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Medicare Education 

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Health Insurance after age 65 ……

Whether you are retired or still working, Medicare will likely become part of your life after you turn 65. In the United States today, most health plans pay secondary to Medicare. So if you are currently covered by a retiree health plan, an individual policy, or a small employer group plan, you must enroll in Medicare when you turn 65.

If you don’t, your insurance claims may not be paid. And if you do not enroll in Medicare on time, you will be subject to late-enrollment penalties. The only people who are exempt from enrolling in Medicare at 65 are workers and spouses who are covered by an employer group plan that covers 20 or more employees. ……Their time will come later !

What you need to know about Medicare ……

Medicare is a national health insurance program for people over 65 and also people who are receiving Social Security disability benefits. Participation is essentially mandatory if you want to have health insurance in this country. While you can – and probably should - have additional private insurance, you must enroll in Medicare in order for supplemental insurance to take effect.

When you turn 65, Medicare becomes the primary payer. Under original Medicare, any private insurance you may have is secondary and will not pay until Medicare has paid its share. The only insurance that remains primary to Medicare is employer group coverage that covers 20 or more employees. So if you or your spouse are still working and covered by an employer group plan that covers 20 or more employees, you don’t have to sign up for Medicare when you turn 65. Otherwise you do !!!!

What Medicare covers ……

There are several parts to Medicare. Part A covers part of the hospitalizations. Part B covers part of the doctor visits and other health care services. Part D covers part of the cost of prescription drugs and is offered through private insurers.

Under original Medicare, when you go to the hospital under Part A or incur a medical expense under Part B, the bill is first sent to Medicare. The government will pay the portion it is responsible for, such as 80% of your doctor bill and the remaining amount is billed to you. If you have supplemental insurance, your other insurance may pay all or part of the bill that remains after Medicare has paid its share.

Part D works a little differently because the insurance is offered through private companies that contract with Medicare. In order to have your prescription drugs covered by insurance, you need to find a Medicare drug plan offered in your area. You will have several drug plans to choose from, each having its own drug list and offering slightly different coverage at differing prices. A key part of enrolling in Medicare is shopping for prescription drug plans and finding one that offers the coverage you need for the drugs you take at a price you can afford.

How much does Medicare costs ……

Some people think Medicare is free. This is not true. Part A may be free if you or your spouse has paid into Medicare for more than 10 years. But when we say “free” we are only referring to the monthly premiums. If you are hospitalized, you will pay a deductible before Medicare pays its share. And if your hospitalization lasts for more than 60 days, you will be responsible for paying part or the entire daily rate.

Part B is not free for anyone, except those who qualify for special assistance for being poor. Medicare charges a monthly premium that is deducted from your Social Security check if you are receiving Social Security. If you haven’t started Social Security yet, you will get a bill from Medicare. High income people pay an extra amount on top of the base premium. In addition to the monthly premium, there is an annual deductible that you or your supplemental insurance must pay before Medicare pays its share. And because Medicare pays only part of the bill, you or your other insurance pays the remaining amount. There is no limit to the out-of-pocket expenses you could pay under Medicare alone. This is why most people have supplemental coverage.

Medicare subsidizes prescription drug coverage through payments to private insures offering Part D prescription drug plans. Still, you will likely have to pay a monthly premium to the insurer offering your drug plan. In addition to the monthly premium, there may be an annual deductible as well as a copayment or coinsurance each time you get a prescription filled. Terms and premiums vary among drug plans, which is why you’ll need to shop carefully for the right plan for your needs.

How to enroll in Medicare ……

Some people think Medicare is automatic. This is only true if you are receiving Social Security when you turn 65. If you are not receiving Social Security, you will need to proactively sign up for Medicare three months before your 65th birthday. You do this through the Social Security Administration, by calling 800-772-1213 or online at socialsecurity.gov.

However, enrolling in Medicare through the Social Security Administration only takes care of Parts A and B. If you want Part D, you will first need to choose a prescription drug plan. Then you can enroll in Part D through the private insurer or through Medicare. 

If you don’t enroll in Medicare during the appropriate enrollment period, you may have to pay a late-enrollment penalty when you finally do enroll.

Because there are so many out-of-pocket costs associated with Medicare, part of your Medicare enrollment process will be shopping for private plans.  These plans will either be one of the many Medicare Supplement Plans offered, like Plan A through N (sometimes referred to as MediGap Insurance)  … Or… possibly you will go a totally different route and go with a Medicare Advantage Plan, sometimes referred to as, Part C. You should do this well before your Medicare effective date so your supplemental insurance will start at the same time.

Medicare and the transition to getting started can be very complex to most. I strongly suggest working with someone who is very well educated in these areas, to assist you in making your decisions. DON’T GO IT ALONE !

Health care could very well be your largest expense you will have during this thing called, retirement. Having the right coverage is vital.

Medicare and the transition to getting started can be very complex to most. I strongly suggest working with someone who is very well educated in these areas, to assist you in making your decisions. DON’T GO IT ALONE !  Health care could very well be your largest expense you will have during this thing called, retirement. Having the right coverage is vital. Contact  us for more information.

Here is a link to Medicare’s official site



This material is for informational purposes only and is not affiliated with the U.S. government or any governmental agency. It is not intended to provide any tax, legal or investment advice or provide the basis for any financial decisions. Please consult a qualified professional before making decisions about your financial situation. The Insurance Advisors of Next Phase Financial are not Licensed or Practicing Physicians and are not qualified to give medical advice

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