Medicare Information

Myth #1: You are automatically enrolled in Medicare when you turn 65.

The truth is “Yes and No.”  Enrollment in Parts A and B is automatic IF you’re already getting Social Security or Railroad Retirement Board (RRB) benefits. You won’t need to do anything. You’ll get a ‘Welcome to Medicare’ packet three months before your 65th birthday. However, if you are not getting these benefits at least four months before you turn 65, you will need to actively enroll at that time.

In order to get Original Medicare, you must enroll through the Social Security office. You can complete your enrollment online at socialsecurity.gov, by calling Social Security at 1-800-772-1213, or by visiting your local Social Security office in person.

Enrollment in Part D, Medigap, and Medicare Advantage plans is voluntary.

Bonus Myth: Medicare will notify me when it’s time to enroll. 

Also not true.  Medicare doesn’t tell you when it’s time to enroll. Unless you are already receiving Social Security at age 65, you’ll need to remember to sign up on your own.

Myth #2:  You can apply for Medicare at any time.

This is not true.  Most people become eligible for Medicare when they turn 65. But not everyone gets Medicare coverage at 65.

Retiring at 65

If you plan to retire at age 65 your chance to sign up for Medicare Part A and B runs for 7 months, which includes the 3 months before the month in which you turn 65, your birthday month, and the 3 following months (aka, the Initial Enrollment Period).  For example: If you turn 65 in June, your Initial Enrollment Period starts in March, and ends in September.

Working past 65

Many people continue to work and receive health care coverage through their employers past the age of 65—meaning they don’t need Medicare coverage yet. If this applies to you, then you most likely qualify for a Medicare Special Enrollment Period. The Special Election Period allows you to defer your Medicare application until your current health care coverage through your employer expires, or you retire. At that point, you have an 8-month window to enroll in Medicare Part A and B.

And another thing:  There is a penalty for not signing up for Medicare at the right time.

If you fail to enroll in Medicare Part A and B during your Initial Enrollment Period (of 7-months), and you don’t have equivalent health insurance through an employer or spouse, you can be subject to penalties in the form of increased premiums when you do enroll in Medicare.  And here’s the kicker: these are lifetime penalties.  And the longer you wait, the higher the penalty will be. The same is true with Part D.

Each year from October 15 to December 7 is the Open Enrollment Period. During this time, older adults can also renew, change, or enroll into healthcare and prescription drug plans.

Myth #3: Medicare is Free Healthcare.

The answer is “yes and no.”  Several parts of Medicare have premiums.

Medicare Part A (Hospital Insurance) is free for those who have at least 40 work credits and/or those who qualify based on their spouse’s work record. Other people will either pay the full monthly premium or a discounted monthly premium, depending on their Medicare payroll tax history.

Medicare Part B (Medical Insurance) has a standard premium of $134(??) a month (2018) The standard premium may increase if your individual tax return is $85,000  (??) and above. The standard premium may also increase if you’ve filed joint tax return of $170,000 (??) and above.

Medicare Part C (Medicare Advantage plans) These plans take the place of Original Medicare (Parts A and B) and may or may not have an additional premium.

Medicare Part D (prescription drug coverage) These plans are purchased through private insurance carriers and vary in cost.

Medicare Supplemental Insurance (Medigap)– These plans have an additional monthly premium that varies in cost.

Bonus Myth: Medicare costs the same for everyone.

So, not only is Medicare not free, but the costs will vary for different beneficiaries.

Again, the truth here is yes and no.

Out-of-pocket costs under Medicare include premiums, deductibles, coinsurance and copayments—or copays. You’ve already seen that your premium for Part A depends on your Medical payroll tax status; and your premium for Part B depends on your income.

The deductibles and coinsurance for Part A and Part B are the same for everyone. The out-of-pocket costs for Part D, Medigap, and Medicare Advantage depend on the plan you choose. However, people with higher incomes will pay higher premiums for Part D.

Medicare Part C and Part D all have variable premiums. Based on the plans and supplements chosen, the amount a person pays for Medicare coverage can vary considerably from one person to the next.

Myth #4:  I can’t sign up for Medicare because I have poor health.

Not true.  Medicare coverage is a function of Social Security benefits, not your health. Medicare can’t deny coverage due to a pre-existing condition or because you’re sick. It can’t raise your rates due to poor health either.

It is the same with Medicare Advantage plans too.

However, Medigap coverage gets tricky. You can buy a Medigap plan regardless of your health status if you sign up during your Medigap open enrollment period. If you miss signing up during this time and want to buy Medigap later, insurance companies can reject your application. If they accept you, they may charge you more.

Myth 5: Medicare covers everything, including long-term care.

Many people assume Medicare coverage is like their regular health insurance—it covers just about everything. The truth is Medicare covers most basic healthcare needs. It covers hospital stays, lab tests, doctor visits, same-day surgery, and preventive services. It also covers durable medical equipment, some home health services, short-term skilled nursing care, and hospice. It does not cover long-term care. And people are often surprised to find out it doesn’t cover most dental care, vision care, hearing services, prescription drugs, or care outside of the United States. You need additional insurance to cover these needs.

Bonus Myth: Medicare Covers Assisted Living and Home (Custodial) Care

For the sake of clarification, Medicare does not cover home care assistance for activities of daily living, such as dressing, bathing, eating, and housekeeping (referred to as custodial care), nor does it cover care in an assisted living facility. Medicare does cover some skilled nursing facility care, nursing home care, (as long as it’s not exclusively for custodial care) and some home health care services, including intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and other services, with varying conditions and restrictions.

For the Medicare Needs Analysis, you will answer several questions about your health and medications.  We’ll use this information to provide an estimate of your costs for each available plan within your zip code.  Then, we can compare the costs and features of the list of plans.

If you’re already 65, or already on Medicare, the time for planning (that is, pre-planning) is short . . . or has run out.  However, we can still help you chose a plan that best suits you by performing a Medicare Review.  We will compare your current coverage with the coverage that is available within your zip code.

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