What is Medicare?
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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).
Medicare is the federal government’s health insurance program 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:
Medicare Part B helps cover medically-necessary services like doctors' services, outpatient care, durable medical equipment, home health services, and other medical services. Part B also covers some preventive services. The monthly Medicare Part B premium is $99.90 (2012 figures), though higher-income consumers may pay more. Medicare Part C is a Medicare Advantage Plan (such as an HMO or PPO), is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “MA Plans,” are offered by private companies approved by Medicare. Medicare Part D Is Medicare Prescription Drug Coverage. Call 800/772-1213or 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, call the Medicare Hotlinet1-800/772-1213. Medicare EnrollmentThere are different enrollment periods. It is important that you sign up at the right time or it is possible you can end up having to pay higher premiums or have coverage gaps.
Be aware there are exceptions to the age 65 sign-up date. If you are eligible for Medicare due to a disability, you can sign up earlier than 65. Medicare has a seven-month initial enrollment window, which includes the three months before you turn 65, your birthday month, and the three months afterward. This window applies to all forms of Medicare—Parts A (hospital), B (doctor and outpatient expenses), C (Medicare Advantage), and D (prescription drugs). Signing up for Medicare Advantage, the managed health care version of Medicare, requires you to have Parts A and B. You can drop your MA plan anytime within the following 12 months and use what’s called original or basic Medicare (Parts A and B). If you missed enrolling in Part A or B during the initial enrollment window, there is a general enrollment period from January 1 through March 31 each year. Waiting until this period could, trigger lifetime premium surcharges for late Part B enrollment, which could end up costing you thousands of dollars. If all this sounds complicated it actually isn’t as 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). If you are confused or worried about enrolling and your options, further down this page we provide contact information for Medicare and other ways to assist you to get your questions answered. Be aware 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 are able to enroll into Medicare. To summarize; during your initial enrolment period you can choose to enroll in Medicare Parts A, B, and D while also selecting a MediGap Policy without the fear of rejection. You can also choose a Medicare Advantage Plan as well but cannot have both a Gap Plan & an Advantage Plan; it is one or the other. If you opt to not have a MediGap Plan you are then subjected to using private insurance companies who can charge you more or deny you coverage later in your retirement. 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. 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. It is also highly recommend that you contact Medicare at1-800-772-1213 with questions as this federal program provides excellent service and responds well to questions. |
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Medicare Open Enrollment Ends Soon (December 7)
Medicare Supplemental Insurance extends coverage over healthcare costs that Medicare doesn’t cover. Different plans offer different amounts of coverage and the costs can vary substantially. Click here to find the best plan to fit your needs and get an actual quote.
Click here to find the best plan to fit your needs and get an actual quote.
Click here to find the best plan to fit your needs and get an actual quote.
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:
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
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 co-payments. 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
Long-Term Care can be expensive; especially for retirees living on a fixed budget. The sobering reality is that one-in-three Long-Term Care policy holders will wind up using their Long-Term Care policy at some point in their retirement.
Click this link to give you the information to assess your need for long-term care, calculate the costs, and see if a long-term care policy will be right for you. http://freeseniorcitizenssolutions.com/long-term-care.html
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 co-payments. 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
Long-Term Care can be expensive; especially for retirees living on a fixed budget. The sobering reality is that one-in-three Long-Term Care policy holders will wind up using their Long-Term Care policy at some point in their retirement.
Click this link to give you the information to assess your need for long-term care, calculate the costs, and see if a long-term care policy will be right for you. http://freeseniorcitizenssolutions.com/long-term-care.html
For additional resources, contact these organizations:
The-National-Academy-of-Elder-Law-Attorneys http://www.naela.org/ or 1- 520-881-4005
Disclaimer: The information above has been provided to assist in your selections but all information must be reviewed with a knowledgeable professional specializing in Medicare and or http://medicare.gov/
- 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.NET/Public/Index.aspx
- SeniorBridge Family http://www.seniorbridgefamily.com/
The-National-Academy-of-Elder-Law-Attorneys http://www.naela.org/ or 1- 520-881-4005
Disclaimer: The information above has been provided to assist in your selections but all information must be reviewed with a knowledgeable professional specializing in Medicare and or http://medicare.gov/