Health care and insurance have been hot topics over the past couple of years, and the sheer volume of information out there can be overwhelming. There are countless Medicare facts, opinions, acronyms, and regulations that it can make the average person feel pretty lost.

And if you are about to turn 65 or have already, then your mailbox is likely flooded with offers and forms and necessary paperwork. It can be challenging to determine what is legitimate, what you should keep, and what you can use to stoke the fires in the hearth this winter.

Once you are eligible for Medicare benefits, you have many decisions to make. It is worth taking the time to understand how this critical service will work for you so that you can make the proper choices for your health care needs.

A Few Basic Medicare Facts

medicare facts

If you grew up in the United States, you probably have heard about Medicare for most of your life. Your grandparents and parents most likely went through this process, too. But until you need it yourself, you may not truly understand what it is. Here is a quick overview:

  1. Signed into law by Lyndon B. Johnson in 1965, Medicare is health insurance coverage that is partly administered by the Social Security Administration.
  2. US residents are eligible for Medicare benefits at 65 years of age.
  3. Permanent residents who have lived in the US for at least five years are also eligible upon turning 65.
  4. Recipients are eligible on the first day of the month in which they turn 65.
  5. Those who have received social security disability benefits for at least 24 months are eligible for Medicare coverage, even before turning 65.

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Explanation of Medicare Parts and Plans

Medicare ads on television, the radio, and in the mail refer to both “parts” and “plans.” But they don’t explain what these are, leaving many people feeling very confused about the Medicare enrollment process. Let’s take some time to clarify what these parts and plans are.

Part A: This part of Medicare is your hospital benefit. It provides coverage for your stay in a hospital or skilled nursing facility. It can also cover hospice and, in some cases, home health visits. Part A coverage is free as long as you or your spouse have worked in the United States for at least ten years. Part A and Part B are run through the Social Security Administration.

Part B: This is your medical coverage, and it does have a premium and co-pays. For 2018, the monthly base rate is $134. This amount may be higher for those with higher incomes. Part B includes benefits that cover:

  • Doctor visits
  • Physical therapy
  • Lab work
  • Chemotherapy and radiation
  • Ambulance transport
  • Dialysis

Part C: While Parts A and B sometimes are called Original Medicare, Part C is a newer addition to the program. It is an optional form of coverage offered through private companies. We will discuss this supplemental program below.

Part D: This is your prescription coverage. Similar to the insurance you probably had while working, you will have a monthly premium as well as a co-payment each time you need to pick up a prescription. Your state probably has more than a dozen Part D plans for you to consider. Tomlin Health Insurance can help you determine which is best for you, based on your budget and current prescriptions.

Supplemental Plans

Open the copious amount of mail you’re receiving, and you’ll likely discover sales pitches for supplemental plans. Basically, you have two choices: Medigap plans or Medicare Advantage plans.

Medigap plans do what their name suggests; they fill in the gap. That is, they cover your portion once Medicare has paid its share. For example, Medicare Part B typically pays for 80% of outpatient care, leaving you with 20% to cover. Medigap plans will typically cover part or all of that 20%.

These plans give participants a lot of freedom in their choice of physicians. There are about 900,000 practitioners that accept Medicare, and a Medigap plan allows you to see any of them. With this level of coverage and freedom of choice in physicians, it’s probably not a surprise that Medicare Supplement plans typically cost more than Medicare Advantage plans.

Medicare Advantage plans, as mentioned above, are also called Part C. These plans are an alternative to Medigap plans, but their coverage is more limited. They are offered through private insurers and offer lower premiums than Medigap offerings. However, they also include more co-pays and have fewer providers from which to choose. If you decide to go with a Medicare Advantage plan, it takes the place of your Part A and Part B coverage.

How to Apply for Medicare

medicare facts

Now that you’ve had an overview of what Medicare is and what the different parts do, you still need to know how to navigate the enrollment process.

First, verify that you are eligible. As mentioned, most US citizens are eligible upon turning 65. Barring any unusual situations, you can enroll in Medicare Parts A and B in any of these three ways:

  1. Visit www.socialsecurity.gov to join online.
  2. Visit your local Social Security Administration office to enroll in person.
  3. Call Social Security at 1-800-772-5772 to enroll over the phone.

You will need to determine if you want to enroll in both Part A and Part B. Also, you will need to decide if you are enrolling in any supplemental plans and choose a Part D (prescription coverage) plan.

It is essential to pay attention to your Initial Enrollment Period, or IEP. This time frame typically covers the three months before you become eligible, the month you become eligible (usually your birth month), and the three months following. Be sure to complete your Medicare enrollment during this window.

We’re Ready to Help

Making the transition to Medicare is a significant life change that comes with a lot of decisions for you to make. Understandably, it can be confusing and overwhelming to make sense of how the system works and who does what. We at Tomlin Health Insurance are on your side. Reach out today and let us take the guesswork out of the Medicare enrollment process by helping you select the plan that best fits your needs.