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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“It’s extremely important. It’s our world and earth being contaminated by all the horrible industries. It’s affecting people every day,” 15-year-old Emma said with authority. She come to New York with friends and family and mingled with the colorful crowd that gathered in front of the Javits Center on the far West Side of Manhattan.
Dianne Lloyd carried a sign demanding “Jobs. Justice. Clean Energy.” The march was like her sign. Something for everyone with a progressive bent. A little bit of something positive for all. But Lloyd’s anger bubbled over. “There’s no question the climate is changing in a way that is already destructive to human beings, and people have to speak up,” she said. “I really hope people in Congress see this and listen to our voices and do something meaningful.”
A block or so away on Eleventh Avenue, Jummy Olagondoye and her Rhode Island group carried signs and felt glad to embrace the larger movement. “It’s good to support a movement like this for the future. We are the future. It’s really important that we all work together,” she said.
And although patients can take NamendaXR once a day instead of twice, the attorney general claimed foul. He claims it’s an anti-competitive gambit. The lawsuit points out Namenda’s patent expires in July 2015 and makers of generic drugs offer cheaper substitutes.
There’s also the possibility that your plan will raise rates and another plan will not. 
Melissa Rivera agrees with him. We met her on the subway after school. Her son Izarean Beltran was fast asleep after his first day at pre-K at P.S. 197 in Manhattan. Melissa really pushed for Izarean to get in. His fourth birthday isn’t until October and he made it under the wire. “I wanted him to learn. I didn’t want him to sit at home and do nothing, or just play all day,” she said.
Last year, her daughter Leanna Rivera, who is now in kindergarten at P.S.197, missed out. “I couldn’t get her into pre-K and I wished that I could have,” she said. “I thank Mayor de Blasio for opening up more spots this year. ”
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