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 be drawing 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 Are Still 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 Are No Longer 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 when and how to sign up for Medicare. Being independent insurance agents, we can also help you evaluate your options to ensure you have the right coverage for your particular needs.

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 not only provide you with a choice, but may make it harder to choose the appropriate coverage because there are so many choices.

Your Medicare Coverage Options:

  • Original Medicare and a Part D drug plan
  • Original Medicare, a Medicare Supplement and a Part D drug plan, or
  • A Medicare Advantage plan

Original Medicare

Original Medicare is a government managed fee-for-service plan that covers many healthcare services. You can go to any doctor or hospital that accepts Medicare. Part A is your in-patient hospital coverage. Part B is your out-patient/doctor visits coverage.  Original Medicare does not cover prescription medications (outside of a hospital stay.)

Part A, or Hospital Coverage

There is no premium for most people because they paid Medicare taxes while working (you must have worked and paid taxes for 40 quarters, or 10 years.) Coverage provides in-patient hospital, skilled nursing care and hospice coverage. There is a deductible for a hospital stay and a copay per day if you are in the hospital longer than 60 days. There is a copay per day for days 21-100 of a skilled nursing facility stay if you have been admitted to the hospital for more than 72 hours first.

Part B, or Medical Coverage

There is a premium for this coverage. It is automatically deducted from your social security check if you are drawing. If you are not yet drawing social security, it is billed to you quarterly. High wage earners will pay more for their Part B premium. This is called the Income Related Monthly Adjustment Amount (IRMAA.) Part B has a deductible and 20% co-insurance. It provides for doctor visits, outpatient surgery and services, diagnostic tests, durable medical equipment, and more.

You can find out more about what Medicare covers and the IRMAA at  Annually, they provide a Medicare & You book that is very informative and informational. 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. 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.