Medicare Basics

On the Shoofly - October 2022

If you're already enrolled in Medicare, a window for making changes in your plan closes December 7.  Find out your options and also: What you need to know if you're approaching age 65 and aren't enrolled yet. 

- by Kristine Gurley, Gurley & Associates
(this is a reprint of an article which originally ran in The Shoofly Magazine in October, 2019.)

​I’ve been working in the insurance industry for 18 years and as a Medicare specialist for 14 of those. Now through December 7 will be a busy time of year for us at Gurley & Associates. It’s called the Medicare Annual Election Period.

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If you’re already on Medicare and want to make changes to your current plan, you must do it during that window of time. Any changes you make will take place on January 1, 2023.
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To help you determine if you want to make changes, let’s review the Medicare system and how it works. 

What is Medicare?

•  National health insurance program for people 65+
• Administered by the Centers for Medicare and Medicaid Services (CMS)
• Enrollment through the Social Security Administration (SSA)

​​Everyone over age 65 is eligible for Medicare. This includes all U.S. citizens and legal residents who have lived in the U.S. continuously for at least five years. Some people under 65 can get Medicare if they receive Social Security disability benefits.
Medicare is divided into four parts:

• Part A covers part of the costs of hospitalizations.
• Part B covers part of the costs of medical services, such as doctor visits, procedures and diagnostic tests.

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​Parts C and D are where the private insurance comes in:

• Part C is an alternative way to get Medicare. You can sign up for a Medicare Advantage plan offered by a private insurer and get all your services under Parts A and B through the plan. They have a lower premium, but have co-pays. Some offer benefits like free health club memberships, dental, vision, etc. A Medicare Advantage plan with prescription drug coverage is called a MAPD and without the prescription coverage is called a MA.
• Part D is prescription drug coverage. It is offered by private insurers who contract with Medicare. Even if you don't take any prescription drugs when you first go onto Medicare, if you’re not signed up for a Medicare Advantage plan with prescription drug coverage (MAPD), you'll want to sign up for a Part D drug plan. If you go without any drug coverage after your initial election period you'll face a penalty when you finally do enroll. Note: The penalty does not go away and will be attached to your plan premium.

 
Medicare Enrollment
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• Unless you are covered by an employer group plan that covers 20 or more employees, you must enroll in Medicare when you turn 65.

• If you are receiving Social Security when you turn 65, you will automatically be enrolled in Parts A and B.
• If you're working and covered by an employer group plan you may not want Part B. In that case you can decline it. Otherwise, you'll go ahead and accept Medicare Parts A and B, and your coverage will start on the first day of the month you turn 65.
• For people who aren't covered by a group plan at 65, the initial Medicare enrollment period starts three months before you turn 65 and lasts until three months after you turn 65. But although it lasts a total of seven months, you really should plan to enroll in Medicare during that three-month period before you turn 65. Then your Medicare coverage will start on the first day of the month you turn 65.

 

 
How to Sign up for A & B

• Go to www.ssa.gov.
• Call Social Security at 800-772-1213.
• For general information about eligibility, go to http://www.medicare.gov/MedicareEligibility

 
Parts C and D are not automatic.
 
If you want Part C (a Medicare Advantage plan that takes care of both A & B through a private insurer), you'll have to contact an insurance company offering it and sign up for Part C through them. Remember, you can get a Medicare Advantage plan that covers prescription drugs (MAPD) or one without (MA).
 
Or, if you want to stay with Original Medicare and have a standalone Part D (prescription drug plan), you'll need to decide which insurance company's plan you want to go with, and you'll have to proactively enroll.

 
If you signed up for Parts A and B during your initial enrollment period, and if you think at some point in your life you’ll need prescription drug coverage, you should enroll in Part D at the same time. If you go more than 63 days without "creditable" prescription drug coverage, you will pay a late enrollment penalty when you finally do sign up for Part D.
 
So, it's better to just go ahead and get your drug coverage from the outset, even if you aren't currently taking any prescription drugs. As mentioned before, you have two options: you can enroll in a standalone prescription drug plan if you have Original Medicare, or you can get your drug coverage through a Medicare Advantage plan.
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I hope this helps clarify some common misconceptions. Please feel free to contact our office with any questions. 

​Kristine Gurley