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9 Things You Need To Know to Prepare for Medicare Benefits

Dana Larsen
By Dana LarsenApril 5, 2013

Fact: Most people who work contribute to the Medicare system, but many are either unaware or misinformed about the Medicare benefits they can receive when they turn 65. Living comfortably with peace-of-mind about health insurance is important for golden years’ enjoyment. So here’s the 411 on Medicare’s beneficial health insurance. 

Learn How to Prepare for MedicareAccording to figures released July 9th by the Centers for Medicare & Medicaid Services, hundreds of thousands of seniors miss out on Medicare benefits each year. Jim Firman, CEO of the National Council on Aging comments on the lack of public awareness when it comes to Medicare benefits: “Most seniors don’t know what’s in the law. ‘The new new wellness visit benefit is a really good benefit, but you have to use it to maximize the opportunity.”

So what do you need to know to make sure you don’t miss out on important health benefits? Read below for the 9 things you need to know about Medicare benefits.

9 Things You May Not Know About Medicare’s Health Benefits

  1. Make sure you sign up on time.
    You have the option to enroll in Medicare three months before you turn 65, and you can start receiving coverage the first day of your birthday month. You have three months after you turn 65 to qualify under the initial enrollment, and if you don’t enroll within the 7-month window around your birthday month, you have the option to sign up between January 1 and March 31st each year. However, this late enrollment is subject to permanently higher premiums. Learn more about signing up for Medicare.
  2. Income affects premium costs.
    Medicare Part A usually covers retirees hospital insurance and the standard premium for Medicare Part B per month in 21013 is $104.90. But it’s important to know that retirees who earn more than $85,000, and couples who earn more than $170,000 annually have higher premiums.
  3. Account for out-of-pocket expenses.
    Remember that Medicare has deductibles, copays and coinsurance. In 2013, the Part B deductible is $147. Medicare usually pays 20 percent of the Medicare-approved amount of the health service and there’s no annual limit on what you might have to pay out-of-pocket.
  4. Consider supplemental/replacement coverage.
    Being prepared during retirement is important, and having good health makes the autumn years even more enjoyable.  So supplementing Medicare coverage with a plan, such as Medigap, plan is always a good idea. You can also replace with Medicare with a Medicare Advantage program; you just have to choose which plan works best for you. While you have to pay additional premiums, having peace-of-mind for medical expenses that Medicare doesn’t cover is often worth it. And it’s important to note that you have have a specific window to enroll in a plan: The one-time Medigap open enrollment period starts the month you turn 65 and enroll in part B. By law, you have the right to buy any Medigap policy in your state, regardless of health conditions. But if you miss this enrollment period, may be denied coverage or be required to pay higher premiums.
  5. There are free physicals!
    Medicare welcomes you be offering free preventative care doctor’s visits during your first 12 months on Medicare Part B. It’s a smart idea to consult a physician and review your medical history and get recommendations on preventative care. After the first year, Medicare offers free annual wellness visits. Preventing disease through personalized health and wellness plans is the idea here.
  6. There is free preventative care!
    Just like there are free physicals, there’s also free preventative care. Resulting from provisions of the Affordable Care Act, which includes bone mass measurements and breast cancer screenings. If problems are found, however, it’s important to note that there may be additional charges that don’t fall under the “preventative care” policy. Typically a copayment of 20% of the Medicare-approved amount for the service is what you’d be responsible for in these instances.
  7. Choose a Part D plan that’s right for you.
    You can save money by making the right choice. Retirees get to choose a new Medicare Part D prescription drug plan during open enrollment, from October 15th to December 7th. Premiums, covered medications and out-of-pocket costs typically change each year, so it’s important to shop around and compare the plans. Sometimes health needs change, as well. Careful consideration means money saved, and it’s also important to join the prescription plan when you’re first eligible; otherwise you may be subject to a late-enrollment penalty.
  8. Be aware of what services are covered.
    Medicare only covers certain services. It’s important to note that dentures, hearing aids or even routine eye or dental care is not covered. Also long-term care in an assisted living community or nursing home is not covered. Another reason why supplemental insurance is so important!
  9. There is a funding deficit.
    The Medicare hospital insurance trust fund has paid out more in hospital benefits and other expenditures than it has received in income since 2008. At this rate, the fund is projected to be exhausted in 2024, according to the 2012 Social Security and Medicare Boards of Trustees. Increasing payroll tax as well as reducing payment disbursement is being discussed as a potential strategy to get the funding back on track, however, it’s not something retirees should count on.

How do you feel about Medicare and retirement in the U.S.? Do you think there’s anything our government can be doing to better prepare for the aging baby boomers? We welcome your comments below.

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