OC Elder Law
What You Should Know About Medicare Before Enrolling
In 2015, an advocacy group analyzed 16,000 calls and determined that senior citizens don’t understand the Medicare enrollment process. Other key areas that cause confusion: What Medicare Advantage covers and how to pay for the rising cost of Medicare Part D prescription drugs.
Here’s what you need to know before signing up for Medicare:
As a Medicare beneficiary, you have between October 15 to December 7, 2017, to review your coverage and make any changes for 2018. Any new changes in coverage made during open enrollment begin on January 1, 2018.
What Is Covered in Parts A, B, and D
• Part A covers hospital care, some types of health care, hospice care (end of life) and elderly care in a place with skilled nursing. You pay no premium for Part A if you or your spouse have worked enough to earn 40 credits towards Social Security.
• Part B will cover doctor’s services, outpatient hospital care, preventive care, and some health care at home. You must pay a monthly premium for Part B. In 2018, it is $ 134.00 for individuals with incomes less than $ 85,000 and less than $ 170,000 per couple. This premium balloons to $428.60 for incomes above $214,000.
• Part D covers prescription drugs, but you must be enrolled in the full Medicare program (A and B) to have Part D coverage. You have to pay a separate monthly premium for Part D, unless you obtain as part of the Medicare Advantage Plan. Individuals with income under $85,000 will pay the same premium for Part D as they do for their regular Medicare coverage. Incomes over $85,000 a year and those who declare taxes as couples with incomes over $170,000 persons will pay premiums on a sliding scale depending on income and tax status.
What Is Medicare Advantage?
Medicare Advantage Plans are health plan options (such as an HMO or PPO) approved by Medicare but offered by private companies. Not all Medicare Advantage Plans work the same. Therefore, it is important that you know what the coverage includes, and if it meets your needs before enrolling. Although confusing, these plans provide all covered services for Part A (Hospital Insurance) and Part B (Medical Insurance), and Part D (Prescriptions), however, you may still be charged co-payments at time of service. Some Medicare Advantage Plans may offer additional benefits, such as vision, hearing, dental and/or vision services, however it’s important to call the plan before signing up to find out how much you may pay, if any, for these supplemental services.
Depending on which state you reside, a half dozen private plans may be available for you to select from. These will offer you different premiums, and co-payments and varied coverage, including which drugs are covered. It is well worth reviewing all your options because choosing a plan that is right for you can save thousands of dollars a year in premiums and out-of-pocket costs, especially important for senior citizens who have started taking new medicines.
What To Watch Out For
If you are eligible but delay your enrollment, you could face penalties. In fact, if you do not enroll in Part B or D, when first eligible, you must pay a late enrollment penalty, and must continue to pay this penalty for as long as you have Part B or D. Thus, you not only face a late enrollment penalty, but you must pay that premium as long as you remain in that Medicare program. What’s worse, if you do not enroll during the open season period, you could find yourself locked out of the program until the following year. Do your shopping before it’s too late.
Consider Your Options
Look carefully all at out-of-pocket costs. Most seniors will focus solely on premiums, but those monthly costs and co-payments usually don’t change. The substantial difference is usually what’s included in the coverage.Decide what is most important to you, and remember, there is very little flexibility, unless you change your coverage, but there is no perfect plan.