Navigating Medicare....................... Christine A. Smyczynski

Navigating Medicare

What you need to know before you turn sixty-five

BY CHRISTINE A. SMYCZYNSKI

Shortly after I turned sixty-four, mail started pouring in from a variety of organizations offering to answer questions regarding Medicare. However, as I perused the various brochures, I felt confused. What exactly are parts A, B, C, and D, what does each part offer, and what do I really need?

What exactly is Medicare?

Medicare is a federal governmentrun health insurance program for US citizens and permanent legal residents aged sixty-five and older; some younger people with disabilities can also be covered. Medicare is not Social Security, which is a whole separate program, although you can apply for Social Security and Medicare at the same time. Be aware that while you can defer applying for Social Security, Medicare applicants who are older than sixty-five may be subject to a late enrollment penalty.

Lots of decisions to make

Situational variables determine which of a variety of plans you should choose. It all depends on what coverage you require for your medical needs and how much you are willing to pay each month as a premium. For example, my husband’s retirement benefits include continuing health insurance coverage and a prescription plan so when we applied for Medicare, we only needed original Medicare, which is Part A and Part B. Part A covers inpatient hospitalization, skilled nursing, and hospice/home care, while Part B covers outpatient services, doctor service, home health care, outpatient hospital services, some preventative services and durable medical equipment. Almost everyone is required to have Part A and B.

Medicare Parts C and D are additional plans offered by insurance companies such as Blue Cross Blue Shield, Univera, and Independent Health etc.—the reason for all those mailings. Medicare Part C, referred to as Medicare Advantage Plans, combines A and B and also usually includes a prescription plan and may offer additional benefits such as dental and vision. Medicare Part D is a prescription drug plan. You can also get supplemental policies (Medigap) to cover out of pocket copays, coinsurance, and deductible expenses.

Do your research

It doesn’t hurt to research well in advance of turning sixty-five to figure out which plans make the most sense for your health care needs. Last year, I attended a Medicare Informational session for people aged sixty-four that was offered through Williamsville Community Education; I’m sure other school districts also offer similar sessions. My husband and I also listened to an online webinar offered by our health insurance company. Many of those mailings you will be receiving advertise either in person or online informational sessions on the ins and outs of Medicare. However, keep in mind that the goal of most of these sessions is to sell you their particular insurance. I found it helpful to keep copies of the advertising flyers and notes from the courses I attended in a small briefcase, along with a copy of the Medicare application I filled out online, so that all my information was in one place.

Signing up

I was apprehensive about signing up for Medicare, as I was under the impression that it would be a long, drawn-out process. I was pleasantly surprised that in my case, it was simple and easy using the online Medicare application found on the Social Security Administration’s website (ssa.gov) The website has helpful information and checklists,

so you might want to visit before applying for Medicare. If you don’t wish to fill out your application online, you can call Social Security at 800-772-1213 to find a local office and schedule an in-person appointment.

Once you complete the online application, you will get an email confirmation; about a week later, you will receive a mailing confirming that you are enrolled. You will be billed for your first three month of coverage initially; after that you will be billed monthly (this is for Part B; there is no monthly premium for Part A). I opted for automatic bank payments so I wouldn’t have to write a monthly check. You will receive your Medicare card in the mail about a month prior to it taking effect.

Note that Medicare will not send you alerts to enroll as you approach your sixty-fifth birthday; you are on your own to start the enrollment process unless you are already receiving Social Security. There is a designated enrollment period. For first timers, you have seven months—three months prior to your birth month, your birth month, and three months after your birth month. I recommend doing it sooner rather than later. Once you are on Medicare, there is an open enrollment period each year between October 15 and December 7; you can make changes to your plan during this time. FY

Christine A. Smyczynski is the author of several travel guides about western New York and New York State. In addition, she has written hundreds of articles on a variety of topics for local, regional, and national publications.