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When is it Time to Start Considering Your Medicare Options? If you’re turning 65 within the next year, now is the time to start planning for Medicare. Understanding your coverage options and enrollment deadlines will help you select a plan best suited for you. Medicare Explained Medicare has different parts, plus additional plan options to help you get the best coverage for your needs. Medicare Part A and Part B together are referred to as Original Medicare. Original Medicare is managed by the federal government. The program helps cover the cost of health care, but it does not cover all medical expenses or prescription drug coverage. Medicare Part A, also known as hospital insurance, covers hospital stays, skilled nursing, hospice care and home health. “If you or your spouse paid Medicare taxes while working for at least 10 years, you will likely not have to pay a monthly premium for this coverage,” says Lynn Specht, licensed sales and service representative for Medical Mutual. Medicare Part B, also known as medical insurance, covers physician office visits, medical supplies and preventive care services. You will pay a premium each month for Part B. While it’s important to know what Original Medicare covers, it may be more important to know what it doesn’t. Original Medicare does not cover every medical expense, such as routine services for vision, hearing and dental care. Original Medicare also does not cover prescription drugs. Other Parts of Medicare Medicare Part C plans, also known as Medicare Advantage, are sold by private insurance companies and help pay some of the health care costs not covered by Original Medicare. “These plans are offered by Medical Mutual and other private insurance companies and replace Original Medicare as your primary insurance,” says Specht. Medicare Part D prescription drug plans are also offered by private insurers and generally
cover generic and brand name prescription drugs. If you don’t enroll when you are first eligible for Medicare, you may be subject to a late enrollment penalty. When a Medicare Advantage plan includes a Medicare Part D prescription drug plan, it is referred to as a Medicare Advantage with Prescription Drugs (MAPD) plan. An MAPD plans offers the benefits of Original Medicare together with Part D prescription coverage. Most Medicare Advantage and MAPD plans also include extra benefits like vision, hearing, dental and/or health and wellness programs. Medicare Supplement Plans Explained Medicare Supplement insurance plans, also known as MedSupp or Medigap, also help pay some of the health care costs not covered by Original Medicare. You must have Medicare Part A and Part B to purchase a Medicare Supplement plan. These plans are not part of the federal Medicare program. Plans offered in Ohio are standardized and are identified by letters, such as Plan F or Plan G. This means that no matter which company is selling the plan, all plans identified with the same letter have identical coverage. Enrollment Periods You can enroll in Medicare for the first time during the Initial Enrollment Period (IEP). The IEP runs three months before the month of your 65th birthday through three months after. If you are still working and covered by your (or your spouse’s) employer’s group insurance when you turn 65, you will be eligible to enroll later when you retire. You have eight months to enroll in Medicare after your employment ends or after your group coverage ends, whichever comes first. If you miss your IEP window, you can enroll in Original Medicare during the next General Enrollment Period, which occurs Jan. 1 through March 31 each year. If you are enrolled in any type of Medicare plan, you can change or add plans, such as Medicare Part D, during the Annual Enrollment Period (AEP), Oct. 15 through Dec. 7, each year.
Lynn Specht, Licensed Sales and Service Representative, Medical Mutual Choosing a Plan “Once you understand your Medicare options, it is important to do a personal needs assessment to help you choose the plan that’s right for you,” Specht says. “Answering the following questions can help.” - What is your budget? Costs may include premiums for Medicare Part B medical insurance and premiums insurance companies charge for Part D prescription drug coverage. Plan premiums will vary by level of coverage and insurance provider. When considering total out-of-pocket costs, generally, the higher your monthly premiums, the lower your copays and deductibles will be. - Do you need prescription drug coverage? If you take prescription medications, then you will likely want to look at Part D prescription drug coverage. Original Medicare and Medicare Supplement plans do not include prescription drug coverage. Part D coverage is included with most Medicare Advantage plans or you can purchase a standalone Part D plan. - Which plans cover your doctors? Original Medicare and Medicare Supplement plans allow you to go to any doctor or hospital that accepts Medicare. Medicare Advantage plans have networks of providers, and some networks are broader than others. Check the network associated with each plan to make sure your physician or specialist is included. Additional Guidance For more information and answers to your Medicare questions, contact the official U.S. government website for Medicare (medicare. gov). You can also review the Social Security website (ssa.gov) or speak with a licensed Medical Mutual Medicare insurance professional at 1-866-406-8777 (TTY 711) Monday through Friday, 8 a.m. to 8 p.m.