By T Michele Walker
I hit a milestone the other day: I received my Social Security statement listing the different retirement amounts I’ll receive when I’m 62 or if I wait and retire at age 67. It’s a few years off, but it was an eye opener. Am I that old already?
That little nugget of a letter along with my mother’s 80th birthday started a chain of events and questions that left my head spinning. So many programs and so little guidance.
Let’s begin with my friend, Jerry. Jerry retired at age 62 and was automatically contacted by Social Security when it was time to enroll in Medicare at age 65. He has terrific insurance from his career as a teacher in Maryland, but there were gaps in coverage. Medicare for Jerry is a lifesaver and made the difference between being able to afford regular health care services like hearing aids, life saving hospitalizations and medicines.
“When I went into the hospital in July,” Jerry explained, “ I didn’t pay anything. When I had the neuromodulator installed, Medicare paid 100 percent. The surgery, doctor visits and all follow up appointments. Medicare also covered the home health nurse who came to the house to check on me.”
Now let’s look at my mother, who didn’t start collecting social security until 67. She has had a far different experience in the healthcare system. Her insurance company warned her against enrolling in Medicare. She pays out of pocket for most dental, some medical and prescriptions. Her latest pair of glasses were over $1,000.
My mother was never contacted by Medicare and now both of us are dazed and confused by the process.
Fortunately, we have Jerry to outline some of the basics, “Some people think you are automatically enrolled in Medicare, but that’s only true if you’re enrolled in Social Security by age 65. If you’re not receiving Social Security by then and you don’t sign up for Medicare at age 65, you could end up paying more for your Medicare benefits and you probably won’t be contacted for enrollment. It doesn’t pay for the insurance companies to lose you as a customer, so they will never recommend Medicare enrollment.”
My mother, who is overwhelmed by the process, wonders if it is worth it to go through all of the trouble of enrollment.
“Basic Medicare doesn’t cover everything,” Jerry explains, “Part B, which you pay for, picks up a lot. The big thing is having a good supplemental insurance plan. Humana is a big one here in Florida. This also usually is Part D, which covers prescriptions. Medicare doesn’t cover prescriptions. There is an expanded plan you can pay for that covers a lot. I didn’t need it because of my CareFirst coverage. There is a plan for dental and vision, but I didn’t need that because of my existing coverage.”
Jerry has created a list of 6 helpful tips to begin navigating the Medicare process:
1. Medicare consists of different parts
Medicare consists of Part A, B, C and D.
- Part A covers hospitalization.
- Part B covers routine care, like doctor visits.
- Part C is the Medicare Advantage program, which bundles Part A, Part B and sometimes Part D into one plan.
- Part D is the prescription drug plan.
2. Sign up by 65
If you collect early social security at age 62, you will be contacted for enrollment. However, if you collect Social Security at age 67, you will need to initiate contact. You are eligible to sign up for Medicare at any point between three months prior to turning age 65, to three months following the month you turn age 65. You can sign up anytime during that seven-month window. Signing up early can be best. Delay, and you risk experiencing a gap between when you’re existing insurance ends and Medicare begins.
3. Stay healthy with prevention coverage
This is my personal favorite: an ounce of prevention is worth a pound of cure.
Even though you have to pay Medicare Part B premiums, deductibles and co-insurance, many preventive health services won’t cost you a dime. Most preventive screenings, including for cancer and cardiovascular disease, are covered by Medicare free of charge. You can also get a free annual wellness visit and flu shots. This is a fabulous benefit of Medicare, so be sure to take advantage of all that’s included.
4. Prescription coverage
Part D drug plans and Medicare Advantage plans must follow basic Medicare guidelines, but beyond those basic rules, there’s a wide variety regarding what drugs plans cover and how much you’ll pay. Prices and services vary greatly, so don’t assume your drug coverage will be the same if you change your plan. Read the fine print.
5. Changing your mind
If you’re unhappy with your coverage, don’t worry. Medicare offers open enrollment between Oct. 15 and Dec. 7, and during this period, you can switch plans. If you plan to use the open enrollment to make changes, review your healthcare spending and carefully compare plans to make sure your needs are covered. If you make a mistake, you could have to wait until next year’s open enrollment to fix it.
There is one exception, though: You can drop Medicare Advantage and switch back to original Medicare every year between Jan. 1 and Feb. 14.
6. Ask for help
All of this information is overwhelming, but there’s help available. Contact Medicare directly at (800) 633-4227 (or 1-800-MEDICARE), or online at medicare.gov, or you can get personalized counseling by making an appointment with your State Health Insurance Assistance Program (SHIP) and it’s free!