Selecting a Medicare Plan That's Right For You

Medicare is a collection of health insurance plans issued by the federal government for those over the age of 65 or younger with disabilities. Although Medicare plans exist to help mitigate the cost of health insurance as people get older, they don’t cover everything.

It’s a complicated topic, and Medicare health plan broker Sacket & Associates is here to help you understand the nuances so that you can get the most beneficial coverage for your situation.

Understanding How Medicare Works

If you’re 65 or older and a U.S. citizen, you can sign up for several different Medicare plans.

• Part A covers inpatient hospital and skilled nursing facility care.
• Part B covers preventative care and doctors’ visits.
• Part C, or Medicare Advantage, is a combination of Parts A and B (also known as Original Medicare) and benefits that can help with dental care, hearing, and vision.
• Part D covers brand-name and generic prescription drugs.
• Medigap, or Medicare Supplement Insurance, is private health insurance that fills any coverage gaps in your Medicare plan.

You must already have Medicare Parts A and B before you can apply for a Medigap plan. You are eligible for open enrollment for six months beginning the first month that you have Medicare Part B if you are 65 or older.

The Cost of Medicare

If you have worked and paid Medicare taxes for long enough (usually about 10 years), there is no premium for Part A. If you do not qualify for premium-free Part A, your monthly out-of-pocket expense will be either $278 or $505.

The premium for Part B depends on your income, and it starts at &174.70 per month. This premium is subject to change each year. Premiums vary for Medicare Advantage depending on your plan choice. These amounts can also change annually.

Part D plans also vary according to income. It is important to note that if you don’t sign up for Part D during your initial enrollment period, it may cost you a penalty if you decide to sign up later and you don’t have existing qualifying prescription drug coverage.

In addition to premiums, you will be responsible for costs such as deductibles and copays.

Points To Consider Before Applying for Medicare

When determining your eligibility for Medicare, several considerations influence when you can apply and when the coverage will take effect.

Employed Past 65

Medicare enrollment is more complicated if you or your spouse continue to work after the age of 65. You must consider factors such as existing coverage, what type of insurance you have, and COBRA.

Marketplace Coverage

The Healthcare Marketplace has no effect on your Medicare enrollment or coverage. You should apply during the enrollment period around your 65th birthday.

Disability Benefits

If you receive disability benefits and you are under 65, you will automatically join Medicare Parts A and B either when you turn 65 or after you have received disability benefits for 24 months.

ALS (Lou Gehrig’s Disease)

If you have an ALS diagnosis, apply for Social Security disability benefits first. Then, you will be automatically enrolled in Medicare.

End-Stage Renal Disease

Medicare takes effect as soon as you enroll if you are in end-stage kidney failure.

Special Enrollment

There are a number of circumstances that will allow you to sign up for Medicare without a penalty if you miss your initial enrollment period.

How To Enroll in Medicare

If you received Social Security benefits for at least four months before turning 65, enrollment in Parts A and B is automatic. However, you must apply for Part D, Medicare Advantage, and Medigap.

Enrollment Periods

Unless you have special circumstances or were automatically enrolled when you turned 65, you have a seven-month window to sign up for Medicare plans. It begins three months before your birthday month and ends three months after. For example, if your birthday is in July, your open enrollment period is April through October.

If you miss the window, you can still apply, but you may be subject to a late enrollment penalty if you do not qualify for a Special Enrollment period. Additionally, after you enroll in Medicare, you can only change or add coverage (Medicare Advantage and Part D) during the two yearly open enrollment periods.

Enrollment Steps

First, you must determine your eligibility. If this is not straightforward, Sacket & Associates can help you find your eligibility status.

Next, complete an application by:

• Meeting with a Medicare health plan broker at Sackett & Associates
• Applying online at the Social Security website
• Calling Social Security at (800) 772-1213
• Contacting your local Social Security office

The online application usually takes about 10 minutes to complete. You may have a long wait if you walk into a Social Security office; they recommend making an appointment.

Partner With Sacket Insurance as Your Medicare Health Plan Broker

Sacket & Associates helps the aging and disabled community afford healthcare with appropriate Medicare plans. We can answer questions and assist you with your Medicare application when you are ready. For more information on how Medicare plans work and how you can get started, contact us today.