How do I enroll in Medicare?
If you and/or your spouse are currently not actively employed with insurance benefits, and collecting Social Security benefits, then you will automatically be enrolled in Medicare Parts A and B. You will receive a card 90 days prior to your 65th birthday. If you are not collecting Social Security benefits, you will have to actively enroll yourself into Medicare by going online to www.ssa.gov or www.medicare.gov., or contact us for assistance at any level.
How much does Medicare cost?
Medicare Part A is the Hospital coverage, and there is no monthly premium for that. However, if you use the coverage, there is a $1,632.00 deductible for a hospital stay benefit period. Medicare Part B is the outpatient Medical coverage. There is a monthly premium of $174.70, an annual deductible of $240.00, and 20% co-insurance for services, hence, leaving “gaps” in the Medicare coverage.
How do I fill the gaps of coverage?
Many people take advantage of the rich Medicare Advantage programs available to us in Southern California. These programs are considered Medicare Part C. The Medicare deductibles are satisfied by these programs. Many of the Medicare Advantage plans have no monthly premiums and have very low co-pays for services.
These programs are run by private insurance companies that have contracts with the federal government in order to administer a Medicare beneficiary’s A, B and D benefits in one bundled plan. The programs include HMO’s, PPO’s and private Fee-for-Service plans. The private insurance companies get paid by the government for each member each month. Many of the plans are network-based and many times require the member to choose a primary care physician. The primary care physician refers the member to his or her network of specialists and hospitals.
Medicare Advantage also bundles the drug coverage, or Medicare Part D, into the health plan with no additional premium for most plans.
Medicare Part C = Part A + Part B + Part D.
Medicare Parts A and B get you via the Social Security Administration. Medicare Parts C and D get you through an agent or broker who represents a private insurance company.
What if I do not want an HMO?
If you want the freedom to go to any doctor who accepts Medicare and the freedom to self-refer to specialists, a “supplement” or “Medigap” plan may be your preferred route. You can also fill in the gaps in Medicare by purchasing a supplement. Locally, a supplement for a 65 year old will run around $170 on average, depending on the insurance carrier. Then you would have to purchase a separate Part D plan, or prescription plan. That may run anywhere between $30-$104 per month. This is the most costly route, but it affords you the most freedom.
What if I have VA coverage? Do I still need to sign up for Medicare?
Yes, the VA encourages you to sign up for Part B, at least. If you delay signing up for Medicare Part B without proof of creditable coverage, you will be assessed penalties. VA medical coverage is not considered creditable coverage. You can have both Medicare and VA coverage simultaneously; they will not interfere with each other. They just give you two sets of healthcare providers from which to choose when you need care. The VA, however, does provide creditable prescription coverage. So you would be able to delay having a Part D plan without a penalty.
What if I want to keep my employer coverage and not pay the $144.60 for Medicare?
You can delay enrolling in Part B if you have creditable coverage through an employer. The coverage is creditable when it is considered as good as or better than Medicare’s coverage. When you lose the employer coverage, whether voluntarily or involuntarily, you can activate your Medicare coverage. But the time frame is limited, so you would want to let Social Security know as soon as you know the employer coverage will be ending.