5 Things You Need To Know About Medicare

Your 65th birthday may bring presents and lots of cake, but it also means you need to make choices about Medicare. Here are 5 things you need to know about Medicare.

1.   Most of us get Medicare Part A at 65

Part A covers:

  • Hospitalization
  • Nursing Care
  • Nursing Home Care
  • Hospice
  • Home Health Services

That’s the easy part.

 

2.  It gets complicated because anyone who doesn’t have a full-time job with health insurances needs to sign up for Medicare Part B within three months of turning 65.

Part B covers:

  • Doctor Visits
  • Routine Medical Care
  • Preventive Care
  • Ambulance Service

3.  If you don’t sign up for Part B within three months of your 65th birthday, you won’t be able to get insurance immediately and you’ll have to pay a monetary penalty.  Medicare Rights Center‘s Joe Baker explains, “If you don’t enroll in that initial enrollment period, you have to wait for January or March of that particular calendar year that you enroll in Medicare for coverage that begins on July 1st of that year. And you would have a 10 percent premium penalty for every year that you could have, or should have, signed up for Part B.  We explain more about this in ConsumerMojo.com’s video and post Boomers, Medicare Part B and Costly Mistakes.

Once you sign up for Part B, you confront a range of options because Medicare only covers 80 percent of your health care costs. Jennifer Cohen Smith of United Healthcare says, “When you buy additional insurance, it will cover that 20 percent.”

 4.  One of the options is Medicare Advantage. This plan coordinates basic Medicare Part A and  Part B  and it’s referred to as Medicare Part C.

Generally, you pay about $35 a month. Diane Wenzler of the Benefits Plus Learning Center at the Community Service Society says, “One of the good things about Medicare Advantage is that there is typically no premium, or there’s a low-cost premium, and a co-pay.

Medicare Advantage is run by insurers like United Healthcare. An analysis by the Kaiser Family Foundation shows that 15.7 million signed up for Medicare Advantage plans in 2014. Insurers offer HMO plans where you get all your health care from their doctors, hospitals and providers. They also offer PPOs or Preferred Provider Networks where you have a wider choice of doctors, hospitals and the rest.

UHC’s Jennifer Cohen-Smith points out, “With every single Medicare Advantage plan there is a maximum out-of-pocket limit. It will vary by plan. But there is a a dollar limit that you can count on that will the very most you can spend.”

Medicare Advantage plans generally include:

  • Dental
  • Vision
  • Hearing
  • Some offer gym memberships and more

They may offer access to a 24-hour nurse helpline and disease management program to help you manage chronic conditions. But still your pool of health care providers is limited and you may want more.

 

5.  That brings us to Medicare (original) with the Medicare Supplement, or Medigap. It’s call Medicare Part F. You pay a higher monthly premium in addition to the basic Medicare fee, but there’s generally no co-pay.

Diane Wenzler says, “With a Medicare Supplemental plan you can go to a provider that accepts Medicare and see the doctors of your choice.

So who should sign up for Medicare Supplemental?

Medicare Rights Center Joe Baker says if you are somebody who travels a lot, or has a second home in another state, you might want to think about original Medicare with Medicare Supplemental because that has no geographic limitations. It covers 90 percent of the doctors across the country.

Medicare Supplemental also includes travel abroad in some plans.

If you take Medicare Supplemental you also need prescription drug coverage.  That’s called Plan D, and you’ll pay an additional monthly fee for that. Still when we asked Joe Baker what he’d advice he’d give his father he said, “I have advised my father. He’s in the original Medicare program with the Supplement and the Part D plan. He travels a lot. He want to have access to as many providers as possible.”

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Barbara Nevins Taylor

As the winner of 22 Emmy Awards and a slew of journalism honors and awards, I created ConsumerMojo.com to give you the straight story about complicated stuff. Tell us what you want to know and we'll get you the answers.