Know the timeline for Medicare

People seem to be getting very confused over when they are to do what. The answer is basically what is needed by the consumer.

MEDICARE ENROLLMENT: Most people are eligible to enroll in Medicare when they turn 65. If you’re receiving Social Security benefits, your Medicare card is mailed to you by Social Security three months before you turn 65. So if your birthday is anytime in October, you would have received your card around July 1.

The only exception would be if your birthday was Oct. 1— then you would have received your card June 1. Medicare always starts on the first of the month of your birth month, or a month sooner if you’re born on the 1st.

That’s for people receiving Social Security benefits early, either because they opted to enroll to receive retirement benefits early or due to an early disability.

If you’re not receiving early benefits, then you must enroll on your own. This can me done online at www.socialsecurity.gov/medicareonly or by calling Medicare at 1-800-MEDICARE. Another service my office provides is telephone registration, and we can also assist you in online registration.

Once you have enrolled in Medicare, you will receive your ID card in about three weeks. It comes in a 6 x 9 white envelope printed on a cardboard form. Remove the card from the perforations and you’re done with Medicare.

You’ll have an 11-digit ID number composed of letters and numbers. Present this to your medical providers, and after the deductibles and co-payments, you only pay part of the bills.

Most people look to private insurance companies to pay the difference, because your out-of-pocket expense can be into the thousands of dollars per year. There are several ways to facilitate payment.

Employer – If you’re employed and receiving health benefits, depending on the size of the employer, Medicare may be primary and your group insurance secondary. For large-group employers, Medicare Part B may not be necessary and could add a financial burden.

Supplement – Many people prefer a Medicare Supplement. These policies are offered by many insurance companies; and rates and benefits vary, with several options available. Some companies offer discounts for people new to Medicare, household discounts or money off when paying by automatic bank draft.

These plans are GUARANTEED ISSUE with no medical questions for people new to Medicare. After an initial enrollment window, there is no guarantee and an applicant must qualify. If your health qualifies, you may enroll at any time.

If first coming off an employer plan or enrolling into Medicare post-retirement, there is a small window to enroll on a guaranteed-issue basis.
Medicare Advantage – This is a type of private insurance where you “assign” your Medicare benefits to a private insurance company. Most or all of the monthly premium is paid by the government to the company to “manage your care.”

In Kern County, most plans have a $0 monthly premium. You just pay your Medicare Part B premium. These plans are the HMO-style, where you select a primary care provider (PCP) from a list, and all specialists and referrals are made by the PCP with approval from the HMO and participating Medical Group.

Enrollment in an HMO plan is for once you are first eligible for Medicare, leave an employer plan, or for other special times. The Annual Enrollment Period (AEP) is Oct. 15 to Dec. 7 of each year. This is why you are seeing so many ads on television and in your mailbox. It is the one time of the year when you can change plans without medical questions!

During the year, plans can be changed only under special circumstances; like moving from one area to another; loss of employment; needing or losing Medi-Cal benefits; requiring “extra help” with prescription costs; or requiring medical help with conditions such as diabetes, blood pressure or heart disease.

Prescription coverage – Most people, even those not currently taking medication, need a prescription plan.

If not provided by an employer group plan, anyone on Medicare should get one. If not purchased along with your Medicare Supplement, Medi-Cal program, or just straight Medicare with no other insurance, you are penalized 1% of the national average premium for every month you went without creditable coverage.

The penalty is charged for the remainder of the time you are late-enrolled in a plan. Most Medicare Advantage plans include a prescription benefit, and although the monthly premium may be $0 for the plan you select, the company will still charge you the penalty.

This is a remarkably busy time of year for the health insurance specialist.
One comment I’m hearing from clients is that they’re happy with their plan and do not need to change.

It’s humorous because the 2021 plan will be different than the current benefits, and many plans offered by other companies may have better benefits using the same identical doctors.

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