Medicare at 65: Tips on How to Get the Most from Medicare Plan Health Coverage

Medicare at 65: Tips on How to Get the Most from Medicare Plan Health Coverage

Turning 65 means becoming eligible for Medicare. For many people, getting Medicare coverage for the first time can be confusing. Medicare has different parts that cover different services, and you have decisions to make about how to get the coverage that’s right for you. Follow these tips to help you get the most from your Medicare benefits.

1. Understand the Different Parts of Medicare Preventive Care

There are four main parts of Medicare:

• Part A is hospital insurance that helps cover inpatient care in hospitals and skilled nursing facilities. Most people may be able to get Part A automatically when they turn 65.
• Medicare Part B covers doctor visits, preventive care, lab tests, surgeries, and other medically necessary services and supplies. You have to enroll in Part B and pay a monthly premium.
• Part C (Medicare Advantage) plans are an alternative to Original Medicare. Private insurers provide all your Part A and Part B coverage. Many Advantage Plans also offer prescription drug coverage.
• Part D Medicare drug plan helps cover the cost of prescription drugs. Like Part B, you have to enroll in Part D prescription drug plan separately.

2. Consider Getting Supplemental Health Coverage

Original Medicare has deductibles, coinsurance, and copays that you’re responsible for paying out of pocket. Many people get additional coverage to help pay these costs:

• Medigap policies are sold by private insurers and help pay your remaining Medicare costs like copays and deductibles.
• Medicare Advantage Plans often have lower out-of-pocket limits than Original Medicare. Some may offer additional benefits not covered by Medicare, like vision and dental care.
• Retiree or union coverage may also help supplement Medicare.

3. Compare Medicare Advantage Plans

Medicare Advantage Plans combine all your Part A and Part B coverage and often include prescription drug coverage too. Many plans also offer extra benefits like dental, vision and hearing. Here are some key points to consider when comparing Advantage Plans:

• Check what doctors, hospitals and pharmacies are in the plan’s network. Make sure your providers are covered.
• Look at the plan’s total out-of-pocket limits. This is the most you’ll pay for covered services in a year.
• See what the plan’s copays and deductibles are for things like hospital stays and doctor visits. Lower costs mean less out of pocket.
• Consider what extra benefits and lower drug costs could save you money.

4. Enroll in Medicare Part D Prescription Drug Coverage

To get the most from Medicare, Part D prescription drug coverage is important because medications can be costly. Here are some tips to get Part D coverage:

• See if any Advantage Plans you’re considering offer built-in Part D coverage.
• Otherwise, enroll in a standalone Part D Plan that works with your other coverage.
• Check the plan’s premium,covered drugs, and deductible. Also make sure your drugs are on their formulary and at a favorable tier.
• Use the Medicare Plan Finder to compare plans available in your state.

5. Understand Enrollment Periods

When you first become eligible for Medicare, you have a seven-month Initial Enrollment Period. It begins three months before the month you turn 65 and ends three months after your birthday month. Some key points about enrollment:

• If you don’t enroll in Part B during your Initial Period, you may pay a late penalty.
• You can make Advantage and Part D Plan changes each year during Open Enrollment from October 15 to December 7.
• Losing other creditable coverage gives you a Special Enrollment Period to sign up for Medicare outside the regular windows.

Use Resources to Help You Choose Plans

Navigating Medicare can be complicated. Use these helpful resources to learn more and get assistance enrolling:

• Attend seminars and classes offered in your area.
• Get free personalized counseling from your State Health Insurance Assistance Program (SHIP).
• Use the Medicare Plan Finder to compare plans available in your location.
• Review the Medicare insurance plan & You handbook mailed to you each fall.
• Contact Medicare at 1-800-MEDICARE (1-800-633-4227) with questions.

How to Make the Most of Your Medicare Benefits

Once you’ve enrolled in Medicare coverage, be sure you make the most of your benefits:

• Take advantage of free preventive care like cancer screenings, vaccines and annual wellness visits.
• Check what medical services are covered before getting care.
• Use in-network providers to minimize costs for services.
• Ask for generic prescription drugs when possible to save money.
• See if you qualify for help with Medicare costs through programs like Medicaid.
• Review your Medicare statements for errors and report fraud if you suspect any.
• Notify Medicare if you move or change your contact information.

Key Takeaways

• Original Medicare covers hospital and medical services but not prescription drugs. You have to enroll separately in Part B and Part D Plans.
• Medicare Advantage Plans can give you all-in-one coverage but restrict you to network providers.
• Medicare Prescription drug coverage is critical for help with medication costs.
• Use resources like the Medicare Plan Finder and SHIP counseling to make informed choices.
• Medicare covers many preventive services at no cost, so take advantage of benefits to stay healthy.

Turning 65 and getting Medicare for the first time can seem complex. But following these tips will help ensure you choose the right coverage and get the most out of your Medicare health and prescription benefits.

We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare Questions. Give Green Insurance Agency a Call at 904-717-1176. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.

Frequently Asked Questions (FAQ)

1. What is Medicare?

Medicare is the federal health insurance program for people 65 or older and certain younger people with disabilities. It has different parts that help cover services like hospital care, doctor visits, and prescription drugs.

2. When can I enroll in Medicare?

You can first enroll in Medicare during your Initial Enrollment Period. This 7-month window begins 3 months before you turn 65, includes your birthday month, and ends 3 months after you turn 65.

3. Does Medicare cover prescription drugs?

Original Medicare does not cover most prescription drugs. You have to join a separate Medicare Part D Plan for drug coverage. Medicare Advantage Plans often include Part D coverage.

4. What is Medicare Supplemental insurance?

Medigap and Medicare Advantage Plans help pay Medicare out-of-pocket costs like copays and deductibles. This supplemental coverage minimizes your healthcare expenses.

5. Are Medicare benefits free?

No, most Medicare enrollees pay premiums for coverage and cost-sharing for covered services. But you get premium-free Part A if you or your spouse paid Medicare payroll taxes for at least 10 years.

6. What is the Medicare donut hole?

With standard Part D prescription plans, you enter a coverage gap called the donut hole when your total drug costs reach a certain amount. You pay more for drugs while in the donut hole.

7. Can I make changes to my Medicare coverage?

Yes, during the annual Medicare Open Enrollment Period from October 15 to December 7, you can switch between Original Medicare, Advantage Plans, and Part D Plans for the next year.

8. Does Medicare cover dental?

No, traditional Medicare does not cover routine dental care. Some Medicare Advantage Plans may offer extra dental benefits not covered by Original Medicare.

9. What is the best Medicare Plan?

The best plan depends on your budget, health needs, and preferred doctors. Use Medicare Plan Finder tools to compare plans and choose one that fits your situation.

10. Will Medicare pay for a scooter?

Original Medicare may cover some or all costs of a scooter or wheelchair if you meet certain conditions. You will need a prescription from your doctor stating your medical need.

11. How do I appeal a Medicare denial?

To appeal a denied Medicare claim, follow the directions on your Medicare Summary Notice. Explain why you think the decision is wrong and submit any supporting documents.

12. What does Medicare Part A cover?

Medicare Part A is hospital insurance that helps pay for inpatient hospital and skilled nursing facility stays. It also covers some home health and hospice services.

13. What should I do if I’m moving and have Medicare?

Notify the Social Security Administration and Medicare when you are moving. This ensures your billing and coverage information transfers to your new address.

14. Can I enroll in Medicare online?

Yes, in most cases you can apply for Medicare online at www.ssa.gov. You can enroll in Original Medicare Parts A and B and sign up for a Part D prescription plan.

15. Where can I get help with Medicare questions?

Contact Medicare at 1-800-MEDICARE. You can also get help from your State Health Insurance Assistance Program (SHIP) or a Medicare insurance broker.