What you need to know about Medicare

 

Primary care doctors that drive health through engagement and access

Turning 65 means you’re eligible for Medicare, a benefit designed to ensure you have access to healthcare as you age.

We want to make sure you understand your Medicare benefits and get the best program for your needs. Medicare has changed significantly over the past twenty years. It’s no longer a one-size-fits-all plan. Our Member Support Representatives (MSR) are here to explain the Medicare program and help you determine the right plan for your health and budget. We will even help you enroll.

If you haven’t scheduled your annual appointment with your Member Support Representative, please use the form below. Or call us at 904-800-7071.

 

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Know when you're eligible

Everyone aged 65 or over who is a citizen or permanent resident of the United States and has worked and paid Medicare taxes for over 10 years — or is the spouse of someone who did — is eligible for Medicare.

Additionally, if you are under 65, you may be eligible for premium-free coverage if:

  • You are entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You are a kidney dialysis or kidney transplant patient.

Enroll at the right time

Enrollment in Medicare is not automatic—unless you are already getting benefits from Social Security or the Railroad Retirement Board (RRB). In that case, you will be automatically signed up for Medicare Parts A and B as soon as you turn 65.

Initial Enrollment Period

You have 7 months to sign up for Medicare Parts A and B for the first time. Your Initial Enrollment Period starts 3 months before the first day of the month you turn 65 and continues for 3 months after that month. Coverage starts the first day of the month you turn 65. If your birthday is on the first of the month, your coverage starts the month before.

Complete Health encourages you to start the Medicare application process as soon as possible.

We will help you enroll. But, if you already understand your options and know what you want, you can enroll in Medicare on your own online at ssa.gov/benefits/medicare. You can also use this site to:

  • Create an online account
  • Check your enrollment
  • Print your Medicare card
  • Download a “What’s Covered” mobile app for easy search
  • Authorize designated person(s) access to your health records
  • Answers to frequently asked questions

Annual Election Period

Every year from October 15 to December 7, you have the option of changing your coverage either to a new Medicare Advantage plan or back to Original Medicare (see below). During the Annual Election Period (AEP), you can also change your Part D drug coverage plan.

General Enrollment Period

If you missed your Initial Enrollment Period, you can enroll in Medicare Part A and Part B between January 1 and March 31. Your coverage then starts July 1.

Special Enrollment Period

There are special circumstances that may allow you to change your Medicare plan at other times of the year. These include, but are not limited to:

  • Moving to a new address outside your plan’s service area
  • Moving home from skilled nursing or a long-term care hospital
  • Losing coverage from an employer
  • Being given new plan options by your employer
  • Having a plan that no longer has a contract with Medicare

If you might meet one of these special circumstances, contact us so we can help you find the right new coverage.

Understand your Medicare plan options

When Medicare was signed into law in 1965, it provided a single health insurance plan for tax paying Americans 65 and over. This plan is now called Original Medicare. It covers roughly 80% of a person’s healthcare costs. As healthcare costs grew, many patients struggled to pay the 20% not covered by Medicare. Over the past thirty years, Congress has passed new laws designed to help enrollees avoid unexpected costs. Today, we have different supplemental insurance plans, Medicare Advantage plans and prescription drug benefits to make healthcare more affordable and give you peace of mind.

Your Complete Health Member Service Representative will help you understand the benefits of all your available options.

Original Medicare

The Original Medicare plan is made up of two parts: Medicare Part A and Part B. Part A provides hospital insurance for everyone 65 and over.

As soon as you’re eligible for Part A, you’re also eligible for Medicare Part B (medical services not covered by Part A) and Part D (drug coverage). Part D is offered by multiple insurance carriers at different prices.

If you choose Original Medicare, you need to enroll in each of these plans separately. Original Medicare provides the flexibility of choosing any doctor who accepts Medicare patients in any area of the United States. It may be a good option if you live in more than one place during the year or travel frequently, especially if you purchase supplemental coverage.

What Medicare Part A Covers

Medicare Part A covers 100% of:

  • First 60 days of care in a hospital, with $1,408 deductible per stay
  • 100 days of care in a skilled nursing facility per illness
  • Home health care
  • Hospice care

There is no cost for Part A if you’ve paid Medicare taxes for 10 or more years. However, if you did not pay Medicare taxes, you may still be able to get Part A by paying a monthly premium.

What Medicare Part B Covers

Medicare Part B covers 80% of:

  • Medicare-approved doctor visits
  • Preventive care and screenings
  • Outpatient care
  • Home health services
  • Medical equipment
  • Mental health services

In 2020, the premium cost for Part B is $144.60 for individuals whose incomes are $87,000 or less. (The cost goes up with income.) The annual deductible is $198.

If you or your spouse is still working at 65 and you have group health insurance through your employer, you can delay enrolling in Part B without a penalty. If you are not working and don’t enroll in Part B during your initial enrollment period, your premium may go up by 10% for every year you were eligible and did not enroll.

Medicare Advantage

Medicare Advantage plans offer a one-stop solution for all your healthcare needs. These plans, often called Part C, are offered by private insurance carriers and combine traditional Medicare Part A and Part B coverage into one plan. Depending on the policy you choose, they may also include:

  • Medicare prescription drug coverage (Part D)
  • Vision coverage
  • Hearing coverage
  • Dental services and treatments
  • Gym memberships
  • Transportation to doctors’ appointments

Each Medicare Advantage plan has its own network of providers, with different deductibles, copays and out of pocket maximums for each calendar year. With a Medical Advantage plan, your primary care doctor coordinates all your care and maintains your electronic health records so you have easy access to your medical history. You pay one monthly premium and never have to manage a collection of health plans and their different invoices.

Medigap Plans

When you want the flexibility to go to any doctor or hospital, anywhere that accepts Medicare, you may decide to stick with Original Medicare. In that case, you should consider investing in a Medigap plan (also known as a Medicare supplement plan).

Medigap plans are designed to supplement the excess charges not covered by Medicare Part A and Part B, including:

  • Copayments
  • Coinsurance
  • Deductibles
  • Medical care when you travel outside of the United States.

Medigap plans do not generally cover vision, dental, or hearing so you need to pay for those benefits separately. And you have to pay for your Plan B and Plan D coverage separately as well.

If you’re unhappy with your Medigap plan and want to switch to a Medicare Advantage plan, you can do so during the Annual Election Period. Be aware that if you switch, you may not be eligible to switch back to a Medigap plan, especially if you have pre-existing conditions.

Have Questions?

Complete Health offers great support in helping you determine the best Medicare plan for your situation. We are not an insurance company, but we’ve made it our job to know all the insurance plans that serve our area. We know what they offer and the kind of service they provide. We can point you in the right direction and schedule meetings with different agents to make the process of selection and enrollment as easy as 1 – 2 – 3.

Make your appointment today.

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