If you are enrolled in Medicare and believe that after your initial enrollment there is nothing else to do, here are a few important reminders. If you are beginning to think about enrolling in Medicare, this general information can help you get started.
Parts of Medicare
- Part A is hospital insurance. This type of coverage applies to hospital stays, hospice, rehabilitation in a skilled nursing facility and some home health services (certain conditions apply). Part A is administered by the federal government under Traditional Medicare.
- Part B is medical insurance. Physician services, outpatient care, medical supplies, and preventive services are covered under Part B. Part B is administered by the federal government under Traditional Medicare.
- Part C is a combination of Part A and Part B coverage that is administered by private insurance companies that have contracted with Medicare.
- Part D is prescription drug coverage. Some Part C plans may already include this coverage, or it may be purchased separately.
- Those who are eligible for Medicare at age 65 have a 7-month initial enrollment period to sign up for the coverage types listed above. This period includes the 3 months prior to one’s 65th birthday, the month of the 65th birthday, and the 3 months following the birthday.
- Individuals with a disability or end-stage renal disease or who receive Medicaid may have a different eligibility date than their 65th birthday.
- Some individuals may qualify automatically for Medicare, while others may need to sign up. Visit www.medicare.gov and use the calculator to determine eligibility or call your local Social Security office.
- Part A – Usually there is no premium for Part A if you or your spouse worked for at least 10 years (40 calendar quarters) and made payments to Social Security.
- Part B – Most people pay the standard premium amount of $104.90 if they enroll when initially eligible. An extra charge may be added if an individual’s modified adjusted gross income on his/her IRS return is above a certain amount. Penalties may apply if an individual doesn’t enroll when initially eligible. Deductibles, coinsurance, and copays may also apply.
- Part C – Participants must pay the same monthly premium that applies to those enrolled in Traditional Medicare Part B. Additional costs may include extra monthly premiums, annual deductibles, copayments, and charges for using out-of-network providers. These costs depend on the type of Medicare Advantage plan chosen. These plans may also change their benefits, premiums, and copayments annually.
- Part D – Costs will vary depending on the plan you choose and the types of medication that you take. These plans should be reviewed annually due to changes in premiums, your prescriptions, and pharmacy formularies (their list of covered medications).
Important Annual Dates
- January 1st – March 31st: This is a general enrollment period for those who did not enroll in Medicare when they were initially eligible.
- January 1st – February 14th: Individuals may choose to change from a Medicare Advantage plan (Part C) to Traditional Medicare (Parts A and B) and a drug plan (Part D).
- October 15th – December 7th: Open enrollment period during which one may change from Traditional Medicare to a Medicare Advantage plan; change from a Medicare Advantage plan to Traditional Medicare; change from one Medicare Advantage plan to another; or join, drop, or change a Medicare drug plan.
Choosing Medicare coverage may sound like a daunting task. While there are many details to consider, the government website www.medicare.gov contains information written in plain English and organized by specific topics. Taking the time to understand the various Medicare benefits which are available may save you money and surprises later on when specific types of benefits are needed. Next week we’ll take a closer look at Traditional Medicare versus Medicare Advantage Plans.
Karen Kaslow, RN, BSN