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What Do I Need to Know About Medicare Before Enrolling?

Medicare can be intimidating. Many of our clients come to us concerned that they don’t know enough as they prepare to enter Medicare, and feel stressed about the transition. We’ll cover five things that you should know before you enroll in Medicare, so you can feel confident with your coverage.

What Do I Need to Know About Medicare and its Costs?

Original Medicare covers your medical services. Your coverage is categorized by inpatient and outpatient services, and the costs for each part vary.

Medicare Part A

Medicare Part A is your inpatient medical insurance. If you’re admitted to a hospital, hospice center, or skilled nursing facility, Medicare will cover most of your treatment up to 80%. You’re responsible for the other 20%.

You’ll receive Part A for free if you’re eligible to receive Social Security benefits. You earn Social Security by working and paying taxes in the United States at least ten years (40 quarters) or are married to someone who’s benefits you can draw from. If you aren’t eligible for Social Security, you may have to pay up to $458 a month (2020).

Medicare Part B

Medicare Part B is your outpatient coverage, which includes services such as outpatient surgery and annual wellness exams, as well as some durable medical equipment. Just like Medicare Part A, Medicare Part B only covers most of your services up to 80%.

Unless you qualify for an income-based Medicare Savings Program, you’ll have to pay a premium for Part B. The Medicare Part B premium is based on your income, but for most people, it’s $144.60 per month (2020).

What Do I Need to Know About Medicare Enrollment?

Enrolling in Medicare is simple, but you need to ensure you’re following the proper timeline. If you don’t enroll in Medicare when you’re supposed to, you could face penalties for being late. Fortunately, Medicare makes it as easy for you to sign up on time.

Medicare Part A

Most people are automatically enrolled in Medicare Part A when they turn 65, and receive it without having to pay a premium every month. If you’re eligible to receive Social Security benefits, this applies to you. Otherwise, you’ll have to proactively enroll by contacting the Social Security Administration, and pay a premium of up to $458 per month in 2020.

Medicare Part B

You’ll be automatically enrolled in Medicare Part B if you’re drawing Social Security four months before your 65th birthday. If you’re not receiving Social Security, you’ll need to notify the Social Security Administration that you’d like to begin. In some cases, people who have another form of creditable health insurance may choose to delay their Part B.

Where Do I Get My Prescription Coverage?

Unlike Medicare Part A and Part B, you have options from a variety of carriers for your Part D Prescription Drug plan. These plans can vary in how much you’ll pay for premiums and copays, but the deductible amount can’t exceed $435 in 2020. Depending on your income, you may need to pay an additional fee on top of your premium. For instance, if you filed an individual tax return in 2018 between $87,000-$109,000, or a joint tax return between $174,000-$218,000, you’ll have to pay an additional $12.20 on your plan each month.

What Can I Do to Avoid High Out-of-Pocket Costs?

While Original Medicare offers great coverage, for many people the risk of deductibles, copays, and an uncapped 20% coinsurance can be downright scary. In order to avoid those costs, most people either select a Medicare Supplement or a Medicare Advantage plan. Both plans are offered by private companies but vary in several ways, such as:

  • Medicare Supplement plans:  Also known as Medigap plans, they allow you to retain the benefits of Original Medicare, like the nationwide network and simple claims-paying process. There are ten standardized plans so that you can choose the one that fits your needs best.
  • Medicare Part C plans: Commonly known as Advantage plans, they replace Original Medicare as your primary insurance. Most plans operate on a smaller network, and offer some additional benefits such as dental coverage.

Does Medicare Offer Dental, Vision, and Hearing Insurance?

Unfortunately, Medicare and Medicare Supplement plans don’t cover most dental, vision, or hearing services. In order to cover this gap, you can purchase a Dental, Vision, and Hearing policy. You may be able to pay for what you need in these areas out-of-pocket now, but that doesn’t mean that you should delay getting a policy. Routine services such as exams are typically covered right away, but expensive procedures and items typically have waiting periods. In addition, some policies offer a lower premium when you purchase them at a younger age.

We know that Medicare can be confusing, and that finding the right coverage can be difficult. We’re here to guide you through every step that you need to take, and help set you up with the plan that works for you. You can speak with one of our helpful Medicare experts by giving us a call at (877)896-4612, or you can view rates and apply online using our online tool. 

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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