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.
Research Medicare for your elderly parents so you can make a fully informed decision about their future care. As you navigate Medicare, keep the following 10 points in mind to help maximize Medicare coverage while minimizing stress and expenses for you and your loved one.
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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, Medicare will automatically become their primary insurer 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.
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 preferred 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.
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 sign-up instructions at the beginning of the initial enrollment period.
Even if you think your loved one will be automatically enrolled in Medicare, you should still double check well in advance of the initial enrollment period.
If you or your loved one miss the initial enrollment period, they may be charged a late enrollment penalty. Depending on the part of Medicare your elderly parent applies for, these penalties can vary.
In the Part A late enrollment penalty, your monthly premium may go up 10% for twice the number of years you go without coverage. For example, if you don’t sign up for Part A for two years, you’d have to pay the higher premium for four years.
You 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 your monthly premium is initially $170.10, the penalty for enrolling late would be an additional $17.10 added to your monthly premium.
You may also face a Part D late enrollment penalty. For every month you were without creditable coverage, you’ll be charged 1% of the standard Part D premium. The monthly penalty is rounded to the nearest $0.10. So, for example, if your initial premium is $33.37, and you go without coverage for 29 months, you’d pay an additional $9.70 on your premium every month.
Keep in mind that these penalties don’t go away. 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 January 1 through March 31. People who sign up during the general enrollment period will be eligible for coverage the following July. The Annual Election Period (AEP) runs from October 15 to December 7 every year. During this time, you’re free to switch to a different Medicare plan that may better suit your loved one’s needs.
There are no family Medicare plans. Medicare is an individual benefit — each member of your family needs to apply for Medicare separately.
If a government official gives you incorrect information that causes your loved one to miss the initial enrollment period, then you may not have to pay the entire penalty. However, you have to be able to prove that the government official gave you incorrect information.
Remember to write down important details about conversations with government officials, including:
You should do this every time you speak with someone in the government about Medicare. For easy access, keep this information in one place, such as a notebook dedicated to Medicare notes.
If you or your loved one can afford it, it is possible to supplement Medicare with a Medicare Supplement Plan called a Medigap policy. These plans will help cover expenses like:
Many seniors have retired by the age of 65 and rush to apply for Medicare. If your loved one plans to continue working or has employer health coverage through a spouse, there may be other options.
Under special circumstances, your loved one may also be able to delay Medicare enrollment and enroll later during the Special Enrollment Period (SEP).
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 you need to know about Medicare plans will help you make an informed decision about your loved one’s health care coverage and overall well-being.
For additional information about Medicare, you can contact:
If you’re thinking about advancing your loved one’s level of care, consider reaching out to a Senior Living Advisor at A Place for Mom to find the right care option to suit your needs. This service is free and has helped families find suitable local care for decades.
COBRA Insurance. (2022, April 5). What is COBRA insurance?
Digital Communications Division (DCD). (2021, October 20). What is Medicare Part C? U.S. Department of Health and Human Services (HHS).
State Health Insurance Assistance Program (SHIP). Navigating Medicare.
United Medicare Advisors. Health coverage designed for your needs and budget.
United Medicare Advisors. Medicare Advantage: A convenient alternative to Original Medicare.
United Medicare Advisors. Medicare Supplement: Filling the gaps left by original Medicare.
United Medicare Advisors. What to do if you missed Medicare’s open enrollment.
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