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You find yourself quickly approaching that magic number, 65 years young. With that comes new learning curves, such as learning about Medicare and what this federal healthcare program has to offer. You might find yourself searching for Medicare for Dummies on Amazon. Thankfully, you won’t need to buy a Medicare for Dummies book, we have everything you need to know right here. Below we’ll go over just what Medicare really is, the different parts, and the best timeframes for enrollment.
Medicare for Dummies
Medicare is health insurance designed for individuals who are 65 years or older, certain individuals with disabilities, and those with End-Stage Renal Disease. If you do in fact qualify to receive Medicare, here are some of the key fundamentals of the different coverages to understand when starting this new journey.
There are several types of Medicare coverage that you should familiarize yourself with, prior to enrollment. In our first chapter of Medicare for Dummies, we’ll go over the four parts of Medicare.
- Part A: This is hospital coverage. It covers your stay in the hospital, a nursing facility, or any inpatient care.
- Part B: This part is considered your outpatient medical coverage. Benefits include physician visits, labs, surgeries, any durable medical equipment, and more.
- Part C: also know as Medicare Advantage plan, these plans replace Part A & Part B. You’ll be responsible to pay co-pays for any approved services and/or hospital and physician visits.
- Part D: This is prescription drug coverage. These are considered your pharmacy benefits. (insurance that you purchase for all your medication needs) Prescriptions can be pricey, so this is a beneficial coverage to have.
Now that you have an idea of what types of coverages Medicare has to offer, here’s chapter two of Medicare for Dummies.
Below, we’ll discuss some of the Medicare Enrollment Periods.
- IEP – Initial Enrollment Period: This enrollment period lasts for seven months. It begins three months prior to turning 65 and lasts up to three months after turning 65.
- SEP – Special Enrollment Period: If you are over 65 years of age and obtain private insurance through an employer, or a spouse’s employer and the employer has more than 20 employees. If this criterion is met, you may delay enrollment for Medicare until after turning age 65.
- GEP – General Enrollment Period: If you fail to apply for Medicare during your IEP or SEP, this will allow you to still sign up for Medicare. This enrollment period begins January 1 and runs until March 31.
- Automatic Enrollment: You may be automatically enrolled in Part A and B at 65 years of age if you begin to receive retirement benefits from either the Railroad Retirement Board or from Social Security.
Breaking Down the Costs of Part B
When breaking down the costs of Medicare, it’s important to know that Part B is dependent upon an individual’s income. Most Medicare beneficiaries will pay a premium, while individuals in a higher income tier will have a higher premium.
When determining one’s income adjustment, Social Security will review previous tax returns, up to two years.
If you find that your income has decreased from the previous years, you may be able to file a reconsideration request. Social Security will require proof of income and will then reconsider your premium costs.
Once the premium costs are determined, they will be deducted from your monthly income.
Part B has a deductible. If you’re enrolled in a first-dollar coverage Medigap Plan, then your Part B deductible will be covered 100%. Medicare changes include all first-dollar coverage plans going away for those newly eligible to Medicare.
Also, keep in mind, Part B only covers 80% of your medical costs. If you do not have a supplement plan, you’re left responsible for the remaining 20%.
Breaking Down the Costs of Part D
When breaking down the costs for Part D, it’s good to know that most states have many different Part D plans to select from. The average premium is right around $35 per month.
When selecting a Part D plan, it is best to choose one that fits your medication needs and that the prices will work for you.
The insurance carriers will automatically pay your Part D premiums. However, it’s possible for Social Security to deduct the cost of your premium directly from your Social Security income benefits.
Now that you know what Medicare is and when the right time to apply is, we can move onto chapter 3 of Medicare for Dummies.
Medicare Part A will cover the first 60 days in a hospital. There will be a hospital deductible that you will be responsible for.
Once you have met 60 days consecutively in the hospital, Medicare’s share will begin diminishing, while your share will increase. It’s suggested to have a supplemental plan to help safeguard you from these increasing costs.
As mentioned above, Part B covers outpatient care while visiting your doctors’ office. A deductible must be paid annually, after which Part B covers 80% of this care.
Again, it‘s recommended to carry supplemental coverage to help safeguard you from high out of pocket expenses associated with the remaining 20% you’re left responsible for.
As stated before, supplemental coverages can be a huge lifesaver in the event you find yourself in a flurry of hospital and physician charges.
- Medigap Plans – These are plans that pay after Medicare pays. This will cover that 20% patient responsibility for your outpatient services. These supplemental plans will also over additional out of pockets such as deductibles & co-pays.
- Medicare Advantage Plans – Rather than these plans paying after Medicare, they pay instead of Medicare. This is private insurance that contains its own network of providers. You will be responsible to pay a copay for physician visits, facility stays, etc.
While Medicare can seem tricky to decipher at first, trust in knowing that beginning to understand the basics will make for a much smoother enrollment period for you. You are well on your way to smooth sailing into Medicare coverage!