Medicare is a federal program that can help people over 65 or individuals with qualifying disabilities pay for healthcare. You can apply for Medicare once you turn 65 or if you are under 65 years and have been on disability for 24 months. Additionally, if you have ALS or end-stage renal disease, you can apply for Medicare at any time.
There are many ways to set up your healthcare coverage. You can choose Original Medicare Parts A and B, add a prescription plan (Part D), add a supplemental insurance policy to cover coinsurance or find a Medicare Advantage Plan that best fits your needs.
Idaho, like every other state, has Medicare. Original Medicare, is offered through the federal government. During your working years, you contribute to Medicare through payroll taxes.
Original Medicare has two parts:
If you are 65 years or older and you or your spouse worked and paid Medicare taxes, you qualify for Medicare. Additionally, if you have been on disability for 24 months, you can also qualify for Medicare. Finally, if you have ALS or end-stage renal disease, you can apply for and receive Medicare as soon as a doctor diagnoses you.
In order to qualify for Social Security retirement benefits, you must have worked 40 quarters. However, Medicare does have some leeway as to how much you worked. You can still get Medicare if you did not work 40 quarters, but you will have to pay premiums for Part A. If you worked for 40 or more quarters, you do not pay a premium for Part A.
You can only sign up for or change Medicare and the Advantage Plans during certain times of the year. Initial enrollment is a little different because it is based on your birthday. When you first sign up, you should apply three months before you turn 65 because of the delay before the coverage starts. You can also enroll up to three months after your birthday, though you should consider the delay in coverage.
You can also sign up from January 1 through March 31 of each year if you elect not to sign up during the year you turn 65. However, you will have to pay a late penalty for Parts B and D if you do not sign up for those during the initial enrollment period.
You can change plan options during annual open enrollment (AEP) from October 15 through December 7.
Medicare Advantage open enrollment is from January 1, through March 31. You can switch from Original Medicare to an Advantage Plan, from one Advantage Plan to another, or from an Advantage Plan to Original Medicare.
Finally, the special enrollment period is any time throughout the year as long as you lose health insurance coverage for a qualifying reason. Reasons might include losing health insurance through your job because you retired or moving out of your plan's network area. Learn more about the various Medicare enrollment periods in this guide.
Before you sign up, make sure the plan you want has facilities that are convenient to you, has doctors you like, is affordable, and covers services you currently need or expect to need in the future.
In some cases, the system automatically signs you up for Medicare. Applying for retirement or disability benefits, whether through the Railroad Retirement Board or Social Security, serves as your application for Medicare.
Once you turn 65, you will automatically start getting Medicare Part A. If you did not apply for retirement or disability benefits, you will have to sign up for Medicare manually, whether for Original Medicare or an Advantage Plan.
If you applied for retirement or disability benefits, that application also serves as the application for Part B, which is also automatic. If you do not wish to purchase Part B, you must sign the form and forward it to the Social Security Administration.
If you have not worked 40 quarters or you have not applied for disability or retirement benefits through Social Security, you will most likely have to sign up for Medicare manually. You can do that by going to SocialSecurity.gov or calling Social Security at (800) 722-1213 to sign up for Medicare. If you prefer, you can also go to a local Social Security office to sign up in person.
If you prefer a Medicare Advantage plan, you must manually sign up for it, whether you have 40 quarters or not. Medicare recommends that you sign up three months prior to your 65th birthday because of the time it takes to process your application – the "waiting period."
Another decision you must make is which Part D plan you prefer. Not all plans cover all medications. You can work with an insurance agent or review the available plans yourself to choose the option that works best for you. In addition to ensuring that the plan you choose covers the medications you need, you should also ensure that your preferred pharmacy accepts the plan.
Additionally, compare the amount of the co-payments for your medications with the premium and deductible for the Part D plan you choose.
Medicare costs can be confusing. We will cover some basics below but also have a guide to Medicare costs, deductibles, and premiums. In most cases, you won't pay a premium for Part A Medicare. However, if you pay the premiums because you worked less than 30 quarters, the cost is $471 for 2021 and $499 for 2022. If you worked 30 to 39 quarters, the premium cost is $259 in 2021 and $274 in 2022.
The deductible for Part A is $1,556 in 2022. For the first 60 days of care, you pay no coinsurance. For days 61 through 90, your share is $389 in 2022. Day 91 and after, the coinsurance is $778 for 2022. After you use the lifetime reserve days, you are responsible for all costs.
Each period of use starts over once you stop using Medicare. For example, if you have a medical incident and spend 59 days in the hospital, then doctors release you, the time count starts over again if you have another incident and need hospitalization.
Part B premiums are $170 in 2022. The deductible is $233 in 2022. Once you meet the deductible, you or supplemental insurance is responsible for 20 percent of the amount Medicare approves.
Parts C (Advantage Plans) and D's monthly premiums vary by plan.
Because the 20 percent that is your "coinsurance" could get quite pricey if you have surgery or extensive medical care, most people purchase a supplemental insurance policy or a Medicare Advantage Plan. A supplemental insurance plan kicks in and pays the 20 percent that Medicare does not pay. Some supplemental insurance plans will also cover your deductible.
If you choose to go with Original Medicare and a supplement plan, make sure the doctors that you want to use accept the supplement you choose.
Medicare Advantage is a replacement for Original Medicare. It’s provided by private insurance companies and may offer additional benefits. More than 1.4 million people are enrolled in an Advantage plan in Idaho. You can find out which Medicare Advantage Plans are available in your area by entering your zip code. This will allow you to see a list of available plans in your area.
A plan may have a higher deductible and lower premiums or a lower deductible and higher premiums. Additionally, you must consider what each plan covers. You will have to go through the various plans available in your area to determine which plan best fits your needs and is financially affordable for you.
Deciding whether you want Original Medicare or an Advantage Plan and then choosing which plan is the best fit can be confusing, especially when you start trying to compare premiums, total costs of plans, co-payments, and other costs of insurance. We can help you weed through the various plans and determine which one is the best for your needs.
If you are ready to apply for Medicare, contact us to compare plans or speak with a licensed insurance agent. To learn more about Medicare and about Medicare Advantage Plans in your zip code.