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“Oh My, “ I am having a birthday and turning 65! How can this be? I remember when my parents turned age 65! Everyone will face this “Oh My” moment. When retirement is in the future, it is time for Medicare.

Medicare is America’s health insurance program for people age 65 or older. Certain people under age 65 may also qualify for Medicare due to disabilities, permanent kidney failure or Lou Gehrig’s disease. The program, signed into law July 30, 1965 by President Johnson, helps with the cost of health care, but it does not cover all medical expenses or the cost of long-term care.

Medicare is financed by a portion of the payroll taxes paid by workers and their employers. It also is financed in part by monthly premiums deducted from Social Security checks. The Centers for Medicare & Medicaid Services (CMS) is the agency in charge of the Medicare program.

4 Parts of Medicare

  • Part A: Hospital Insurance helps cover inpatient care in hospitals. It also helps cover skilled nursing facilities (not custodial or long-term care), hospice care and home health care. People with Part A are responsible for paying a deductible or co-pay for each covered service.

  • Part B: Medical Insurance helps pay for doctors’ services and other medical services and supplies that are not covered by Part A such as outpatient care and durable medical equipment. People with Part B are responsible for an annual deductible and 20% of the Medicare approved charge.

  • Parts C: Medicare Advantage Plans are plans required to provide the same coverage as Original Medicare Part A and B. Some plans offer extra benefits, such as dental and vision services (benefits not covered by Original Medicare) and many include Part D drug coverage. You must have Part A and B of Medicare to be eligible to enroll in a Medicare Advantage Plan. These plans are only available in certain areas and include Shawnee County, Kansas.

  • Part D: Prescription Drug Coverage is available to everyone with Medicare. Enrollment in Part D is optional, but if you decide not to enroll when first eligible you may pay a penalty if you join later. However, if you have prescription coverage that is at least as good as what Medicare offers, you may not need to enroll in Medicare Part D.

Signing up for Medicare:

  • If you are already getting Social Security retirement or disability benefits or railroad retirement checks, you will be contacted a few months before you become eligible for Medicare and given the information you need.

  • If you are not already getting retirement benefits, you should contact Social Security about three months before your 65th birthday to sign up for Medicare. You can sign up for Medicare even if you do not plan to retire at age 65.

Supplemental Insurance:

Medicare Supplement (Medigap) is health insurance sold by insurance companies to fill gaps in Medicare Parts A and B. While Medicare pays most of your healthcare costs, Medicare Supplement policies help pay your share (co-payments or deductibles) of the costs of Medicare approved services.  Depending on the plan, you incur little or no out-of-pocket expense after Medicare and the Supplement policy pay the healthcare provider. Medicare Supplements do not cover the cost of prescription drugs so a separate drug plan is needed.

Frequently Asked Questions:

  • Can I delay enrollment in Medicare Part B? Medicare rules allow you to delay enrollment in Medicare Part B when you are covered by an employer group health plan, regardless of the number of covered employees, if your health coverage is based on you or your spouse’s current, active employment.

  • Is Medicaid and Medicare the same? No, they are two different programs. Medicaid is a state-ran program that provides hospital and medical coverage for people with low income and little or no resources. Each state has its own rules about who is eligible and what services are covered under Medicaid.

  • What is open enrollment and when is it? For Part C (Medicare Advantage Plans), Medicare Open Enrollment is the period between October 15 and December 7 each year when an individual can choose a plan for the next calendar year. This enrollment is guaranteed with no medical underwriting.

For Medigap polices (in the State of Kansas) open enrollment is a six-month period following the effective date of Medicare Part B. Insurance companies must offer coverage regardless of your health. If you apply after six months of obtaining Part B, insurance companies may decline to offer coverage based on your health history unless you have a special enrollment situation.

So when your “Oh My” moment happens, do not panic! Contact your local Social Security office and a licensed insurance agent specializing in Medicare. With the help of a professional, the transition into Medicare can be easy and painless. 

Happy Birthday! 

TK Expert:

Bob Evenson

Century Health Solutions

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