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Learning Center > Aging into Medicare: A Step by Step Guide

Aging into Medicare: A Step by Step Guide

Aging into Medicare: A Step by Step Guide

Medicare, as a federal health coverage program, is intended to help provide access to healthcare for those who may not get it through an employer. Often, this means retirement age, which in the United States is age 65. Once you turn 65, you have aged into Medicare eligibility.

If you’re approaching your 65th birthday, it’s important to understand what Medicare options are available to you. While you may be automatically enrolled in Medicare, it’s possible that the default options are not the coverage that’s best for your situation. This guide will answer common questions and help you choose the Medicare plan that’s right for you or your family member. Medicare is for the nation's elderly and certain individuals with qualifying disabilities However this article will focus on those aging into Medicare.

Are you or someone you care about turning 65? Turns out, you’ll be joined by thousands of birthday buddies.

In fact, 10,000 Americans turn 65 every day - a real cause for celebration, whether it’s the milestone of retirement or your journey to the right Medicare coverage.

Still, many Americans are confused by Medicare: how to enroll, when their enrollment period is and what plan to even enroll in. But the process doesn’t need to be so complex. In this guide, we’ll help you understand what you should do when you’re aging into Medicare. Remember that while age is one trigger for being eligible for Medicare, it’s not the only one.

Aging into Medicare: what you need to know

Approaching age 65 may bring a lot of changes into your life. As you look at your Medicare options, you may have some of the questions we address below.

At What Age Should I Start Looking Into Medicare?

Because Medicare can be a complex subject, it pays to start learning early. There’s nothing wrong with beginning to review Medicare rules in your state, along with the available options, in your early 60’s. By the time you turn 64, it’s a good idea to start looking into specific plans.

Your initial enrollment period will start three months before your 65th birthday, include your birthday month, and extend three months afterward. You’ll have unique options in your initial enrollment period that will not happen again, like guaranteed acceptance into a Medigap plan, so it’s important to make the right Medicare plan choices from the very beginning.

Is It Mandatory to Go on Medicare at Age 65?

Many people who turn 65 will be automatically enrolled in Medicare if they are already receiving social security retirement benefits or other retirement payments. It is not mandatory to enroll in Medicare at age 65, but you might pay a financial penalty if you delay your enrollment.

Medicare Part A is premium-free for most people, so there’s no harm in enrolling in that coverage immediately. Medicare Part B, which covers outpatient care, doctor’s visits, and more, does have a monthly premium. If you defer enrollment in Part B because you have a qualifying employer coverage through your job or a spouse, you won’t have to pay a late enrollment penalty when you do sign up for Medicare Part B.

If you do not sign up for Medicare Part B during your initial enrollment and you don’t have qualifying coverage, when you do decide to enroll in Part B you will need to pay a late-enrollment penalty.

Enrollment Periods

As you approach age 65, you’ll want to make a note of the different enrollment periods that affect Medicare recipients. AEP stands for Annual Enrollment Period. You can make any change or update to your Medicare plan each year between October 15 and December 7th. Coverage changes go into effect on January 1. Learn more about annual enrollment periods.

The OEP is the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year. During this time you can make changes to your Medicare Advantage plan or go back to Original Medicare. You can learn more about Medicare enrollment periodshere.

Special Enrollment periods happen due to specific life events. For example, if you move out of a plan’s service area, have a chance to get other coverage, or lose current coverage, you may get a special enrollment period. This guide gives more information about special enrollment periods.

What Happens if You Don’t Enroll in Medicare in Time?

If you don’t sign up for Medicare during your initial enrollment period, you may be penalized with higher premium if you do decide to enroll later. Every year, you may enroll in Part A or Part B during the General Enrollment Period from January - March.

6 Steps for Aging Into Medicare

Now that you know the eligibility requirements and when to enroll, follow these tips to prepare for Medicare enrollment.

1. Make Sure You Qualify For Premium-Free Medicare Part A

Most people qualify for Medicare Part A because of their work history. If you’re a U.S. citizen or permanent legal resident, you qualify for premium-free Part A as long as you have paid payroll taxes for at least 10 years.

Call your local Social Security Office to see if you’re eligible for Medicare Part A. You may receive a paper statement from SSA [sample here] as a reference, or you can create an account online at ssa.gov.

What If You Didn’t Work Enough?

You may still qualify for Medicare Part A through your spouse if you don’t (or won’t) have 40 quarters of work history. You’re eligible if your spouse qualifies for premium-free Part A, and:

  • You have been married for at least one year and your spouse is eligible for Social Security benefits.
  • You're divorced and your former spouse is eligible for Social Security benefits. You must have been married at least 10 years, and you must be single now.
  • You’re widowed, but were married for at least nine months, and you are currently single.

If you don’t meet any of these criteria, you can either continue working until you’ve logged 40 quarters, or pay for Part A. For 2022, the Part A premium is $499 per month, but this amount may be reduced if you have some work history.

2. Decide When Need You Medicare Part B

If you are currently employed and you are covered by an employer health plan, and your employer has more than 20 employees, you don’t have to sign up for Part B until you retire and give up your employer-based health coverage.

Many people can’t take full Social Security benefits until age 66, so it’s common to delay retirement by a year. You can delay Part B as long as your employer coverage meets Medicare’s minimum requirements.

But if you work for a small company with less than 20 employees, you’ll probably need to enroll in Part B when you’re first eligible. Be sure to talk about this with your employer before your 65th birthday. There’s no reason to pay the Part B premium until you’ll actually need Medicare.

3. Decide When You’re Taking Social Security

There are a few nuances to receiving Social Security and how it impacts when you can enroll in Medicare Parts A and B:

  • If you take Social Security at age 65, your enrollment in Medicare will be automatic.
  • If you pass on Social Security at age 65, but want to sign up for Medicare, you’ll have to apply for it separately.
  • You can use ssa.gov to enroll if you choose to enroll before your 65th birthday.
  • If you wait until after you’re 65, you’ll have to visit a Social Security office to sign up for Medicare.

4. Know Which Doctors You Want To See When You Have Medicare

Make sure the doctors you see, or want to see, accept Medicare. Finding out ahead of time can help you avoid surprises.

If you plan to move during your retirement, it’s wise to get recommendations for doctors in your new hometown and see if they accept Medicare patients.

5. Get A Firm Understanding Of Your Medications

When it comes to medications and aging into Medicare, there are 3 steps to take:

  • You should always know your medications and their doses.
  • Talk to your doctor about generic versions of your prescriptions to reduce costs.
  • Find out if your doctor thinks you might need a new or different medication in the future.

6. Understand The Gaps In Original Medicare

Medicare doesn’t cover 100% of your health care costs. Instead, you’ll pay a portion out of your own pocket. The costs you pay for Part A differ from what you’ll pay for Part B.

Gaps In Medicare Part A

Part A will cover you for inpatient type of events, like:

When you have a hospital stay, you’ll have to pay the Part A deductible. For 2022, the deductible is $1,556. You’ll pay this inpatient hospital deductible each time you are admitted to the hospital, provided you haven’t received hospital or skilled nursing facility services within the previous 60-day benefit period.

Gaps In Medicare Part B

Part B of Original Medicare covers the services you’d receive in an outpatient setting, including:

  • Doctors and therapy appointments
  • Lab work and diagnostic imaging
  • Outpatient surgeries
  • Medical equipment like oxygen machines
  • Some cancer treatments like chemotherapy

When you use Part B coverage, you can expect to pay out of pocket for each service. Your share of cost can include:

  • Part B deductible: $233 for 2022 (you only pay the Part B deductible once each year).
  • Part B coinsurance: 20% of the cost for each service or procedure.
  • Part B excess charges: Up to 15% of the Medicare-approved charge if your doctor does not accept the Medicare-approved amount for a service (known as Medicare assignment).

The biggest Part B expense is the 20% coinsurance, which you’ll pay throughout the year. There are other costs you can expect to pay out of pocket with Original Medicare, including things like dental care, eye exams, hearing aids, and more.

Keep in mind that there is no cap on how much you can spend out of pocket with Original Medicare.

How To Find The Right Medicare Plan For You

Make sure any Medicare plan you consider:

  • Covers the doctors you want to see
  • Covers the medications you need
  • Has a premium you can afford

You can also narrow your choices down further by asking yourself:

  • Do I intend to split my time between two or more States?
  • Am I comfortable with an HMO-type arrangement, or using a set group of doctors and facilities?

If you spend a lot of time travelling or living in a second home, you’ll want to consider Medicare Supplement Insurance. But if you’re comfortable with a particular HMO-type medical group and plan to live in one place, then Medicare Advantage could be right for you.

Your Options Beyond Original Medicare

There are Medicare plans available that help close the coverage gap of what Original Medicare doesn’t cover. They include:

  • Medicare Advantage
  • Medicare Part D (Prescription Drug Plans)
  • Medicare Supplement (Medigap)

Medicare Advantage Plans

Medicare Advantage plans, also known as Medicare Part C, is a contract between a private insurer and Medicare. These plans must cover everything that Original Medicare covers.

Medicare Advantage plans work like traditional private health insurance, so you may see certain out-of-pocket costs with Medicare Advantage, including:

  • Monthly premium: Many Part C plans don’t have a monthly premium.
  • Annual deductible: Most plans don’t have a deductible.
  • Copayments or coinsurance for services and procedures.

Medicare Advantage plans also offer a number of added benefits, which vary by state and health plan. Some benefits include:

Medicare Advantage plans can also provide emergency coverage outside the United States. With the international coverage, out of pocket maximum protection, and a wide range of extra benefits, you can see why many people choose Medicare Advantage plans.

Prescription Drug Plans

Prescription Drug plans (PDPs or Medicare Part D) help with the cost of prescription drugs. Each company creates their PDPs differently, but you can expect to pay these costs for coverage:

  • Monthly premium, which varies based on income
  • Annual deductible (although many plans don’t have a deductible)
  • Copayment or coinsurance per filled prescription

The copayments and coinsurance costs increase as the total amount your plan pays rises above certain thresholds, also known as coverage stages:

Coverage Stage 1 – Deductible Stage: You pay full price until you’ve spent $480 (for 2022).

Coverage Stage 2 – Initial Coverage Stage: You pay small copayments or coinsurance for each prescription.

Coverage Stage 3 – Coverage Gap Stage: Also known as the Medicare “Donut Hole.” Once your total drug costs (what you’ve paid plus what your plan has paid) exceed $4,020, you hit the coverage gap. You’d then pay 25% of the cost of prescriptions.

Coverage Stage 4 – Catastrophic Stage: Once your total drug costs (excluding what your plan has paid) exceed $6,350, you pay no more than 5% for medications

These coverage stages reset on January 1 each year. But it’s important to know that there is no out-of-pocket cap on drug costs under Part D.

Click the link if you want to more about the phases of Medicare Part D.

Medicare Supplement Insurance

Medicare Supplement Insurance, also known as Medigap, is designed to fill the gaps in Original Medicare. Medigap supplements Original Medicare by paying some or all of the expenses that you’d normally have to pay out of pocket.

Medigap policies are issued in 10 standardized plans: A, B, C, D, F, G, K, L, M, and N. Each of these plans cover a slightly different portion of the Original Medicare gaps.

Plan G is a popular Medigap option that covers every gap except for the Part B deductible. If you have Plan G, you can expect to pay for the first $198 in Part B expenses (like doctor’s visits). Plan G will then cover every penny of any Medicare-approved service or procedure.

Several Medicare supplements provide some international coverage, including plans C, D, F, G, M, and N.

Medigap plans also give you maximum flexibility, so you can see any doctor or use any facility that accepts Medicare patients, anywhere in the United States. You’re not bound to a network, or reliant upon referrals.

Medicare Supplement Insurance plans don’t cover prescription drugs, so you’ll need to enroll in a stand alone Prescription Drug plan to get drug coverage.

Considerations Before Choosing A Plan

Make sure any Medicare plan you consider:

  • Covers the doctors you want to see
  • Covers the medications you need
  • Has a premium you can afford

You can also narrow your choices down further by asking yourself:

  • Do I intend to split my time between two or more States?
  • Am I comfortable with an HMO-type arrangement, or using a set group of doctors and facilities?

If you spend a lot of time travelling or living in a second home, you’ll want to consider Medicare Supplement Insurance. But if you’re fine with HMO-type medical groups and plan to live in one place, then Medicare Advantage could be right for you.

As you approach age 65, it’s important to start your research sooner rather than later. Make sure you know what plans your doctors will accept, and which plans cover your medications.

Comparing Medicare plan features and costs doesn’t have to be complicated though. You can get Medicare quotes through our site. Or you can call 800-620-4519 to reach one of our licensed Medicare agents who can guide you through your Medicare plan options.

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For many seniors, having a walk-in tub can be very helpful. When you have limited mobility, getting in or out of a traditional tub can be very difficult. If you have Medicare for your health insurance coverage, you might wonder, “Can a walk-in tub be covered by Medicare?” This guide will help you understand if this type of tub is considered durable medical equipment and eligible for coverage. Let’s get started! Does Medicare cover walk-in tubs? Does Medicare cover the cost of a walk-in tub? Original Medicare covers specific types of durable medical equipment (DME) as long as you get the equipment from a DME provider that accepts assignment from Medicare.  Durable Medical Equipment must meet the following requirements: Can be used repeatedlyIs used only for a medical reasonIs used in the patient’s homeIs expected to last 3 years or longerIs not useful to people who are not sick or injuredUnfortunately, a walk-in tub is not considered DME by Original Medicare. However, if you have a Medicare Advantage plan, you may be able to get coverage for a walk-in tub using that plan if your doctor prescribes it.How much are walk-in tubs for the elderly?Walk-in tubs can be quite expensive. For a basic model, you could pay between $2,000 and $3,000. Wheelchair-accessible tubs are more than twice as expensive, with prices between $5,000 and $10,000. There’s also the cost of installation to consider, which can vary significantly based on where you live, your bathroom layout, and what types of plumbing, tile work, and other changes need to be made.Getting a walk-in tub is a significant investment, which is why so many seniors would like to have help from Medicare in paying for it.How to get Medicare to pay for a walk-in tubWhile you won’t be able to get Original Medicare to pay for a walk-in tub, you might have better luck with a Medicare Advantage plan. These plans can offer additional benefits above and beyond what Original Medicare provides.Before you choose a Medicare Advantage plan, make sure it fits your needs. For example, they often have specific medical provider networks, and you’ll want to ensure that your preferred doctors and specialists are included. You also want to compare monthly premiums, deductibles, and copayments when you are deciding between plans.A walk-in tub can help you significantly if you have mobility issues, but there are other options that are less expensive. For example, you might look to installing grab bars in your bathroom to help you balance. These can cost as little as $75, up to $200 or so.Keep in mind that Original Medicare doesn’t cover these items, but a Medicare Advantage plan might. This could provide savings to you not just in terms of the walk-in shower, if covered by the plan, but with your overall Medicare costs.  Contact us to learn more about Medicare and walk-in tubsIf you have questions about other aspects of your Medicare coverage, we’re here to help. When you’re comparing Medicare plans and trying to choose the right option for your needs, talking to a licensed agent can help put your mind at ease.Contact us today to compare plans or ask questions about your Medicare coverage!
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The Medicare Annual Enrollment Period (AEP), sometimes called Medicare Annual Open Enrollment or the Medicare Annual Election Period, runs from October 15 to December 7 each year. This is the time period in which Medicare beneficiaries can make certain changes to their Medicare plans, which we will cover below. Those plan changes would then become effective on January 1. But if Medicare beneficiaries are satisfied with their current Medicare plans, they don't have to take any action during Medicare AEP and there are no penalties involved. Medicare plan details can change annually, though, so it's wise to review your Medicare coverage each year. Overview of Medicare Enrollment Periods It's important to know that the Medicare Annual Enrollment Period is different from other Medicare enrollment periods. Here’s a quick overview of the differences: Annual Enrollment Period (AEP): Any changes to Medicare or Medicare Advantage plans Initial Enrollment Period (IEP): Only happens around your 65th birthday, any changes to Medicare or Medicare Advantage plansOpen Enrollment Period (OEP): Applies only to those with Medicare Advantage, who can change Medicare Advantage plans or drop them and return to Original MedicareGeneral Enrollment Period (GEP): Open enrollment period to join Medicare Part A and B.Special Enrollment Period (SEP): Occurs if you have eligible life changes that mean you need to change your plan before the next annual enrollment period.Be sure to visit our guide to different enrollment periods to learn more.What’s the Difference Between Medicare AEP and the Medicare General Enrollment Period?The Medicare Annual Enrollment Period is sometimes confused with the Medicare General Enrollment period, which is January 1 to March 31 each year. It’s important to understand the differences between the two enrollment periods.The Medicare General Enrollment Period is for Medicare beneficiaries who didn’t sign up for Medicare Part A) or Part B when they first became eligible and aren’t eligible for a Medicare Part B special enrollment period. The AEP, however, is for beneficiaries who are already enrolled in Medicare and want to change their Medicare coverage.What Changes Can I Make During the Medicare Annual Enrollment Period?The first thing to know is that you cannot use the Medicare Annual Election Period to enroll in Medicare Part A or Part B for the first time.If you’re enrolled in Medicare Part A and Part B and you’d like to change your Medicare coverage, here are some things you can do during the Medicare AEP:Change Medicare Advantage plans.Change Prescription Drug (Part D) plans. Enroll in a Prescription Drug Plan.Cancel your Prescription Drug Plan.Switch from Original Medicare to a Medicare Advantage plan.Switch from a Medicare Advantage plan back to Original Medicare (and add a Part D plan or Medicare Supplement plan if needed). 5 Tips to Prepare for the Medicare Annual Enrollment PeriodThere are many Medicare insurance carriers and plan options, but there are several steps you can take to be a savvy shopper and choose the right plan for your unique needs.1. Mark Your CalendarThis may seem like an obvious tip, but it’s worth mentioning: Mark your calendar for October 15 through December 7 if you’d like to make a change to your Medicare plan.You might even set aside a few hours to research and compare Medicare Advantage plans and Prescription Drug plans ahead of October 15. These plans announce their benefits for the next year starting on October 1.Writing down these Medicare AEP dates and to-dos will help you to commit to these priorities.2. Review Your Medicare Annual Notice of ChangeYou’ll receive lots of information over the next month or so prior to and during AEP, so if you’re currently enrolled in a Medicare Advantage or Prescription Drug Plan, the Annual Notice of Change (ANOC) is one piece of mail you’ll want to read.Your Medicare plan will mail your Annual Notice of Change letter to you by September 30. The ANOC letter will inform you of most changes to your Medicare health plan, including coverage and benefits that will take effect on January 1 each year.Each year, your Medicare health plan sets the amounts it will charge you for premiums, deductibles and other services. Medicare doesn’t set these rates - but your insurance company does. With this in mind, the amounts you pay could change each year.While evaluating your current Medicare plan, you may want to ask yourself questions like:Did the plan cover the services I needed?Did I use out-of-network providers?Did I spend more out of pocket than I originally anticipated?Has something changed with my health (new diagnosis, new prescriptions, etc.)?The ANOC will also provide a side-by-side comparison of your current plan and next year’s plan benefits, costs and other changes (if any).Moral of the story: Don’t toss this piece of mail aside. Always review your ANOC to ensure your plan continues to meet your needs on an annual basis. And if you don’t receive your ANOC by September 30, contact your Medicare insurance company.3. Make a List of What’s Important to Your HealthKeeping a list of what’s important to your health is an invaluable way to prepare for the Medicare Annual Enrollment Period.Start by writing down all of your doctors, preferred health care facilities and hospitals, and prescription drugs, if you take any.We also recommend making a list of value-added benefits that may fit your health, lifestyle and budget.For example, you may be someone who likes to keep active and have social interaction. So a fitness program like SilverSneakers, which gives you access to a network of gyms and other programs, might be a good fit for you. A Medicare Advantage plan may provide these types of fitness or wellness programs.Another thing to consider is whether or not you have an elective surgery planned for 2023. If so, you’ll want to check your hospital-specific benefits under your current Medicare Advantage plan.4. Check Your Plan’s Drug FormularyYour Medicare plan’s drug formulary will not be included in your Annual Notice of Change, so be sure you call your insurance carrier to see if your prescription drugs will be covered for the 2023 plan year.If your prescription drugs aren’t covered, it’s wise to use the Medicare Annual Enrollment Period to find a plan that does cover them.5. Talk To Your DoctorAnother “Medicare must-do” is to make sure all of your doctors and healthcare facilities will remain in network with your current Medicare plan. 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Or, you call (855) 651-5094 to talk to a licensed insurance agent to get help enrolling in Medicare.Whatever option you choose, be sure to have 3 items handy before you enroll in a plan or make changes to your current plan during AEP:Your Medicare number, which is found on your red, white and blue ID card.Your list of prescription drugs and preferred pharmacy.Your list of preferred doctors and hospitals.How To Find A Medicare Advantage or Prescription Drug Plan During AEPYou don’t have to go it alone when choosing a Medicare Advantage plan or Prescription Drug Plan. We’re here to help you navigate the Medicare Annual Enrollment Period through a number of ways, including:Our licensed agents: 1-800-620-4519Our Medicare plan comparison toolOur online Medicare resourcesView Our Medicare Annual Enrollment Period GuideThe experts at TogetherHealth have developed a Guide to the Annual Enrollment Period to help you prepare and make an informed choice for your healthcare needs during AEP each year.
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