The answer to this question is “it depends”. You need to weigh life variables and understand your personal needs. You need to weigh your financial situation, your health history for both you and your family. You need to understand your risk tolerance. Are you able to sleep at night without health insurance? Do you worry about an accident or sudden health issue to appear? Another factor is the number and type of medications you may be taking.

2. How much does Medicare cost?

You will likely pay the Part B premium to Medicare. In 2019 the Part B premium is $135.50 per month. Supplement and Advantage plans prices vary. You will find Part D Prescription Coverage will vary depending on your list of medications and the carrier.

Part C Advantage Plans and Medigap Supplement Plans have premiums to pay.

Part C Advantage Plans tend to be HMOs (in our region are HMO – you have to get medical care in-network). They also may have maximum out-of-pocket amounts made up of deductibles, co-pays and co-insurance. The total amount will depend on the Medicare overage you choose, and the health care services you use.

Medigap Supplement Plans (The Alphabet Plans) are structures to cover a certain percentage for health coverage categories. They have monthly premiums; some have deductible and co-pays. They do not have a maximum out of pocket that needs to be reached.

3. What do I do about Medicare if I work past age 65?

Many people enroll in Part A only when they turn 65 and have employer coverage. The Medicare deductions you see on your payroll over the years has paid for your Part A hospital coverage.  Thusly, your Part A is premium free with enough Medicare credits (40).  If you or your spouse worked and paid Medicare taxes for at least 10 years and your income meets the IRMAA levels, you will need to pay an additional premium.

You may be able to delay enrollment in Part B without late enrollment penalties if you are 65, still enrolled in an employer sponsored health plan (through your or your spouse’s health plan) that is deemed creditable coverage.

When you separate from your employer, you will need to enroll in Medicare Part A and Part B, select a drug plan within 63 days of your employer plan ending. You then will have 8 months to add a supplement plan (to cover the 20% Medicare does not cover).

4. How can I get dental and vision coverage with Medicare?

Original Medicare (Parts A & B) do not cover routine dental, hearing, and/or vision care. However, some private Medicare Advantage plans do. Medigap Plan carriers may also provide dental, vision, and additional hearing coverage. Note: Conditions such as glaucoma, retinal degeneration, cataracts, etc. are covered under Part B because it is a medical condition.

5. What’s the difference between Medigap Plans and Medicare Advantage Plans?

Medicare supplement insurance plans are also known as Medigap Plans. We call them the Alphabet Plans around here. See the Medigap Plan section in your Medicare & Your booklet for a chart with the coverage levels offered. Do not confuse Medigap Plans with the Parts of Medicare. The Parts of Medicare are like the Departments of Medicare – Part A: Hospital, part B: Providers, Part D: Drug Coverage, and Part C: Advantage Plans

It’s private insurance you can buy to help pay some costs not paid by Original Medicare (Parts A & B). Medicare Advantage is an alternative to Original Medicare. It’s a different way to get your Medicare benefits. Learn more about Medicare supplement insurance vs. Medicare Advantage.

6. What’s the difference between a Medicare Advantage HMO and a PPO?

A Medicare Advantage HMO plan usually helps pay only for care you receive from providers in the plan network. They have contracted a select group of providers and you have to go to those providers for the carrier to cover the medical care and services received.  A PPO plan contracts with specific providers but also allows you to see providers outside of their contracted providers. They will generally help pay for care received outside their plan network but will likely pay less than for the same care received within the network.

7. Where can I get help paying for Medicare?

Financial assistance programs for people with limited income and assets include Extra Help for prescription drugs, Medicare Savings Programs, and Medicaid, to name a few. Qualifications for each program and the level of help offered vary. Talk with us to help you with eligibility information.

8. How does Medicare automatic renewal work?

Your Medicare coverage choices will stay in place year after year unless you make a change. This ensures that your coverage continues, but plan benefits and costs may change. It’s a good idea to review your Medicare choices every year during Medicare Annual Enrollment, Oct. 15 – Dec. 7, to make sure you have the Medicare coverage that fits with your needs.

9. What’s the difference between Medicare and Medicaid?

Medicare and Medicaid are both government health care programs that provide financial assistance for eligible covered medical care. Medicare is generally for people who are 65 and older and those who have a disabled classification for more than 24 months. Medicaid health care is for people with limited income and resources. Those who are eligible for Medicare and Medicaid are classified as dual eligible. Individuals must apply for the Medicare Savings Program. The application ion is done though Social Services. There is also a financial assistance program to help with prescription drug costs and premiums. It is called the LIS Program. The LIS program application is done through Social Security administration. Contact our SHIP Medicare Assistance Program for more information and assistance for financial assistance.

10. I’m disabled. When can I get Medicare?

In general, you are eligible for Medicare after receiving Social Security disability benefits for 24 months. There are exceptions for people with certain medical conditions. Get your enrollment dates and learn more about Medicare and disability.

1. How does eligibility and/or enrollment in other coverage affect my eligibility?

If you are enrolled in either Medicare Part A or Medicare Part B, you are ineligible to purchase a plan through the Marketplace. However, if you have to pay the premium for Part a Medicare, you may choose to drop your Premium Part A (or choose not to enroll when eligible) and can then enroll in a plan through the Marketplace.

If you choose to drop Part A, it is very important for you to seriously consider the financial implications and potential financial consequences of not enrolling in Medicare.

Late enrollment penalties may apply when/if you choose to enroll in Part A and/or Part B at a later date.

Also, if an individual is entitled to free Part a Medicare and drops it, there could be a loss of retiree benefits and paying back all retirement benefits received, and costs incurred by the Medicare program.

Please also be aware that Medicare enrollment periods and start dates for coverage are not the same as those available on the Marketplace.

Please note: If you are enrolled in a retiree health plan or other minimum essential coverage, you may not be eligible for financial assistance through the Marketplace.

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