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OCTOBER USHERS IN A SEASON of celebration: Halloween, Thanksgiving, and the December holidays. But for those 65 and older, it marks something else: a chance to change health coverage.
We’ll get to that in a bit. For now, welcome to the world of Medicare.
Medicare is the country’s health insurance program for people aged 65 and up. It helps with the cost of health care, but it doesn’t cover all medical expenses or the cost of most long-term care. There are options to cover these situations.
But first, a person must sign up for the original Medicare. What’s called the Initial Enrollment Period (IEP) is three months prior to a person’s 65th birthday, the birthday month, and three months afterward—a seven-month window. Enrollment is online at Medicare’s official website, medicare.gov.
Most people aged 65 and up are eligible for free medical hospital insurance—Medicare Part A—if they have worked and paid Medicare taxes long enough, the website explains. A person can enroll in the medical insurance component—Medicare Part B—by paying a monthly premium. A registrant can sign up with the online application for Parts A and B, but, the website explains, because Part B carries a premium, the registrant can turn it down.
While the IEP begins three months before turning 65, registrants are encouraged to study the process earlier. “I typically advise people that about six months ahead of their 65th birthday they should start researching Medicare plan options to get an understanding of what those plans mean to you,” says Ron Myers, a licensed independent health and life insurance agent with Citizen Advisory Group LLC in Perrysburg.
“One of the challenges,” he continues, “is that up to 12 months prior to turning 65 an individual receives so much solicitation from those who want to sell them supplemental plans, through email, TV, and mailings, that it creates a lot of confusion. That’s why I suggest people do the research so they’re as knowledgeable as they can be.”
Part of the research should include the variety of extra healthcare plans, including coverage from insurance companies, associated with Medicare. As the Medicare website explains, supplemental polices—referred to as Medigap—help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
The Medicare Advantage Plan, known as Part C, includes benefits and services covered under Parts A and B—prescription drugs and other benefits such as vision, hearing, and dental—bundled together in one plan, the website says.
Then there’s Medicare Part D, which covers the cost of prescription drugs and carries a premium.
So yes, there are a lot of healthcare options associated with Medicare. To eliminate some of the confusion, medicare.gov lists seven points to consider when choosing coverage:
1. Costs
How much are the premiums, deductibles, and other charges? In original Medicare, there’s no limit on out-of-pocket expenses per year unless you have supplemental coverage. In Medicare Advantage, there’s a yearly limit on out-of-pocket expenses.
2. Coverage
How well does the plan cover the services you need? Original Medicare covers services in hospitals, doctors’ offices, and other healthcare settings. Medicare Advantage plans offer coverage of those services plus vision, hearing, and dental.
3. Other coverage
If you have other types of health or prescription drug coverage, make sure you understand how that fits in with Medicare.
4. Prescription drugs
In original Medicare, you’ll need to join Part D or get other drug coverage. Most Medicare Advantage plans include drug coverage; if not, you can join Part D.
5. Doctor and hospital choice
In original Medicare, you can go to any doctor who accepts Medicare. In Medicare Advantage, you may need to use healthcare providers who participate in the plan’s network; some plans offer out-of-network coverage.
6. Quality of care
The quality of care can vary, so compare what’s offered by plans and other providers; the website provides a link to make this easier.
7. Travel
Original Medicare generally doesn’t cover care outside the US; you may be able to buy supplemental insurance that offers travel coverage. Medicare Advantage usually doesn’t cover care outside the US.
So, what’s the significance of October in the Medicare world? October 15 through December 7 is the Annual Enrollment Period (AEP). “This is for someone already on Medicare who wants to make a change,” Myers says. “An individual can change their existing Medicare Advantage plan or Part D plan or enroll into one of these for the first time.”
To those about to turn 65 and those pondering changes to their health coverage, be calm, do the research, and ask for help if needed. And enjoy the upcoming holidays.
For more details, visit medicare. gov and citizenadvisory.com.
Dennis Bova is a freelance writer and editor. ✲
