Medicare can play a major role in the life of anyone 65 and older. But applying for this federal health insurance program is a lengthy and complicated process. There are no easy, one-size-fits-all coverage options, and the system is underfunded. At times, you may feel like you and your loved one are on your own in dealing with the application and enrollment process. As you navigate Medicare, keep the following 12 points in mind to help maximize Medicare coverage while minimizing stress and expenses for you and your loved one.
Most people initially become eligible for Medicare three months before turning 65. A person may also be eligible earlier if they have a disability, End-Stage Renal Disease (ESRD), or ALS, also known as Lou Gehrig’s disease.
Before becoming eligible for Medicare, your loved one may already be insured with another form of insurance, such as retiree health insurance, individual health insurance, or COBRA insurance. Regardless, they’ll be required to enroll in Medicare once they turn 65. After their 65th birthday, any other forms of insurance will be considered a secondary insurer. This is true even if they haven’t applied for Medicare yet.
This consideration is an important factor to know and understand. It means once their 65th birthday passes, your loved one can’t count on their other forms of insurance to pay for their hospital or physician bills.
Medicare is divided into four separate parts. Each part helps pay for different health care costs as outlined below:
You can choose either Original Medicare (Parts A and B) or a Medicare Advantage Plan (Part C). You can also opt for the other parts as mentioned above, like adding prescription drug insurance (Part D).
The type of Medicare a person selects will depend on their unique circumstances — there’s no right or wrong answer. Consider the following when choosing between Original Medicare and a Medicare Advantage Plan for your loved one.
What you get with Original Medicare:
What you get with a Medicare Advantage Plan:
It’s preferable to apply for Medicare as soon as your loved one is eligible. You must apply during the initial enrollment period, which starts three months before their 65th birthday and ends four months after their 65th birthday. This allows a seven-month window to apply.
Because applying for Medicare is a lengthy process, you and your loved one should start researching when they turn 64. Applying before turning 65 helps avoid late penalties or having to go temporarily without coverage.
Our free tool provides options, advice, and next steps based on your unique situation.
For anyone who’s just turned 65 who is already receiving Social Security benefits, the Social Security Administration will automatically sign them up for Medicare Parts A and B. They’ll send you or your loved one a welcome package three months before Medicare coverage starts that explains additional coverage decisions (such as Part D coverage) that you’ll need to make.
Even if you think your loved one will be automatically enrolled in Medicare, you should still double check these materials well in advance of the initial enrollment period.
If your loved one misses the initial enrollment period, they may be charged a late enrollment penalty. Depending on the part of Medicare your parent applies for, these penalties can vary.
In the Part A late enrollment penalty, their monthly premium may go up 10% for twice the number of years they go without coverage. For example, if your parent didn’t sign up for Part A for three years, they’d have to pay the higher premium for six years.
Your loved one could be charged a Part B late enrollment penalty for every 12 months enrollment is delayed. This penalty is 10% of the standard Part B premium. For example, if they waited 12 months to sign up and their monthly premium is initially $170.10, the penalty for enrolling late would be an additional $17.10 added to their monthly premium.
Seniors may also face a Part D late enrollment penalty. For every month your loved one was without creditable coverage, they’ll be charged 1% of the standard Part D premium. The monthly penalty is rounded to the nearest $0.10. So, for example, if their initial premium is $33.37, and they go without coverage for 29 months, they’d pay an additional $9.70 on their premium every month.
Keep in mind that these penalties don’t go away. With the exception of the Part A penalty, they’ll follow your loved one through life, and the amounts change every year.
Anyone who is eligible can sign up for Medicare during the general enrollment period from October 15 to December 7 every year. During this time, seniors are free to switch to a different Medicare plan that may better suit their needs. Those who are already enrolled in a Medicare Advantage Plan can switch to a different Medicare Advantage Plan during the Medicare Advantage Open Enrollment Period from January 1 to March 31 every year.
There are no family Medicare plans. Medicare is an individual benefit — each member of a family or couple needs to apply for Medicare separately. This is different from private insurance, which allows spouses and families to enroll together. One benefit of Medicare is that senior couples can each choose their own Medicare plan to help ensure that their most important medical needs are covered.
When your loved one applies for Medicare used to have a great impact on their coverage. For seniors who missed their initial enrollment period, this meant waiting up to six months for Medicare coverage to begin.
However, the Consolidated Appropriations Act (CAA) revised Medicare enrollment rules. Seniors can now get coverage the first day of the month following their enrollment.
While it’s best for your loved one to enroll in Medicare during the initial enrollment period that occurs when they turn 65, sometimes circumstances don’t allow it.
Under extenuating circumstances, your loved one can enroll during a special enrollment period (SEP). The CAA has affected some of these circumstances and the waiting period before coverage starts.
SEPs may be allowed in the following situations:
If you or your loved one can afford it, it is possible to supplement Original Medicare with a Medicare Supplement Plan called a Medigap policy. Medigap policies are offered by private insurance companies and help pay for costs associated with Original Medicare, such as the following:
However, Medigap doesn’t cover the following:
Many seniors have retired by the age of 65 and applying for Medicare is a logical next step. If your loved one plans to continue working or has employer health coverage through a spouse, they might have other options:
Our advisors help 300,000 families each year find the right senior care for their loved ones.
For more details about how employment affects whether your loved one needs to enroll in Medicare, refer to Medicare’s page on working past 65.
Whether or not a senior plans on continuing to work, Medicare plays a crucial role in health coverage for everyone 65 or older. Understanding ahead of time what they need to know about Medicare plans will help your loved one make an informed decision about their health care coverage and overall well-being.
For additional information about Medicare, you can contact:
Whether you’re helping your loved one look for senior living now or are simply considering their future care needs, it’s best to plan ahead. Many seniors and their families think Medicare will cover long-term care costs such as assisted living, but unfortunately Medicare only pays for medically necessary parts of care. Things like assistance with activities of daily living aren’t covered. If paying for senior living is a concern, you can view our complete guide to paying for long-term care.
A Place for Mom also offers free, personalized assistance for families. You can connect with one of our Senior Living Advisors today to discuss your loved one’s care needs, budget, and lifestyle to get personalized senior living options.
Original article by Grace Styron.
Centers for Medicare and Medicaid Services. Get started with Medicare. Medicare.gov.
Centers for Medicare and Medicaid Services. Parts of Medicare. Medicare.gov.
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Centers for Medicare and Medicaid Services. Compare original Medicare and Medicare Advantage. Medicare.gov.
Centers for Medicare and Medicaid Services. When does Medicare coverage start? Medicare.gov.
Centers for Medicare and Medicaid Services. Welcome to Medicare package (automatically enrolled). Medicare.gov.
Centers for Medicare and Medicaid Services. Avoid late enrollment penalties. Medicare.gov.
Centers for Medicare and Medicaid Services. Part D late enrollment penalty. Medicare.gov.
Centers for Medicare and Medicaid Services. Joining a plan. Medicare.gov.
Centers for Medicare and Medicaid Services. How does Medicare work? Medicare.gov.
U.S. Department of Health and Human Services. Administration for Community Living. (2023, April 20). Quick guide to recent changes to Medicare.
Centers for Medicare and Medicaid Services. Learn what Medigap covers. Medicare.gov.
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