Medicare, Know Your Options

Sign post that points to confusion on Medicare Options
Know Your Medicare Options!

Know your Medicare options! Medicare is a Federal health insurance program for citizens who are age 65 and older, people under age 65 on disability for 24 months and for those of all ages with End Stage Renal Disease (ESRD) or ALS. You automatically qualify for Medicare if you are 65 years of age and are eligible for Social Security or Railroad Retirement benefits. You do not need to draw social security to receive Medicare.

Know Your Medicare Enrollment Responsibilities and Benefits

With the age of full social security extending beyond age 65, it is important to note that you are still eligible for Medicare at age 65 regardless of your full social security eligibility date. It is critical you understand this to avoid penalties with Part B and protect your guaranteed eligibility for a Medicare supplement or initial enrollment period for a Medicare Advantage plan or drug plan. Your Part A will start automatically the month you turn 65.

When You Continue Working

There are special considerations for people who are still working when they turn 65.  It may not be necessary to sign up for Part B if you are actively working and have insurance through your employer. If your employer has more than 20 employees, then there is no need to sign up for Medicare as your employer insurance will be primary.

It is critical that you sign up for Medicare when you stop working or leave employer insurance, whichever happens first.

When You Stop Working

If you are not drawing social security when you turn 65, you are not automatically enrolled in Medicare Part B. You must contact Social Security to sign up for Part B. Failure to do so may result in a delay in Medicare taking effect and you may incur a penalty.

If you don’t sign up for Part B when you should have, there is a 10% penalty for every 12 months that you go without coverage and that penalty stays with you for life.

At Imagine Insurance Advisors, we know this can be confusing and the potential for delayed coverage or penalties can be stressful. We can assist you in understanding exactly what to do and when to do it when you are retiring after age 65 and coming off employer coverage to avoid penalties or gaps. Call us as soon as you know when you plan to retire and we can set up a timeline with the necessary materials to get the process started.

Medicare Options – Know Your Benefits

Once you are enrolled in Medicare, you now have choices in how you receive your Medicare health care and prescription drug coverage. The options empower you with choice and personal preference, but the abundance of options also makes it hard to choose which one is right for you.

Your Medicare Coverage Options:

Just one of these three avenues is the one that you will take to completing your Medicare coverage:

  • Original Medicare (Part A & B) and a Part D drug plan (PDP)
  • Original Medicare, a Medicare Supplement/Medigap and a Part D drug plan, or
  • Medicare Advantage-Prescription Drug Plan (Part C/MAPD)

Each one has its own pros and cons and in many cases, the pros and cons are subjective and we will help you decide what fits your budget and healthcare needs the most appropriately. You are welcome to share your need in a particular area so that we can make sure to focus on those benefits in particular when recommending plans. We may ask you voluntary needs-analysis based questions so that we recommend plans that tailor specifically to your needs and anticipation.

Original Medicare, Part A & Part B

Original Medicare is a government managed fee-for-service plan that covers most medically-necessary healthcare services. You can go to any doctor or hospital that accepts Medicare. Part A is your in-patient hospital, skilled nursing care and hospice coverage. Part B is your out-patient treatment/doctor visit coverage.  Original Medicare does not cover prescription medicine (outside of a hospital stay.)

Part A, Hospital Coverage

There is $0 premium for most people for Part A because they paid Medicare taxes while working (you must have earned premium-free Part A by working and paying taxes for 40 quarters, or 10 years. Or by having a spouse that earned premium-free Part A.)

Coverage provides in-patient hospital, skilled nursing care and hospice coverage. There is a deductible for a hospital stay and a copay per day for days 61-90.    Medicare covers the first 20 days of skilled nursing care after a 72-hour hospital admittance, then there is a copay per day for days 21-100. There is no coverage for more than 100 days in any one benefit period of skilled nursing care; Medicare does not pay for long-term care or assisted-living.

Part B, Medical Coverage

Everyone must pay a premium for Part B (unless you are approved and re-certify for Medicaid.) If you are drawing social security, it is automatically deducted from your check monthly.  If you are not yet drawing social security, then they bill you quarterly. You can sign up for Easy Pay through your account and have it deducted from a bank account monthly.   High wage earners pay a higher Part B premium. This is called the Income Related Monthly Adjustment Amount (IRMAA) and they base it off your tax return MAGI always on a two-year lookback.

Part B has an annual deductible ($240 in 2024,) then pays 80%, with your co-insurance responsibility of 20%. It covers doctor visits, diagnostic tests, outpatient surgery and treatment,  durable medical equipment, and therapy. Basically, everything that does not fall under Part A.

You can find out more about what Medicare covers at  Annually, they make available the updated Medicare & You Handbook that is very informative. You can download it on the Medicare website or call Medicare at 1-800-MEDICARE (1-800-633-4227.)

Our Agents Are Ready to Help

Don’t make a mistake; get the help you need to navigate Medicare for the first time or re-evaluate how you are covering yourself after having made your initial decision. The friendly agents at Imagine Insurance Advisors take their role in informing you of your choices in easy-to-understand terms seriously. Call us for a free appointment to discuss your Medicare options and benefits.