Medicare is the federal government’s health insuranceprogram for the disabled and those 65 years and older. Many Americans believe Medicare will pay their long-term care bills, but in fact it pays for a small percentage of all nursing home costs. At present, it may cover skilled care in a nursing home for the first 20 days (and a portion of the cost for the next 80 days) if admission follows a three-day hospital stay. The biggest gaps in Medicare’s long-term coverage are:

• No coverage for custodial care, either at home or in a nursing home
• No coverage in a nursing home without prior hospitalization
• No coverage for nursing home care after 100 days
• Coverage only in a Medicare-approved facility

To apply for Medicare or obtain information about the program, contact your local office of the Social Security Administration. For a free copy of The Medicare Handbook, write to CMS, Office of Public Affairs, 200 Independence Ave. SW, Washington, DC 20201, or call the Medicare Hotline at 1-800/772-1213.

Medicare Enrollment

Enrollment into Medicare is fairly simple if you are already receiving Social Security before age 65, you are automatically enrolled into Part A & Part B (Since Part B has a premium attached to it there is an option to refuse it).

For the rest of us who are not collecting Social Security before age 65 we have to wait until our Initial Enrollment Period (IEP), which is a 7 month period that consists of the 1st three months prior to our 65th Birthday, the month of our 65th Birthday and then the next 3 months after that.

 As long at the person applying for Medicare are is a permanent U.S. resident and has at least 10 years of working history, meaning they have paid into Social Security they can now enroll into Medicare.
At this period we also, have the option of enrolling into Medicare Part A, B & D and with another window of opportunity to choose either a MediGap Plan or a Medicare Advantage Plan.

This is important because after enrolling into Medicare Part B we only have 6 months after our 65th Birthday to register for a MediGap Policy. In these 6 months we are guaranteed the right to purchase a MediGap Policy, the right to have immediate coverage and we cannot be turned down for any reason.
If we so choose not to select a MediGap Plan at this time, we will then be subject to the terms and conditions of Private Insurance Companies who can charge a higher premium based on health and or delay coverage or flat out reject us.

To summarize;  During our IEP we can choose to enroll in Medicare Parts A, B, and D while also selecting a MediGap Policy without the fear of rejection. We can also choose a Medicare Advantage Plan as well but we cannot have both a Gap Plan & an Advantage Plan; it is one or the other.
 If we opt to not have a MediGap Plan we are then subjected to Private Insurance Companies who can charge us more or deny us coverage later in our retirement.
For more information on what these two plans cover see HealthView Services’ Medicare Advantage Plans along with MediGap Plan.

What if I am working at age 65 or older and still have coverage that I like from my employer?
 Enrollment is still going to happen for Medicare Part A and it is strongly advised to file and then inform Medicare as to what the needs are. Also, it is strongly advised to keep Part A while employed just in case there are some coverages that your private insurance lacks.

As for Parts B & D along with the Supplemental choices (Advantage Plans or MediGap Plans); as long as there are health insurance benefits all the coverage can be delayed without penalty but enrollment periods will be different.

From Medicare.gov “If you didn’t sign up for Part A and/or Part B (for which you pay monthly premiums) when you were first eligible, you can sign up between January 1–March 31 each year. Your coverage will begin July 1. You may have to pay a higher premium for late enrollment.”
For Supplemental Coverage & Part D; the enrollment period is between October 15–December 7 with an opportunity from January 1 to February 14 to switch from an Advantage Plan to Original Medicare and purchase a Part D plan as well.
 You may need to provide proof that you were fully insured by an employer for the period that was delayed.
**That penalty is only for those who delayed enrollment & were not covered in any way**

What happens if I just decide to delay Medicare in its entirety and forgo any health insurance coverage as well?
 The enrollment periods are still the same as if you had stayed employed and had coverage, the big difference is the penalties you will face.
 For Part A; if you were subjected to pay for coverage due to not meeting qualifications the penalty is - 10% of the Part A premium and you will have to pay the premium penalty for twice the number of years you could have had Part A, but didn’t sign up.
 For Part B; For each 12-month period you delay enrollment in Part B, you will have to pay an extra 10% of the Part B premium and you will be subjected to this as long as you are enrolled in Part B.
 For Part D; please see Late Enrollment Penalty from Medicare.gov questions.medicare.gov/app/answers/detail/a_id/2255/~/late-enrollment-penalty-%28lep%29 Supplemental Coverage; The major penalty is the sacrifice of not having the guaranteed opportunity to purchase a MediGap Policy and now you will be subjected to terms and conditions of Private Insurance Companies.
For more information on Enrollment Periods please Medicare.gov – Publications PubName=enrollment+periods&PubCat=All|All+Publications&go2.x=0&go2.y=0&Type=NameCat&Language=English&pagelist=Home&dest=NAV|Home|Search|Results|SearchCriteria&comingFrom=13&version=default&browser=Firefox|4|Windows+7
It is also highly recommend  that you contact Medicare at 1-800-772-1213 or at www.medicare.gov

Preventive Services
The federal Medicare health insurance program, which is generally open to people 65 and older (and to some younger people who are disabled), now fully covers most preventive services.

The list of preventive services (some of which may have already been covered under Medicare, at least in part) includes the following:
􀂄 Abdominal aortic aneurysm screening
􀂄 Bone mass measurement
􀂄 Cardiovascular screenings
􀂄 Colorectal cancer screenings
􀂄 Fecal occult blood test
􀂄 Flexible sigmoidoscopy
􀂄 Colonoscopy
􀂄 Barium enema
􀂄 Diabetes screenings
􀂄 Diabetes self-management training
􀂄 Flu shots
􀂄 Glaucoma tests
􀂄 Hepatitis B shots
􀂄 HIV screening
􀂄 Mammogram (screening)
􀂄 Pap test and pelvic exam (includes breast exam)
􀂄 Pneumonia vaccination
􀂄 One-time “Welcome to Medicare” physical exam
􀂄 Yearly “wellness” exam
􀂄 Prostate cancer screenings
􀂄 Smoking cessation
Source: U.S. Centers for Medicare & Medicaid Services

Medicare supplement insurance (often called Medigap) is private insurance that supplements Medicare benefits and may cover copayments and deductibles for medical and hospital expenses. Medigap policies generally do not provide coverage for long-term care.

Medicare managed care. Instead of purchasing a Medigap policy, some people enroll in a Medicare HMO to supplement their Medicare benefits. Such plans may provide more preventive services and charge lower copayments. However, you are generally restricted to participating providers (physicians, hospitals, nursing homes, etc.). Again, such plans generally do not provide coverage for long-term care. Short-term nursing home care covered by Medicare and your Medicare HMO is usually available only in participating facilities.

Medicaid is a joint federal/state program that pays for health care for people with limited income and assets. More than half of all nursing home costs are picked up by Medicaid. To be eligible for Medicaid reimbursement, nursing home care must be provided in a Medicaid-approved facility. To receive Medicaid you must meet federal poverty guidelines for income and assets and may have to “spend down” or use up most of your assets. Some assets, such as your home, may not be counted when determining Medicaid eligibility. To obtain information about the program, contact your local Medicaid office or Department of Social Services.

Long-term care insurance is private insurance designed to help pay for nursing home or home health care expenses. It is available to individuals and may be available under a group policy. You pay a premium to an insurer in return for protection against the high costs of long-term care

For additional resources, contact these organizations:

AARP http://www.aarp.org/ppi

Home Renovations for the Elderly http://www.homemods.org/

Consumer Consortium on Assisted Living, http://www.ccal.org/

National Assn for Homecare & Hospice http://www.nahc.org/

National Center for Assisted Living, http://www.ncal.org/

Assisted Living Federation of America, http://www.alfa.org/

Total Living Choices, http://www.tlchoices.com/

National Alliance for Care Giving http://www.caregiving.org/

National-Family-Caregivers-Associations http://www.nfcacares.org/

Caring From a Distance http://www.cfad.org/

Center-for-Medicaid-and-Medicare-Services http://www.medicare.gov/

Alzheimer's Association http://www.alz.org/

Oncolink (Cancer help) http://www.oncolink.upenn.edu/

Aging Network Services http://www.agingnets.com/

Eldercare-Locator http://www.eldercare.gov/Eldercare/Public/Home.asp

SeniorBridge Family http://www.seniorbridgefamily.com/

You may also contact the National Association of Professional Geriatric Care Managers http://www.caremanager.org/520-881-8008

The-National-Academy-of-Elder-Law-Attorneys http://www.naela.org/520-881-4005