5 tips for navigating the confusing maze that is Medicare

For most people turning 65 means becoming eligible for Medicare. Understanding options and making wise choices seems a difficult path for many, but starting early is the key to success.

Jerry and Sue recently sought help from an APPRISE Medicare Counselor. They had seen a notice offering free, unbiased help to those turning 65 at their local library and called to schedule an appointment.

Jerry said, “I thought I was pretty savvy, but reading about all the choices I needed to make along with warnings from friends that I’d better enroll ASAP or be penalized really scared me. I knew I needed help!”

Sue said her neighbor told her to “enroll in the Medicare supplement company I have because ‘it’s the best one’ whatever that means,” thought Sue.

So, finding that there was help just around the corner at the library was the perfect solution to explore and learn about Medicare options.

Pennsylvania offers a free health insurance counseling program (APPRISE) designed to help older Pennsylvanians with Medicare. Counselors are specially trained staff and volunteers who can answer your questions about Medicare and provide you with objective, easy-tounderstand information about Medicare, Medicare Supplemental Insurance, and Medicaid. To learn more call (610) 8341040 ext. 20 or see www. rsvpmc.org.

You can enroll in Medicare three months before your 65th birthday, so get started as soon as you can. Free unbiased help is as close as a phone call.

1. Know when and where to enroll

You can enroll at a Social Security office or online at www.socialsecurity.gov beginning three months before turning 65 and no more than three months after to avoid late penalties that can permanently impact your premium. Those who have a disability, special condition, or receive benefits from Social Security or the Railroad Retirement Board may qualify before turning 65, or could be enrolled automatically when they’re turning 65. Determine your eligibility and calculate your premium on the official Medicare website www.medicare.gov.

2. Evaluate current coverage

If you or your spouse are working and you’re covered by an employer’s plan, ask the benefits administrator if they require you to enroll in Medicare. If not, you can sign up later during a special enrollment period without incurring a late penalty. Also, make sure any prescription drug coverage you receive through an employer after turning 65 is creditable — deemed by Medicare to be at least equal to its drug coverage — or you’ll be on the hook for another late penalty.

3. Understand the Medicare basics

If you’re not covered by an employer or former employer, there are two main ways to get Medicare coverage:

Original Medicare (Parts A and B) – managed by the federal government.

Medicare Advantage (Part C) – managed by private insurance companies to replace Original Medicare while also providing other value-added benefits.

Those who choose Original Medicare must purchase separate prescription drug coverage (Medicare Part D). They can also opt for Medicare Supplement (Medigap) to work alongside Original Medicare.

Original Medicare (Parts A and B) and Part D Prescription

Medicare Part A provides hospital insurance for inpatient stays, skilled nursing facilities, and hospice care. Medicare Part B provides medical insurance for doctor services, outpatient care, medical supplies, and preventive care. Parts A and B do not include many value-added benefits and services such as routine vision and dental visits, health management programs, and more. These costs would be outofpocket. Most people who have contributed to Medicare during their employment years have no premium to pay for Part A. There are premiums for Parts B and D.

Most prescription drugs are not covered by Original Medicare and require a separate Medicare prescription drug plan (Medicare Part D). Some people who opt for Original Medicare also purchase at various costs Medicare Supplement Plans (Medigap) from a private insurance company. This type of plan works alongside Original Medicare and helps pay for some uncovered medical costs, though a separate Medicare Part D plan would still be required to receive prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage plans (Medicare Part C) are offered by health insurance companies to replace Medicare Parts A and B. Medicare Advantage covers the services provided by Original Medicare ,and sometimes dental, hearing, vision, annual physicals, and wellness benefits not covered by Original Medicare. Many Medicare Advantage plans also provide prescription drug coverage (Part D) and the convenience of having all of your Medicare benefits administered by one plan. Monthly premiums for Medicare Advantage plans vary by company and change yearly.

4. Avoid late penalties

Failing to enroll on time can result in significant penalties, which can be permanent.

5. Remember open enrollment

There is an open enrollment period, called AEP or Annual Election Period, for making changes to your Medicare Advantage or prescription drug plan that spans from Oct. 15 to Dec. 7. While you can sign up for Medicare plans up to three months before turning 65, and have the coverage begin on the first day of your birthday month, changes to your plan can only be made between those dates.

AEP is not only for new enrollees. No matter how long you’ve been a Medicare recipient, open enrollment provides an opportunity to revisit your plan and make changes that reflect your current needs. Has your health changed? Are you happy with your current plan? Did you have significant out-of-pocket costs? What were these costs for? Will your current plan change in the coming year? Having these answers prior to open enrollment will help you make smart choices.