Medicare is the federal health insurance program for people who are 65 or older, some people under age 65 who have disabilities, and people with End-Stage Renal Disease

You will likely start getting mailed information at least a full year before your 65th birthday. Although it’s wise to start planning and budgeting for this transition early, you don’t really need to do anything until about 6 months prior to your birth month.

• 12 months prior – Start to consider whether Medicare is the right choice for you (if you’re on an employer-sponsored plan). We can help you with that decision, just contact us and get a copy of your current employee benefits book from your employer.
• 6 months prior – If not receiving Social Security, you’ll want to apply for Medicare Part A and Part B, either online or at your local Social Security office. Start reading your Medicare & You handbook, and start asking questions! We are happy to meet with you to explain how Medicare works in a free consultation.
• 3 months prior – Once you receive your Medicare card, we can finalize your enrollment decisions and get you set up with the plan that’s best for you and your budget.
• Medicare eligibility! – Assuming your application is submitted within the 3 months prior to your Medicare Eligibility month, your Medicare coverage will begin the 1st of the month.

• Original Medicare covers hospital, outpatient services, and preventive care
• Medicare Advantage plans may also cover prescription drugs, dental, vision, and hearing.
• A prescription drug plan should be added to your Original Medicare

Original Medicare

Part A – Hospital

In general, Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care (does not cover custodial or long-term care)

Part B – Outpatient

In general, Medicare Part B covers outpatient services. This includes services and supplies to diagnose or treat a medical condition, as well as preventive services. This also includes ambulance, mental health, and DME.

Original Medicare covers, on average, about 80% of your medical costs. You are responsible for the other 20%. That’s where the additional plans come in.

Other costs

Part D – Prescription Drugs
Part C – Medicare Advantage
Medicare Supplement (Plans C, D, F, G, N, etc)

• Medicare Supplements help to take on the “other 20%” that Original Medicare doesn’t cover. Each Medicare Supplement has slightly different coverage, which does affect how much you pay for the monthly premium.
• Plans C and F are only available to Medicare members who were first eligible for Medicare parts A and B prior to January 1, 2020.

What’s NOT covered?

Medicare generally does not cover long term or custodial care, dental care, dentures, eye exams for prescribing glasses, cosmetic surgery, acupuncture, hearing aids or fittings, or routine foot care

Visit Medicare.gov to find out if Medicare covers something you need. Some of the extra plans (Advantage or Supplement) help pay for some of those items not generally covered by Medicare.

Technically speaking, you probably can stay on your employer’s plan. However there are many things to consider before deciding to stay on your employer’s plan. Some of the questions that go into this decision are:

• Is my employer plan creditable?
• Do I want to continue contributing to my HSA?
• How much does my employer plan cost me each month?
• What are my out of pocket costs on my employer plan vs on Medicare?

The best way to decide this is to speak with a Medicare expert. That’s where we come in! Call us for a free consultation on your options.

Current legislation does not allow you to contribute to your HSA unless you’re on an HSA-qualified plan. Medicare is not HSA-qualified, and once you have Medicare Part A, you’re considered not eligible to contribute to your HSA. However, the funds that you’ve already saved can still be used for your medical expenses, and in some situations you may be able to pull your HSA funds for other things (without paying a penalty, though you may have to pay tax).

If you’re on employer-sponsored coverage and elect to not enroll in Part A when you first become eligible, be careful when you apply. Once you apply for Part A, it will be backdated to be effective by 6 months, but not earlier than your 65th birth month.

As of March 2020, we have heard some rumblings in national legislation to change this, however at the moment the rules have not changed.

www.medicare.gov is a great resource to find out more information

We are here for you! Finding a local expert can make the transition much easier and simplify the process.