For people who are soon turning 65 – and for those 65 and older – fall is a critical time to make decisions about healthcare and to enroll for Medicare health benefits. 

The decision is not as simple as it may seem. There are quite a few options, and understanding the differences can be confusing. However, it is important to learn what these Medicare plans cover, what they don’t, which providers are included, and which are not. Also, knowing when to apply and when to enroll is critical for selecting the best option. 

About Medicare 

Medicare was created in 1965. It is a federal health insurance program administered by the Centers for Medicare and Medicaid Services, which covers people who are 65 and older. People who are disabled or diagnosed with end stage renal disease can be covered at any age. More than 60 million Americans are currently enrolled and covered by a Medicare health plan.

People may begin signing up for Medicare three months before their 65th birthday or up to three months following their birthday month. Medicare strictly adheres to this timetable, and no notice or alert will arrive in the mail. Missing the deadline could result in paying higher premiums.

Medicare Options

Part A (Hospital Insurance) covers inpatient care in hospitals, skilled nursing facilities, and some home health and hospice care. It does not cover long term care. The is no monthly premium for Part A for most people. 

Part B (Medical Insurance) covers doctor services and outpatient care. It also covers other medical services not covered by Part A. There is a monthly premium for 2019, but may be less based on income. Late enrollees may pay a 10% penalty for each year of delay.

Part C (Medicare Advantage) offers both Part A and Part B coverage through private companies. Plans could include HMOs, PPOs, and private fee-for-service arrangements. Some offer prescription drug coverage, too.

Part D (Prescription Drug) Prescription drugs are covered through private companies that contract with Medicare. While there is an average monthly premium, all plans have a different cost structure and formulary.

Considerations

This list is not meant to include all options, and there are still many factors to consider. Here are a few:

• Medicare does not typically cover medical care if you’re traveling out of the country.

• Depending on the plan you select, Medicare Advantage may only cover in-network providers, and may charge more or not pay for any for out-of-network providers.

• Medicare Advantage and Medicare Supplement are different. A Medicare Supplement is a private insurance policy that can help pay for some of the health care costs that Medicare does not cover.  

• For people already covered by Medicare, switching between Medicare Advantage and Medicare Supplement plans is not always guaranteed. 

How to Enroll

The open enrollment period for Medicare is coming soon. It begins on Oct. 15 and will end on Dec. 7. During this time, Medicare enrollees must make their Medicare coverage choices for 2020. Enroll online at Social Security, by calling Social Security, or in-person at a local Social Security office. 

Learn more and hear from a trusted expert at the next Redefine Retirement event, Get Covered: Understanding & Enrolling in Medicare featuring Mary Leep-Pichert, a community liaison with the Ohio Senior Health Insurance Information Program. OSHIIP is part of the Ohio Department of Insurance. 

Leep-Pichert will share the basics of Medicare benefits and how to benefit from them. She will also share who can apply for Medicare as well as how and when to enroll. For those already enrolled in Medicare, Leep-Pichert will offer some tips to help manage benefits and maximize existing plans.

The Redefine Retirement series is a partnership and is sponsored by AgeWell Cincinnati. The event, Redefine Retirement: Get Covered! is sponsored by Cedar Village.

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