11 essential things to know about Medicare made simple
For people turning 65, understanding the details of Medicare insurance can be complicated, the enrollment process may seem like a stressful task. While no single Medicare plan is right for everyone, understanding the available Medicare options can help you select the best option that is right for you.
Jeanet Reyes-Cordero, Corporate Account Manager for Medicare Growth at Advocate Aurora Health offers these 11 tips individuals should consider when thinking about Medicare:
- There are two main ways to get Medicare coverage:
- You can choose Original Medicare (Parts A and B), which is provided by the federal government.
- Or you can choose a Medicare Advantage plan (Part C). Medicare Advantage plans are offered through private insurance companies.
- With Original Medicare, you’ll pay a share of the cost.
- Original Medicare was not designed to pay all your health care costs. You still pay a share of the cost in monthly premiums, deductibles, copays and coinsurance.
- Medicare supplement insurance, also called a Medigap policy, can be purchased from private health insurance companies.
- Medicare supplement insurance fills the gap of many expenses that Original Medicare Parts A and B don’t pay, like copays and deductibles.
- There is an all-in-one Medicare option.
- Medicare Advantage (Part C) provides bundled medical and prescription-drug coverage plans through private insurance companies. Medicare Advantage may have monthly costs that vary depending on which plan you choose. With most Medicare Advantage plans, you don’t need to sign up for Part D or buy a Medigap policy.
- Medicare Part D Prescription drug coverage helps limit drug costs.
- As a Medicare member you can get optional prescription drug coverage (Part D).
- You can enroll in a stand-alone Part D plan to go with your Original Medicare coverage.
- Or you can enroll in a Medicare Advantage plan that includes prescription drug coverage.
- Know the choices in your state.
- Original Medicare (Parts A and B) is the same across the United States.
- Medicare Advantage (Part C) and prescription drug (Part D) plans are offered by private insurance companies and may be available only in certain counties, states or regions.
- Medicare supplement policies offer nationwide coverage and are available by state.
- Enroll at the right time.
- The Initial Enrollment Period (IEP) is your first chance to enroll in Medicare. It’s the period three months before your 65th birthday month, the month of your birthday, and the three months after your 65th birthday month.
- When you enroll will determine when your coverage begins.
- An important tip to remember: If you don’t sign up for Part D coverage when you enroll in Medicare, you may pay a penalty if you enroll later unless you qualify for an exception.
- Review your choices annually.
- After you choose your Medicare coverage, you can make changes each year during the Medicare Annual Open Enrollment Period, also called the Annual Election Period (AEP), which occurs October 15 – December 7.
- It’s important to review your coverage to see if it still fits your needs.
- Understand the Special Election Period (SEP).
- In some cases, you may be able to enroll in, or switch, plans outside of the Initial Enrollment Period and Open Enrollment Period. This includes changes in your life situation, such as:
- You retire and leave a health care plan through your employer or union
- You move out of your current health plan’s service area
- Review your current coverage.
- For example, if you have group coverage from your job, or retiree insurance from a former employer, you’ll want to see how it fits with Medicare.
- Be mindful of Medicare fraud.
- Review your Medicare claims and Medicare Summary Notices on a regular basis to check for any services billed to your Medicare Number you don’t recognize. If you suspect fraud, call 1-800-MEDICARE to report suspicious activity.
Finally, it is important to remember help is available. Medicare can be complicated, but help is available to ensure you have the right coverage. You may even qualify for financial help.
For more information on Medicare resources and related services in your area:
- If you are a resident of Illinois, visit advocatehealth.com/Medicare.
- If you are a Wisconsin resident, visit aurora.org/Medicare.
- To view and compare 2023 available plans in your area, visit the Medicare plan finder at Medicare.gov/plan-compare or call 1-800-MEDICARE after Oct. 1.
- State Health Insurance Assistance Program (SHIP) counselors are available to assist you. To contact SHIP, visit www.shiptacenter.org or call 877-839-2675. TTY users can call 1-877-486-2048.
About the Author
health enews staff is a group of experienced writers from our Advocate Aurora Health sites, which also includes freelance or intern writers.