It’s wise to study up on Medicare before you turn 65, even if you’re still working 40 (or more) hours each week.
What is Medicare?
Medicare is a federal health insurance program. It’s available to people ages 65 and over, younger people with certain disabilities, and anyone with end-stage renal disease (ESRD). It’s kind of an alphabet soup.
· Medicare has two parts: Part A and Part B. You’ll often hear these combined options called “Original Medicare.”
· Part A – hospital insurance. Part A covers care you receive when you stay in a hospital (also called “inpatient” care), skilled nursing facilities, hospice care, and some home health care. You may pay premiums for Part A, but the amount can vary.
· Part B – medical insurance. Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Based on your situation, there may be a late enrollment penalty if you don’t sign up for Part B when you’re first eligible. Similar to Part A, you may pay premiums for Part B. (This fee may be higher based on your income.)
Part C – Medicare Advantage. This brings all your health care coverage under one plan, managed by a private insurance company. You’ll still get all the benefits of Medicare Parts A and B. Medicare Advantage Prescription Drug Plans also include Medicare Part D drug coverage. Plus, many plans give you extra benefits not covered by Original Medicare, like routine care, fitness, and dental. With a Medicare Advantage plan or Medicare Advantage Prescription Drug plan, you can have one monthly plan premium or (in some cases) no added monthly premium besides what you pay for Part B.
· Part D – Prescription drug coverage. You can sign up for Part D with Original Medicare or in combination with some other Medicare-related plans, like Medicare Advantage plans. You can also get a stand-alone Medicare Part D plan. It’s optional, and your premium amount may vary. All Medicare Part D plans have a list of covered drugs, called a formulary. Plan drug lists include both generic and brand-name drugs that are shown in levels, or tiers, based on cost.
· Medicare Supplement – Sometimes called “Medigap.” Medicare Supplement helps pay for some of the costs that Original Medicare doesn’t cover, such as copayments, coinsurance, and deductibles. It does not include prescription drug coverage. Medicare Supplement plans are sold by private insurance companies. You pay another monthly premium for a supplement plan, in addition to your premium for Parts A and B.
Turning 65 is a big deal in the world of health care.
You have a seven-month window around your birthday – three months before, the month of your birthday, and three months after – to sign up for Medicare.
This is called your Initial Enrollment Period, or IEP. Even if you have health insurance through work or a spouse, you should still sign up for Original Medicare during your IEP. Learn more about when to enroll in Parts A and B. A licensed health insurance agent or broker may be able to help.
If you currently have medical coverage through an employer or spouse:
· Talk with your employer (if you’re still working) or your spouse’s employer several months in advance to see if your current insurance will change at age 65.
· Learn the Medicare basics. Call us or make an appointment at one of our Neighborhood Care Centers. We’re happy to give you more information on the parts of Medicare, what they cover, and how much you will pay.
· Enroll in Medicare Part A when you’re eligible. (You may choose to wait to enroll in Part B, but you may face a late enrollment penalty.)
If you’re not currently covered through an employer or spouse:
· Enroll in Medicare Part A before you turn 65 so you don’t have a lapse in coverage. (You may choose to wait to enroll in Part B, but you may face a late enrollment penalty.)
· Look at options that give you more coverage than Original Medicare alone, like Medicare Advantage plans.
· Check with your doctors to see if they accept different types of Medicare coverage.
· Check your prescription drugs to see if they’re covered.
We can help.
If you don’t have a broker and would like more information on your EmblemHealth Medicare Advantage options, call us at 800-859-4880 (TTY: 711) from 8 a.m. to 8 p.m., seven days a week, or visit one of our Neighborhood Care Centers.