The Medicare Maze

. October 1, 2015.
medicare_maze

by Chris Watson

Starting in 2011 one person became eligible for Medicare every eight seconds;  according to AARP.  Medicare, created in 1965, has become the most ubiquitous public-private venture in the country.  With its dizzying array of letters (Parts A,B,C,D), acronyms (IEQ, MSNs, EHRs, MTM, SEP), Medicare can seem too large and cumbersome to manage.

“It doesn’t have to be hard,”  says Daniel Trombley, Senior Coordinator of Medicare Plans at Promedica.  “What people naturally fear is the unknown. To first conquer that fear it is important to evaluate your health care needs.”  At 18 to 24 months before retirement it is a good idea to looks at your health care portfolio.  Trombley recommends asking some basic questions.  “Will I be traveling?  Will I have any coverage from my former employer?  Am I going to continue to work after 65?  Do I feel I need a supplement or advantage plan? Above all,”  he states emphatically, “start with the government website.  Once you get past the home page it is a wealth of good, reliable information on starting or changing your Medicare coverage.”

Eligibility is remarkably straight forward.  With only a few exceptions, you are eligible for Medicare at age 65.  If you continue to work and are covered by an employee plan you may continue to use that plan until you choose to retire.  After age 65 and upon your exit from the employer health plan you will be granted a SEP (Special Election Period) to sign up for Medicare for the first time.  There are some exceptions with additional rules for both eligibility and sign up period but for the lion’s share of people Medicare is available at age 65.

The biggest surprise most people find is that there are costs associated with Medicare. Medicare is a 80/20 style insurance with deductibles, co-pays, and a monthly premium.  You may also have to pay additional money for a drug coverage program (along with its associated premiums and co-insurance costs).

SELECTING A PLAN

The second issue people run into is the alphabet soup of Medicare Plans. If you understand your needs and financial circumstances this decision is not as intimidating as it first appears.  It breaks down to original Medicare or Medicare Advantage.  Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance). You will usually pay a monthly premium for Part B. Medicare provides the coverage directly.  For drug coverage you also need to join a Part D plan (Medicare Prescription Drug Plan), run by a private company and approved by Medicare. This cost will be in addition to your other premiums.

Part C, Medicare Advantage Plans, cover both part A and B but are run by private insurance companies approved by Medicare.  Typically you will pay a higher premium for Part C plans but they provide extra coverage.  Many Advantage plans also include Part D drug plans.

It all goes back to understanding and, if possible, anticipating needs and financial stability.  Beyond the basic choices, many people elect to enroll in a Medicare Supplement.  Medicare Supplements, or Medigap, are plans that are typically more expensive than Advantage plans but offer many more services and a significant level of coverage above an Advantage plan.

“The bottom line,”  says Trombley, “is that what is right for Bob may not be right for Betty.  It is important to realize that Medicare has many, many options to meet individual needs.”  These options may seem confusing but they are available to construct a Medicare plan that fits the individual. For more information start with www.Medicare.gov.

Trending

My Slice of the 419 – Title It & Top It Contest with Gino’s Pizza

Are you as original as Gino’s? Compete by designing a pizza that reflects your slice of the 419! Official Rules No changes can by made to the Original Gino’s crust or sauce recipes Can name the pizza anything, does not have to be a “localized name” You list the toppings & create the “name” of

Affordable And Comfortable Country Living

Whitehouse Meadows, a new, in-town subdivision, offers affordable country living.

Spring Into A New Season With Inspirational Gardening Ideas

Spring is finally here! And it is time to get your garden growing. Local gardening experts offer unique ways to beautify your outdoor space.

Home Style Guide

Spring is the perfect time to work on those home improvement plans. As the weather gets warmer, you want your home to look its best – inside and out. We talked to some local experts who can help you add style to your home.