Medicare: Approaching Age 65

Becoming Eligible for Medicare

 

Congratulations as you enter your “Golden Years”!

The time has finally come! You’ve spent your working life preparing for this moment . . .

  • you are preparing to retire and will soon turn 65 OR
  • you’ve already retired and will soon turn 65 OR
  • you have qualified for Social Security disability and are closing in on the twenty-fifth month of eligibility

What do all of these scenarios have in common? All of these individuals will qualify for the Federal Health Insurance program known as Medicare, which can be quite overwhelming!  There are many decisions to make as you enter this transition. Undoubtedly, you are being inundated with mailings and being barraged with phone calls. It is important to seek reliable sources for information so you can learn about all the options available to you. Your decision can have consequences that directly affect your future.

A brief overview of Medicare, eligibility for Medicare, and a comparison between Medicare Supplement and Medicare Advantage plans are provided below. Please note that this information is a very brief overview of a very complex topic. Want to learn more? Consider signing up for a Medicare Madness course offered through GEARS on a regular basis or call Jon Ebersole at 717-798-1603 for an individual consultation.

 

Medicare Overview

 

Medicare is composed of several different parts. Original Medicare consists of Medicare Part A and Medicare Part B. Part A covers inpatient medical care while Part B covers outpatient medical care. Both Part A and Part B are administered by the Centers for Medicare and Medicaid Services (CMS). Medicare Part C refers to Medicare Advantage Plans. Medicare Part D covers outpatient prescription drugs and are administered by private insurance companies. Medicare Advantage plans are administered by private insurance companies and typically combined Part A, Part B, and Part D all under one plan.

 

Medicare Eligibility

 

Turning 65: Individuals turning 65 have a seven month “Initial Enrollment Period” to enroll in Medicare. The Initial Enrollment Period consists of the three months prior to the 65th birthday, the month someone turns 65, and the three months following. If an individual is turning 65 and is receiving Social Security benefits, they will automatically be enrolled in Medicare Part A and B. If an individual is delaying Social Security benefits, they will need to submit an application to Social Security to enroll in Medicare Part A and Part B.

 

Disability: Individuals receiving Social Security Disability will automatically be enrolled in Medicare on their twenty-fifth month of disability.

 

Special Enrollment: Individuals may delay their enrollment in Medicare without a penalty if they have coverage through an Employer’s Group Health Plan, the Employer employs 20 or more people, and they provide prescription drug coverage that is deemed to be “Creditable”. Individuals that lose coverage from the Employer’s Group Health Plan have a Special Enrollment Period to elect Medicare coverage without a penalty. Many other Special Enrollment Periods exist, but losing/leaving employer coverage is the most common.

 

Medicare Supplement Insurance or Medicare Advantage

 

Medicare Part A and Part B have large potential out of pocket costs with no annual out of pocket maximums so most individuals select either a Medicare Supplement (also known as Medigap) insurance plan or enroll in a Medicare Advantage plan.

 

What is a Medicare Supplement (Medigap) Plan

 

Medicare Supplement plans are designed to supplement the coverage gaps in Medicare Part A and Part B. The following are important items regarding Supplement policies:

 

  1. Supplement plans are identified by letters (A-N) and are standardized by the federal government, which means the benefits do not vary. The Plan F sold by one company will be the exact same Plan F that is sold by another.
  2. Supplement plans have no network. You can obtain services from any health care provider that accepts Medicare and is willing to see you.
  3. There is a six month open enrollment period that begins once an individual enrolls in Medicare Part B. During this open enrollment period an individual can enroll in any Supplement plan from any company with no health questions and must be provided the policy at the standard rates.
  4. You cannot be terminated from the plan or have your premium increased due to a health condition.
  5. Gender, age, and location can affect the monthly premium. Attained-age policies are the most common, which means the policy will increase based on age and health care inflation.
  6. There is no Annual Enrollment Period (AEP) for Supplement plans. You can apply for coverage with another letter plan or with another company at any time during the year, but will need to complete medical underwriting. The company you are applying to can accept or decline an application based on answers to the health questions.

 

What is a Medicare Advantage Plan

 

Medicare Advantage plans are private insurance plans (PPO, HMO, PFFS, etc.) that typically combine all the benefits available through Medicare Part A, Part B, and Part D all under one plan.  These plans provide medical benefits that are similar to group health plans provided by employers. The following are important items regarding Medicare Advantage policies:

 

  1. Advantage plans are reviewed and approved by Centers for Medicare and Medicaid Services (CMS). The company providing the Advantage plans and are paid a stipend from Medicare for every individual that enrolls in one of their Advantage plans.
  2. The stipend paid by Medicare allows companies the ability to offer several different plan options that vary in monthly premium and out-of-pocket costs.
  3. The premium is set according to the plan so gender and age are not factors.
  4. Advantage plan typically have a network of hospitals and physicians that members must utilize or are incentivized to utilize.
  5. There is an Annual Enrollment Period (AEP) from October 15 – December 7. Medicare Advantage enrollees can elect a new plan that will start January 1st of the upcoming year.
  6. Changing Advantage plans during AEP does not require medical underwriting.
  7. Plan premium and benefits can change each year so it is important for you to review plan options on an annual basis.

 

Want to know more about Jon Ebersole?

Jon serves as a full-time senior account manager in benefits consulting and as an independent Medicare consultant providing education and Medicare consultation. Prior to specializing in Medicare, Jon earned an MBA from Millersville University, a B.A. from Bloomsburg University, and became licensed in life and health insurance in PA, MD, and FL.

As a senior account manager, Jon supports employer group health plans for 200+ municipalities. Jon provides client management services including claim resolution, strategic planning, and presentations on all topics related to healthcare policy and benefit plan design. Previous professional responsibilities include managing the Commonwealth of Pennsylvania’s retired employees’ health program of over 90,0000 retirees when Jon served as an HR analyst with the Pennsylvania Office of Administration.

As a consultant, Jon provides educational services at no charge to ensure that everyone who needs to know fully understands Medicare eligibility, enrollment, and options.

  • For those eligible for Medicare, Jon provides a full review of current benefits and educates clients regarding their options so they can make the best decision based on their unique needs.
  • Jon also provides informative, educational, and professional Medicare presentations with up-to-date information at no cost to businesses, organizations, and groups.

Whether you are confused about Medicare, new to Medicare, or just want to make sure you are fully informed about your options, contact Jon today at 717-798-1603 or jon@medicaremadness.com to schedule an appointment or presentation! You may also view his website at www.medicaremadness.com.