While it has been around for half a century, Medicare is still something new for thousands of Americans who turn 65 and become eligible to enroll into the national health insurance program.
So, if you’re eligible for Medicare, be ready to learn Medicare terminology before deciding on a plan that best fits your health needs.
For initial enrollment, you can sign up during the seven-month period that begins three months before the month you turn 65. If you don’t sign up when first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare.
If you’re already enrolled, be ready to go over that glossary again, especially if you’re thinking of switching Medicare plans. If you’re reading this now, don’t wait too long. Open enrollment for Medicare runs from Oct. 15 through Dec. 7. Your coverage will begin on January 1 as long as the plan gets your request by December 7.
Medicare can be very confusing. For example, do you know the difference between Original Medicare, Medicare Advantage and Medicare Supplemental Insurance? Here is a list of terms to learn and steps you can take to better understand your options and make sure you get the most from your health plan benefits.
First, there are two main ways to access Medicare, either through Original Medicare or a Medicare Advantage plan. It is also important to know about prescription drug coverage and supplemental plans.
Original medicare is made up of two parts. Part A provides your hospital insurance. Part B provides medical insurance for things like doctor visits and checkups. Everyone can have Part A, regardless of whether you’re still employed.
If you’re still working at 65 and are covered by your employer’s health insurance, you may not need to enroll in Part B. Compare your employer coverage with Medicare coverage to help you decide which is best for you. Once you stop working, you’ll have a special enrollment period of eight months after your employment ends in which to sign up for Part B.
Medicare Advantage plans, also known as Plan C, are typically HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) products. These insurance plans combine the benefits of Original Medicare Parts A and B. They may also include prescription drug coverage (Part D) and extra benefits and services for an additional cost. These plans usually require the patient to access a limited physician network for services.
If you’re enrolled in a Medicare Advantage plan, you can enroll or switch to a different plan during two open enrollment periods:
- Annual Medicare Open Enrollment Period from Oct. 15 to Dec. 7
- Medicare Advantage Open Enrollment, from Jan. 1 to March 31.
A special enrollment period is also available for Medicare beneficiaries in San Diego due to recent wildfires in the region. Medicare-eligible individuals have until Jan. 31 to enroll and switch their Medicare Advantage plan and prescription plans.
Medicare Part A and Part B do not cover prescription drug benefits. For prescription drug coverage you can enroll in a prescription drug coverage or Part D plan. Drug coverage is often included in Medicare Advantage Plans.
Medicare imposes a penalty for late enrollment in Part D plans once you are covered by Part B. Also, Part D drug plans may have very different formularies, so be sure to check that the drugs most important to you are covered by the plan you choose.
This coverage is an alternative to Medicare Advantage plans and allows individuals to customize their health plan coverage. These plans help fill “the gap” by partially or fully covering expenses that would normally be payable by the patient under original Medicare.
Supplemental plans are only available to purchase for people who are enrolled in original Medicare. People with a Medicare Advantage plan cannot buy Medicare supplemental insurance.
Once you have evaluated your choices, choose the Medicare plan that is the best fit for you and complete the enrollment process. You may be able to sign up in person with a broker, through the mail, over the phone or online.
If you’re enrolled already, you’ll need to decide whether or not you want to change your coverage and be aware of important deadlines.
Review your existing health and drug benefits and pay attention to any changes announced for the coming year. Your current insurance provider will send information to let you know what, if any, changes will be made to your Medicare coverage in 2021.
Review these carefully to ensure the providers, services and medications you need are covered and at what cost. Check your premiums, coinsurance, co-payments, deductible and out-of-pocket limits, and ask yourself whether another plan would better suit your needs in 2021.
If you have employer or union coverage, check with your plan’s benefits administrator before making any changes to your coverage. Otherwise, you could lose coverage for yourself and your dependents.
Finally, take advantage of the benefits your plan offers. Your Medicare coverage offers more than just sick care. Review your benefits and take advantage of wellness and preventive services such as an annual exam, weight and blood pressure check, flu shots and more.
If you are in a retiree plan, your former employer may be a good source of information about your Medicare options. The following may also be resources in your search for information about Medicare enrollment, benefits, and other helpful tools:
- Free Medicare seminars at Scripps
- Medicare.gov - The official U.S. government site for Medicare
- Centers for Medicare & Medicaid Services (CMS)
- Social Security Administration
- Health Insurance Counseling and Advocacy Program (HICAP) - Provides free and objective information and counseling about Medicare
- Medicare & You 2019 - The official U.S. government Medicare handbook
- Department of Defense — TRICARE for Life - Medicare-wraparound coverage for TRICARE-eligible beneficiaries who have Medicare Part A and B
According to the Centers for Disease Control and Prevention (CDC), older adults and people who have severe chronic medical conditions, such as heart, lung, or kidney disease are at higher risk for severe illness from COVID-19.