Health insurance is critical throughout your life, but it’s more important than ever to have good coverage as you age. Gaps in coverage can lead to lack of medical treatment, which could impact your long-term health and well-being. However, at age 65, Americans become eligible for Medicare, a federal health insurance program that is separated into parts that cover specific services.
The basics
Before you can decide which Medicare, insurance is right for you, it’s important to understand what each part covers. According to medicare.gov :
- Part A Medicare covers inpatient hospital stays, hospice care, skilled nursing facility care and some home health care. Every American is eligible for Part A of Medicare for free, as long as you are a U.S. citizen, and either you or your spouse has worked at least 10 years in this country.
- Part B Medicare covers outpatient care, certain doctor services, preventive services and medical supplies. Part B does have a monthly cost, and the rate is determined by your modified adjusted gross income from two years prior.
- Medicare Part D adds prescription drug coverage to other Medicare plans. Some plans have Part D included at no additional monthly premium.
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Eligibility age for Medicare
- If you are already receiving Social Security at age 65, you’ll automatically be enrolled in Medicare. If you are not receiving Social Security then you will need to apply for Medicare either online or in person at your local Social Security office during your eligibility period.
- If you’re still working at age 65 and are covered by your employer’s health insurance or spouse’s work insurance, you likely won’t need to sign up for Part B. When you stop working, you’ll have a special enrollment period of eight months in which to sign up for Part B.
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Medicare eligibility window
- The eligibility rules of Medicare state that you have seven months to apply: three months before your birthday, the month of and three months after. If you enroll later than this period and don’t qualify for a special enrollment period, you’ll be assessed a late enrollment penalty. NOTE * Enrolling within the three months after your birthday may leave you with a gap in coverage, as it can take up to two months before your Medicare Part B is activated.
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Choosing your plans
- Original Medicare A & B only covers 80% of all Medicare approved expenses. This puts people at unlimited risk of paying 20% of all medical expenses. To help people with this liability there are two types of additional coverage to choose from.
- “Medicare Advantage plans, typically HMO or PPO products, are insurance plans that combine the benefits of Part A and B and, in most cases, include prescription drug coverage.
Certain plans may also include extra benefits including vision, transportation, and gym membership. - Medigap plans, also known as Medicare supplement plans, keeps Medicare as the primary insurance. This means that you can go to any doctor, specialist, or hospital in the country, as long as they accept Medicare. These plans usually have higher monthly premiums with few or no copays and deductibles. You should compare benefits between different Medigap plans and companies to determine which plan works best for you.
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Open enrollment
- Each year from Oct. 15 to Dec. 7, you can use the Annual Enrollment Period to switch from original Medicare to a Medicare Advantage plan; change from your current Medicare Advantage plan back to original Medicare, or switch from one Medicare Advantage plan to another. You can also switch between the various drug plans, during this time.
Medicare Made Easy / Just Us Insurance Services / INSR4U.com
