of the equation other than just cost. The size of your deductible and potential exposure to out of pocket medical bills also factor in. Medicare Supplements and Advantage Plans generally have little or no deductible. Another consideration when deciding to opt out of an employer plan and go with Medicare is what prescriptions you’re taking.
Those who take expensive brand name drugs are almost always best to stay on employer insurance due to the “Doughnut Hole.” One of our agents will be happy to help determine if remaining on your plan at work or going on Medicare is the better option. Please be advised that you absolutely should not drop Part B if you get health insurance from the company you retired from. Only those who are still working can do so and avoid what is known as the “Part B Late Enrollment Penalty.” We have met far too many retired teachers and Federal employees who made that mistake.
If you remain on an employer plan past 65 and opt out of Part B, when you do retire or decide that Medicare’s a better value, a document titled “Request for Employment Information,” will be required by Social Security. This form needs to be filled out by your employer in order to in enroll in Part B without penalty. We can provide a copy when needed.
I can’t stress this enough. When going on Medicare for the first time, it’s vital you get all options explained thoroughly. Not all Medicare plans are Supplements! I estimate 95% of people I meet for the first time have no idea Medicare Advantage Plan HMO’s and PPO’s aren’t secondary to Medicare. Advantage Plans are not designed to pick up the portion of the bill Medicare doesn’t pay (generally 20%). People on Advantage Plans have co pays for practically every medical service. If you have an Advantage Plan you will pay for doctor visits, blood tests, X-Rays, MRI’s, CT Scans, ambulance services, Emergency Room visits, etc. Other more expensive services like hospitalizations, Chemotherapy, Radiation, and Skilled Nursing stays can have out of pocket costs in the thousands of dollars.
Advantage Plans are quite popular and can make sense for those looking to save money on monthly premiums. However, they need to be chosen wisely. There are now approximately 50 HMO and PPO plans available in the Western PA market. It’s my professional opinion only a handful are worth considering. If you currently have Medicare and want to ensure you’re on what I consider to be one of the most competitive Advantage Plans for 2020, we can give you our thoughts in a matter of minutes with a simple phone call.
Advantage Plans have networks of doctors. And while most plans provide access to all Western Pennsylvania hospitals, there are plans that don’t. We have had many clients who got a rare disease or form of Cancer who needed to use out of State hospitals such as the Cleveland Clinic, UCLA, MD Anderson Cancer Center. That isn’t possible with most Advantage plans.
Supplement on the other hand, give you access to virtually all doctors and every hospital in the entire country, not just Western PA. There are no additional costs to use out of area medical providers.
Very few people realize when you initially go on Medicare that’s generally the only time in you life when Supplement companies accept you regardless of your current or previous health conditions. Federal regulations state they cannot deny your acceptance. However, seven months after you get Medicare Part B, those companies can deny your acceptance based on pre-existing conditions.
If you haven’t compared Advantage plans from multiple companies, or to Supplements the risk of receiving large medical bills and paying more premium than necessary are often the results.
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