If you’re eligible for Medicare, now is the most important time of year. Why? It’s open enrollment season. This is the only time of the year seniors can make changes to their Medicare coverage. Open enrollment ends on December 7th, so it’s important to think about your options. This article will cover some key points on eligibility, coverage options, and plan changes.
Who Can Qualify For Medicare?
If you’re new to Medicare, the first thing you’ll want to know is if you can qualify. Generally speaking anyone age 65 and older is eligible. It’s also possible to qualify for Medicare under age 65 if you’ve been receiving Social Security disability benefits for 24 months.¹
Medicare has a lot of different coverage options, separated into parts. There is a Part A, B, C, and D which all provide different pricing and coverage, outlined below.
Medicare Part A (Hospital Insurance)
Medicare Part A covers hospital inpatient care. This includes semi-private rooms, meals, nursing, medicines, and other hospital services and supplies. To qualify for this coverage, you must be referred to a hospital that accepts Medicare by a doctor.²
Medicare Part A also covers the cost of skilled nursing facility care in addition to long-term care in a long-term hospital.
The great news is that for most people, Medicare Part A is completely free. The only requirement is that you paid Medicare tax for at least ten years. If you don’t meet this requirement, you can still get Medicare Part A if you pay a premium.
Medicare Part B (Medical Insurance)
Medicare Part B covers medically necessary services as well as preventative services. Examples covered under Medicare Part B include ambulance services, diagnostic tests, screenings, mental health care, physical therapy, medical equipment, getting a second opinion before surgery, and many other medical treatments.³
In order to take advantage of Medicare Part B, you must enroll and pay a monthly premium. This is in contrast to Part A, which is usually free and requires no enrollment. Premiums for Medicare Part B are generally deducted from your Social Security benefits.
Medicare Part D (Prescription Drug Coverage)
Medicare Part D covers the costs of prescription drugs. It is an optional benefit that also requires the payment of a monthly premium. You can get it in two ways:
– By enrolling in a separate Medicare Part D plan that fits your local area. Plans can vary in terms of cost and drugs covered.
– Through a Medicare Advantage Plan (Part C) which also includes Part A and B in the plan.
Medicare Advantage and Medigap Plans
Taken together, Medicare Part A (hospital care), Part B (doctors, medical procedures, and medical equipment), and Part D (prescription drugs) provides basic coverage for 65+ Americans.
However, Part A, B, and D still doesn’t cover deductibles, co-pays, and other medical expenses. These could be a major financial burden if your health takes a turn for the worse. For this reason many Americans still seek additional Medicare coverage.
There are two popular forms of additional coverage – Medicare Supplemental Insurance (Medigap) and Medicare Advantage Plans (Part C).
Medigap can be very confusing with many different plans of its own – Plans A, B, C, D, F, G, K, L, M, and N.
There is one important plan to know about – Plan F. Although Plan F is the most expensive, seniors love it because it covers pretty much everything not covered by the basic medicare package. There are no surprise bills, no deductibles, co-payments, or coinsurance. Plus, seniors can go to pretty much any doctor or hospital that accepts Medicare patients.
However, in an effort to control costs, the government is getting rid of Medigap Plan F at the end of 2019. This means if you’re 65+, now is the time to look into Plan F before the doors close for good in 2020.
If you’re turning 65+ after 2020, you might want to look into Medicare Plan G instead. It has been suggested as a suitable alternative for seniors who want to get the most coverage with the fewest surprise bills.⁴
Both Medigap Plan F and G are billed as a monthly expense and are sold by private insurance companies. Again, these plans cover everything under Part A and B plus additional coverage.
How To Change Plans
Now that we’re in open enrollment season (October 15th to December 7th) it’s easy to change plans. If you’re only interested in basic coverage under Parts A and B, you can purchase that through the federal government. If you want the basic coverage in Parts A and B plus more, you can purchase a Medicare Supplemental Insurance Plan (Part F, G and more) through private insurance companies.
If you’re already on the basic plans through the government and want to purchase extra coverage, the process is simple. Simply contact a suitable private Medicare Supplemental Insurance company and they’ll help you take care of everything. To find a great insurance company, it makes sense to do an online search.
If you want to leave your existing private plan and go back to the government Medicare plan, contact your existing insurance company and they can help with that as well.
Remember, although basic government Medicare is a fantastic benefit, its coverage is limited. Considering Medicare Supplemental Insurance is often a wise option. A supplemental insurance policy can protect you by covering all of the expenses not covered under basic Medicare. This can save you a lot money if things take a turn for the worse.
Remember The Deadline – It’s Important!
Remember, Medicare open enrollment season only lasts until the 7th of December. There are still options if you miss this date, but they are limited and often come with penalties.
So, if you’re looking to sign up for Medicare or change your existing plan, now is the time to do so. If you don’t, you could be forced to pay a penalty or wait another year.
[1] https://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html
[2] https://www.medicare.gov/coverage/long-term-care-hospital-services
[3] https://www.medicareresources.org/medicare-benefits/medicare-part-b/
[4] https://www.reuters.com/article/us-column-marksjarvis-medigap/medicare-supplement-plans-are-changing-what-you-need-to-know-idUSKCN1LZ18F
