The Who, What & When of MEDICARE

Contributed by Emily Hanson, Hanson Insurance • http://www.hansonfirst.com • 512-817-6906

Medicare is a federal health insurance program for eligible U.S. citizens and legal residents that is funded in part by taxes you pay while working. It is an individual health insurance that, without help, can be very difficult to navigate. Following are answers to the most common questions I receive:

Q Do you have to be 65 to get Medicare?

A. Typically, yes. However, those under 65 with a qualifying disability, ESRD, or ALS are also entitled to Medicare.

Q Is Medicare enrollment automatic at 65?

A. 1) If you are receiving Social Security Retirement benefits at the time of enrollment, you will be automatically enrolled in parts A (hospital) and B (medical) of Medicare. In this scenario, you will receive your Medicare card in the mail, without initiating it, 3 to 4 months before your 65th birthday. 2) If you are NOT receiving Social Security Retirement benefits when you turn 65 you will need to initiate your enrollment as you will NOT be enrolled automatically.

Q I do not get Social Security Retirement benefits yet. When do I need to sign up for Medicare?

A. Your initial enrollment period is the 7-month window around your 65th birthday; 3 months before, the month of and 3 months after. If you miss this 7-month time frame you will be required to wait until January - March of the following calendar year for your next opportunity, unless you qualify for a Special Enrollment Period.

Q What are the Medicare penalties I’ve heard about?

A. If you do not sign up during your Initial Enrollment Period, and you do not have creditable coverage (as good or better than Medicare), you will incur penalties for part B at 10 percent per year and for part D (prescription coverage) at 1 percent per month. Once assessed, these penalties will be added to your monthly premiums for the rest of your life!

Q I’m still working, do I have to sign up for Medicare?

A. It depends on your situation. If your group plan has 20 or fewer employees, you may be required to have Medicare to pay primary coverage while your employer plan becomes secondary. Plans with 21 or more employee plans typically pay primary, and if you enroll in Medicare, it will pay secondary. Be sure to ask for clarification.

Q Do I have to stay on my group plan when I turn 65?

A. No. Once you are 65 you have the option of enrolling in Medicare and adding a Medigap Plan + Prescription Coverage or a Medicare Advantage Plan. It is always a good idea to consult a Medicare broker to compare your group coverage with one of these individual coverage options.

Q This is so confusing. How much does it cost to get help to figure all of this out?

A. Absolutely nothing! Medicare brokers are paid via 100 percent commission, which is paid by insurance companies, so there is no cost for you to receive our services. If you are asked to pay a fee for help provided, shop for another broker.