I usually always focus on exercise, diet or other ways to address easing the effects of aging. Today I’m taking another approach and looking at health care because as we migrate to Medicare the choices made can dictate some aspects of quality of life. As we age it is expected that we will use our healthcare provider more. While exercise and proper diet choices can mitigate that expectation we should plan for the possibility of increased use of the health care system. Where and how we received medical care will directly impact our quality of life. With that in mind lets look at the inevitable Medicare and the sometimes confusing possibilities of choice involved.
Hospital care is covered by Medicare Part A. Medicare Part B is medical insurance that covers doctors visits and outpatient services. Medicare Advantage Plans are an alternative to the Federal Government Medicare Part A and B plans that go through private insurance companies that carry different premiums and restrictions. Prescription drug coverage is provided by a separate Medicare Plan called Part D prescription or drug coverage can also be included in a Medicare Advantage Prescription drug plan which is again separate from traditional Medicare and is private insurance.
The timing of when you make a Medicare plan choice is important and can carry penalties if you miss your window so please pay attention. You can first sign up for Medicare during the seven month window that is calculated as follows. Three months before your 65th birthday, your birthday month and the three months following your birthday month. For example if you were born in the month of June, you would be eligible to sign up for Medicare in March, April, May, your birthday month of June and July, August and September during the year that you turn 65 years of age. If you miss this seven month window you could be subject to late enrollment penalties for as long as you are enrolled in Medicare. If you are still covered by group health care through your current job you can delay Medicare enrollment without penalty if you sign up for Medicare within eight months of leaving your current employment or the insurance coverage ending. But check with your Social Security Office to ensure you will remain in compliance and not be subject to penalty.
Most people don’t have to pay a premium for Medicare Part A. The standard premium for Medicare Part B is $134, but can be adjusted higher based upon income. Premium costs are also higher for retirees with a modified adjusted gross income above $85,000 for individuals and $170,000 for couples. There is a $183 Medicare Part B deductible after which you will be charged 20 percent of the Medicare approved amount for most services. There is no annual limit on out-of-pocket costs for each benefit period. Medicare Part A has a $1,340 deductible if you are hospitalized and additional costs apply if hospital stay exceeds 60 days.
Medicare beneficiaries must choose between an average of 23 Medicare Part D presecription drug plans, which each have different covered medications, premiums and copays. The covered medications and their costs change annually so it is a good idea to shop around for a new plan each year during the Medicare fall open enrollment period. It goes without saying that if you are on a particular medication or anticipate a new prescription that you check to ensure what will be covered and what will not.
You can supplement Medicare with a Medigap Plan that will pay for some of the traditional Medicare out-of-pocket costs. You need to choose a Medigap policy during the six month period when you are 65 or older and enrolled in Medicare Part B. You can be charged significantly higher premiums or denied coverage if you try to buy a policy after that six month deadline.
There is more to know including how to get coverage for prescription eyeglasses and hearing aids and long term nursing home but that will be coverage in another post.
It can be confusing but with a little time and effort you can get yourself on track for the proper Medicare coverage for you. Whatever your Medicare coverage choices be sure to keep your healthy life choices in the forefront. You will need less of the healthcare Medicare provides and will more of the health span that accompanies those health choices.