Ten Things You Should Know About Medicare

You’ve received the mailings, seen the television ads and gotten advice from your sister’s, friend’s cousin… but what do you really know about Medicare and the benefits you’re eligible to receive?

“People are inundated with information – this and that,” said Holly Klein Gillespie, president of HKG Insurance Solutions and an expert in Medicare-related consulting. “If you don’t make the correct decision, you’re kind of stuck and, unfortunately, you can be penalized. It is amazing to me how stressful it can be for people coming to age 65 or those who are trying to make the right decisions for their loved ones.”

In a new podcast, HCAN President and CEO Mark Goetz spoke with Gillespie, president of HKG Insurance Solutions and an expert in Medicare-related consulting. She said there are several things to keep in mind if you or someone you love is about to become eligible. 

When should I sign up?

You have three months prior to your 65th birthday, the month of your 65th birthday and the three months after your 65th birthday to get on Medicare without being penalized for not having it or it’s credible coverage.

If I have group coverage through my employer, do I have to enroll?

If you’re turning 65, you’re still working and you have coverage through an employer of more than 20 people, you are not required to go on Medicare. You will not be penalized, because you have employer provided group coverage.

What does Part A cover?

Part A is hospital coverage. If you’ve worked at least 10 years and have been paying taxes, you don’t have to pay for Part A – it’s just available to you. If you are eligible, still working and enrolled in employer provided group coverage, you should still consider getting Part A, because it doesn’t cost anything. When you have both, your group coverage will be considered primary coverage, and Part A could help take care of some of the extra expenses.

What is Part B?

Part B covers the doctor side of things – services or supplies that are needed to treat medical conditions. If you are eligible, you can be penalized for not going on Part B unless you have group coverage through an employer with more than 20 people. Do not sign up for Part B if you have group coverage, because you’ll be double paying. 

Are prescriptions covered?

When you become eligible, you must have credible prescription coverage. If you don’t, you can be penalized. If you have coverage through an employer, it’s typically considered credible, but it’s important to confirm that through human resources.

If I’m sick or hospitalized, will it cover the entire bill?

If you have Part A and B, you can expect it to pay 80 percent of medical costs. The other 20 percent will your responsibility. There is no out-of-pocket max, so there is the potential for costly medical bills.

I have a health savings account, can I still contribute to that?

If you are eligible, you cannot contribute to a health savings account. You can draw on an existing account, but you can no longer contribute to it. 

What can I do to defray my out-of-pocket costs?

There are two pathways to help alleviate the potential financial burden – Supplements and Advantage plans.

  • Supplements (also known as Medigap plans) are offered through private insurance companies that are built to fill in coverage gaps. They range from Plan A to Plan N and are government set. That means it doesn’t matter which company you use, because the mandated plans cover the exact same things – the more you pay, the more gaps are filled. Supplement plans typically do not cover dental, vision or hearing needs. Essentially, if it doesn’t approve something, that supplement plan can’t approve it either. It all starts with Medicare. 
  • With Advantage plans, or Part C. you’re actually leaving original Medicare and going to a private insurance company. That private insurance company will be responsible for providing your benefits – not the government. The plan will typically have the same A, B and prescription coverage, but it’s all tied together in one comprehensive plan. One of the things people really like about Advantage plans, is that they usually include some extras that aren’t covered by original Medicare – like dental, vision, hearing and even gym memberships.

Which option is better – Supplements or an Advantage plan?

  • It depends on your unique situation. With a supplement plan, you pay a little more in monthly premiums. but your out-of-pocket is less. With an Advantage plan, you have a lower monthly premium, but you have co-pays up to the out-of-pocket maximum. 

Do I need to do anything during the open enrollment period?

Open enrollment is Oct. 15 through December 7th every year. During this time, people have the opportunity to review their coverage. You can go on to an Advantage plan. You can leave an Advantage plan. You can enter a prescription drug plan. You can change your prescription drug plan. There are lots of different options available during this time period.

If you have additional questions about Medicare and are looking for expert advice , contact Holly at HJK Solutions – 402. 502.5286.

For more information about the HomeCare Advocacy Network, visit hcanthrive.com or call 402.965.0737.