Medicare Facts

How to Get the Most Out of Medicare

Don’t understand Medicare coverage? You aren’t alone. Millions of Medicare recipients will need an agent to assist them with different prices throughout the country for different plans. If you are simply just turning 65 you will have no idea what Medicare covers and costs or how to change it. Watch our short video above and for further information you can go to our YouTube channel Medicare Solutions Center to learn about the many different plans available.

It really is important to talk to a certified Medicare agent or better yet a broker who can offer multiple plans. Signing up for a supplement may cost more than a free plan if you are eligible. If you don’t fully understand Medicare, it can cost you dearly, you could choose the wrong coverage, wind up with higher premiums or copays, or miss out on crucial components you need for your health. Here’s how to maximize your Medicare coverage while minimizing your out-of-pocket costs.

Sign Up As Soon As You’re Eligible

It’s a common assumption that, as soon as you turn 65, you’re automatically enrolled in Medicare. Yes and No automatically eligible yes, enrolled NO, You have seven months total but if you don’t take action after your 65th birthday, you might miss out on Medicare entirely. Three months before you turn 65 and three months after. Your coverage only begins when you enroll, so in order for Medicare to take effect when you turn 65, you need to sign up before your birthday arrives.

Medicare enrollment is only automatic in one specific case. If you’re already receiving Social Security benefits before you turn 65, the government will automatically enroll you in Medicare. Otherwise, if this isn’t the case, you have to sign up as soon as you’re eligible.

Wait too long to enroll and you could pay the price. While Medicare Part A is free for all seniors, Part B is not. Part B is designed for retirees. However, if you aren’t retired by age 65, make sure you take action to enroll in Part B right before you’re ready to retire. If you wait too long, you’ll pay a penalty – a penalty that increases by 10 percent every year. Wait until you’ve been retired for one year, you’ll pay a premium that’s 10 percent higher. Wait two or three years and you’ll pay 20 and 30 percent more, respectively.

And there’s one more reason you need to sign up ASAP: if you sign up for Part D too late, you’ll be hit with a permanent penalty that’s added to your monthly premium every single month, Medicare.gov reports. It’s a smart idea to sign up for Part D as soon as you sign up for Part B to cut costs and ensure you’re covered.

Know What Each Part of Medicare Covers

Signing up for and understanding how to use your Medicare coverage is much easier when you have the assistance of a certified medicare specialist they know exactly what’s covered. They have to go rigorous training and recertify every year in order to stay abreast of the latest products and rules.

If you know the four different basic parts of Medicare, you’ll know just which to use for different medical and health needs.

The four parts of Medicare are:

1. Part A, which covers hospital care, hospice care, and skilled nursing facilities. Part A has a small premium per month for some seniors.

2. Part B, which covers doctors’ appointments, outpatient hospital care, preventative care, and some at-home healthcare for a monthly premium.

3. Part C, which is also called Medicare Advantage, acts as a replacement for Parts A and B. Unlike Parts A and B, Part C is offered by private insurance companies, so premiums can vary.

4. Part D, which covers prescription drugs only, is optional. Because most Medicare Advantage plans include Part D coverage, many seniors don’t need Part D enrollment.

With knowledge of these coverage components, you can better choose what you’d like to pay for and what you’d like to skip. For example, if you’re enrolled in Parts A and B, you’ll likely want to add Part D to cover the cost of your medications. However, if you choose a Part C (Medicare Advantage) plan, you won’t need to worry about Part D and you may not require Part B either.

And this could ultimately save you money on both premium and out-of-pocket costs. By opting into only the coverage you need, you won’t have to pay for expenses you never utilize.

Understand the Basic Costs

Another common Medicare misconception is Medicare is entirely free. While Medicare is funded by the government, only some parts of this senior healthcare are actually free. The majority of Medicare coverage options come with costs of some kind. Advantage plans which are only available in some areas can significantly lower your costs if you are fairly healthy and near a provider in a plan area.

Original Medicare (Parts A and B together) are not free. Though some seniors don’t have to pay a premium for Part A, there is a premium of $422 per month for others – and that’s on top of an annual deductible of $1,340. And Part B comes with a premium of approximately $130 per month.

The premiums and deductibles for Parts C and D vary, as these plans are optional and can be switched out for Medicare Advantage plans or no plan at all. These parts, however, come with costs similar to private insurance plans because they’re offered by government selected providers who offer plans outside of the Medicare system.

Part D in particular can become expensive, as it sets caps and out-of-pocket requirements on prescription medications – meaning individuals on many medications may wind up paying more.

Take Advantage of Open Enrollment

Once you’re armed with all of the information you need to know about the different parts of Medicare, Advantage plans, and supplemental insurance options, your work still isn’t finished. In order to maximize both your coverage and your costs, it’s important to take advantage of the Annual Enrollment Period (AEP), which is better known as open enrollment.

Each year from October 15 to December 7, Medicare subscribers get one chance to make changes to their coverage. During this brief window, you’re able to add or drop Medicare Advantage, change your Part C plan, and enroll in or drop Parts A, B, and D.

Why does this matter? Well, Medicare changes every year. Whether there are small changes to Medicare coverage, price changes in monthly premiums, or new plans offered, it’s crucial that you know what’s happening year after year.

During open enrollment, you can do research and a bit of comparison shopping. You can search for private insurance plans through Part C or Medicare Advantage, compare the premiums of options like Part D or supplemental gap insurance, and look into the coverage and copays of all of the available options. Doing this each year will ensure you’re paying the lowest price possible while still getting all of the coverage and care you need to stay healthy.

Here are a few tips to help you make the most of open enrollment and the Medicare options available during this period:

• Look for annual changes. These must be mailed to all Medicare subscribers each year, so be on the lookout for updates and new coverage changes in summer and early fall.

• Consider different plans’ quality ratings. On the Medicare.gov website, you can see star ratings for all plans. The plans with the best ratings are often the best both financially and coverage-wise.

• Check copays and annual out-of-pocket limits. These are often the biggest expenses of any health insurance, including Medicare. Make sure you compare these costs and look into which will cover the procedures, visits, and health needs you use most.

• Consider dental and vision coverage. Original Medicare doesn’t cover any vision or dental services, so you’ll want to consider gap or supplemental plans that do to keep your eyes and teeth healthy.

Remember, you have to work to find the Medicare parts and plans that’ll best benefit you and your health. We would be happy to schedule an appointment with you to help you understand your solutions for Medicare if you are located in the midwest and would like to have a local agent answer your questions. Simply call 877-775-0812 our certified Medicare specialists can easily answer any of your pressing questions. We also have licensed Medicare specialists whom are standing by to help you with our solutions if you click on the green button below which will take you to our national quoting website that allows you to search online from the comfort of your home.

What are my Medicare coverage choices available? If the choices are difficult call a Medicare certified specialist here at The401Kman most people have a hard time sorting through the many choices available in their area

There are 2 main ways to get your Medicare coverage—Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Use these steps to help you decide which way to get your coverage:

Step 1:

Decide if you want Original Medicare or a Medicare Advantage Plan. You can choose Original Medicare or a Medicare Advantage Plan (like an HMO or PPO).

Step 2: Decide if you want prescription drug coverage (Part D). This may need to be purchased separately depending on what you have available from the the plan you just chose.

Step 3: Decide if you want supplemental coverage (Original Medicare only)

You may want to get coverage that fills gaps in Original Medicare coverage. You can choose to buy a Medicare Supplement Insurance (Medigap) policy from a private company. Costs vary by policy and company.

Not sure what kind of coverage you have?

• Check your red, white, and blue Medicare card.

• Check all other insurance cards that you use. Call the phone number on the cards to get more information about the coverage.

Medicare F.A.Q.s

Medicare has many rules which may at first seem confusing or hard to find an answer for. We have included answers below to many of the most frequently asked questions and also have a full listing of definitions provided by (C.M.S.) the Centers for Medicare and Medicaid in our partial Glossary page below.

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part C

(Medicare Advantage Plans)

A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D (prescription drug coverage)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

• Check your Medicare health or drug plan enrollment.

• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

• 8 things to consider when choosing or changing your coverage

• Coverage: How well does the plan cover the services you need?

• Your other coverage: If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or insurer before making any changes.

• Costs: How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.

• Doctor and hospital choice: Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network ? Do you need to get referrals?

• Prescription drugs: Do you need to join a Medicare Prescription Drug Plan? Do you already have creditable prescription drug coverage? Will you pay a penalty if you join a drug plan later? What's the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan's formulary? Are there any coverage rules that apply to your prescriptions? Are you eligible for a free Medication Therapy Management (MTM) program?

• Quality of care: Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services? Get help comparing plans and providers.

• Convenience: Where are the doctor's offices? What are their hours? Which pharmacies can you use? Can you get your prescriptions by mail? Do the doctors use electronic health records (EHRs) or E-prescribe? Can you get an electronic copy of your information by email or to store in a personal health record? Which pharmacies can you use? Is the pharmacy you use in the plan’s network? If it’s in the network and your plan has preferred pharmacies, is your pharmacy preferred? You may pay more at non-preferred pharmacies. Can you get your prescriptions by mail?

• Travel: Will the plan cover you if you travel to another state or outside the U.S.?

• All supplemental plans will cover you anywhere in the United States, while Advantage programs are generally limited in coverage areas but different plans will have different levels so it is important to ask your local agent who specializes in Medicare or the plan sponsor and carrier since they vary.