Navigating Medicare

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Affordable medical coverage is something everyone wants, especially as people age. Luckily, our nation has safeguards for workers as they get older. Millions of people rely on Medicare, and it can be part of your health insurance plan when you retire.

Medicare is our country’s health insurance program for people age 65 or older. The program helps with the cost of health care, but it doesn’t cover all medical expenses or the cost of most long-term care. You have choices for how you get Medicare coverage. If you choose original Medicare coverage, you can buy a supplemental policy (called Medigap) from a private insurance company to cover some of the costs that Medicare does not.

Medicare has four parts:

Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care.

Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.

Medicare Part C (Medicare Advantage) includes all benefits and services covered under Part A and Part B. Some plans include Medicare prescription drug coverage (Medicare Part D) and other extra benefits and services.

Medicare Part D (prescription drug coverage) helps cover the cost of prescription drugs. Some people with limited resources and income may also be able to get Extra Help with the costs – monthly premiums, annual deductibles, and prescription co-payments – related to a Medicare prescription drug plan. The Extra Help is estimated to be worth about $4,900 per year. You must meet the resources and income requirement.

Medicare’s different parts are further explained in a publication at socialsecurity.gov/pubs/EN-05-10043.pdf.

You can learn more about Medicare, including how to apply for Medicare and get a replacement Medicare card, at socialsecurity.gov/benefits/medicare.

Medicare is also available for younger people who have received Social Security disability benefits for 24 months, and people with certain specific diseases. You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least ten years. Part B usually requires a monthly premium payment.

You can apply online for Medicare even if you are not ready to retire. Use our online application to sign up (socialsecurity.gov/benefits/medicare). It takes less than ten minutes. In most cases, once your application is submitted electronically, you’re done. There are no forms to sign and usually no documentation is required. Social Security will process your application and contact you if we need more information. Otherwise, you’ll receive your Medicare card in the mail.

If you don’t sign up for Medicare during your initial enrollment window that begins three months before the birthday that you reach age 65 and ends three months after that birthday, you’ll face a ten percent increase in your Part B premiums for every year-long period you’re eligible for coverage but don’t enroll. You may not have to pay the penalty if you qualify for a Special Enrollment Period (SEP). If you are 65 or older and covered under a group health plan, either from your own or your spouse’s current employment, you may have a special enrollment period during which you can sign up for Medicare Part B. This means that you may delay enrolling in Part B without having to wait for a general enrollment period and without paying the lifetime penalty for late enrollment. Additional rules and limits apply, so if you think a special enrollment period may apply to you, read the Medicare publication at socialsecurity.gov/pubs/, and visit the Centers for Medicare and Medicaid Services at Medicare.gov for more information.

Health and drug costs not covered by Medicare can have a big impact on how much you spend each year. You can also estimate Medicare costs using an online tool at medicare.gov/oopc/. If you can’t afford to pay your Medicare premiums and other medical costs, you may be able to get help from your state. States offer programs for people eligible for or entitled to Medicare who have low income. Some programs may pay for Medicare premiums and some pay Medicare deductibles and coinsurance. To qualify, you must have Medicare Part A and have limited income and resources.

Keeping your healthcare costs down allows you to use your retirement income on other things that you enjoy.

 

 

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