Answer: With all the ads for Medicare plans on TV, the endless junk that comes in the mail, phone calls to your home or cell, and different opinions from friends and family on what people turning 65 should do, I understand how seniors can feel overwhelmed and stressed. 

Costs, coverage, and options

Try not to worry. The reality is going on Medicare can often be a blessing, less expensive and/or with better coverage than what people get with employer plans or through the ACA (Affordable Care Act), aka Pennie or Obamacare, before age 65.

Let’s start with costs and briefly go over coverage as well. Original Medicare Part B is currently $185 per month and projected to be around $200 in 2026. Medicare has gaps and doesn’t pay for everything, namely the $1,676 Part A Hospital deductible, 20% of Part B outpatient costs, and prescription drugs. There’s also no limit on what someone on Original Medicare can be billed, which could potentially be $20,000 to $100,000 in the event of a hospital stay over 100 days or the need for extensive chemotherapy or dialysis.

For this reason, almost everyone who is eligible for Medicare gets either a Supplement (Medigap) policy, or an Advantage Plan, the two choices that reduce the potential medical costs associated with Original Medicare and eliminate the possibility of tens of thousands of dollars in bills as I mentioned above. Both usually supply better overall coverage than what people like Donna have prior to age 65. Supplements almost completely eliminate out of pocket medical costs. And the most popular Advantage Plans have no medical deductible, very fair co-pays, and often include generous ancillary benefits, “extras,” that provide valuable goods and services at no additional cost. 

Supplements premiums start at $72/month for a 65-year-old female and $81 for a man the same age. Well-chosen Advantage Plans have lower premiums and the most popular are generally in the $25/month range or less. I do need to mention that it’s vital to have the differences between Supplements and Advantage Plans explained properly prior to making your initial choice when turning 65. By far, the most common mistake made by those going on Medicare for the first time is not fully understanding the pros and cons of Supplements and Advantage Plans. The consequences of this decision can literally last a lifetime!

Who must enroll in Medicare and when it can and should be done

As far as who needs to get Medicare and when, that’s very cut and dry for someone who doesn’t have the option of getting health insurance from an employer. With almost no exceptions, everyone who can’t get employer coverage needs to enroll in Original Medicare Parts A and B. Be advised at age 65 you no longer qualify for subsidies through the ACA. In addition, failure to get Medicare Parts A, B, and or D when first eligible can result in huge medical or prescription bills, limited access to health care, and/or late enrollment penalties. 

It’s very simple for those who are currently collecting Social Security because they don’t need to even apply for Original Medicare Parts A and B. A card will automatically come in the mail about 100 days before the first day of the month one turns 65. For example, anyone turning 65 in January, and is already on Social Security, can expect their Medicare card to come in mid-September. Those who aren’t collecting prior to age 65 do need to apply for Medicare, which is easy to do via the official Social Security website, ssa.gov. The earliest that can be completed is 90 days prior to the first day of the month of one’s 65th birthday.  Again, using the example of someone turning 65 in January, October 1st would be the first available day to submit an application for Medicare. This is also the earliest that an application can be made for a Supplement or Advantage Plan as well. 

Options for those still working past age 65

Anyone who is still working past age 65, or married to someone who is, and has the option of getting health insurance from an employer may opt out of Parts A and/or B without the fear of late enrollment penalties. However, this can be very complicated and the wrong decision expensive. Before you ever opt out of Medicare A or B, I highly recommend reaching out to us and having that analyzed. We provide that service free of charge. With the cost of employer plans and deductibles rising, it’s becoming more common, often a better financial choice for those who working past 65, to opt out of employer health insurance and enroll in Medicare A, B, and a Supplement or Advantage Plan. 

How The Health Insurance Store can help

There are many variables however, so don’t take advice from friends, family or even your employer’s HR staff or Social Security. We’ve met far too many people who got bad information and made the wrong choice.

The licensed agents at The Health Insurance Store can walk you through all scenarios, processes, provide any necessary forms, answer questions, and most importantly go over how Original Medicare works along with the differences, pros and cons of both Supplements and Advantage Plans. We will help you make an informed, educated decision so you choose the type of plan that fits your individual needs. And once you become a client, our staff are always available to solve any problems that may arise such as erroneous bills, claims delays or denials, prescription issues or expenses, and anything else remotely related to your policies.

If you have any questions regarding this column or any other Medicare, health, or life insurance related topic, give us a call or email me personally at Aaron@GetYourBestPlan.com.