Question:

How do I enroll in Medicare?

Answer:

You’ll be automatically enrolled in Medicare when you turn 65 if you’re already receiving Social Security benefits, or when you apply for Social Security benefits at age 65. In either case, the Social Security Administration will notify you that you’re being enrolled.

Although there’s no cost to enroll in Medicare Part A (Hospital Insurance), you’ll pay a premium to enroll in Medicare Part B (Medical Insurance). If you’ve been automatically enrolled in Part B, you’ll be notified that you have a certain amount of time after your enrollment date to decline coverage. Even if you decide not to enroll in Medicare Part B during the initial enrollment period, you can enroll later during the annual general enrollment period that runs from January 1 to March 31 each year. However, you may pay a slightly higher premium as a result.

If you decide to postpone applying for Social Security past your 65th birthday, you can still enroll in Medicare when you turn 65. The Social Security Administration suggests that you call (800) 772-1213 three months before you turn 65 to discuss your options. You can apply by visiting your local Social Security office. If you are unable to visit your local office, you may be able to enroll over the phone.

If I delay receiving Social Security benefits, should I stillsign up for Medicare at age 65?

Answer:

 

Even if you plan on waiting until full retirement age or later to take your Social Security retirement benefits, make sure to sign up for Medicare. If you’re 65 or older and aren’t yet receiving Social Security benefits, you won’t be automatically enrolled in Medicare Parts A and B. You can sign up for Medicare when you first become eligible during your seven-month Initial Enrollment Period. This period begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.

The Social Security Administration recommends contacting them to sign up three months before you reach age 65, because signing up early helps you avoid a delay in coverage. For your Medicare coverage to begin during the month you turn 65, you must sign up during the first three months before the month you turn 65 (the day your coverage will start depends on your birthday). If you enroll later, the start date of your coverage will be delayed. If you don’t enroll during your Initial Enrollment Period, you may pay a higher premium for Part B coverage later.

Will Medicare alone be enough to cover my health-care needs in retirement?

Answer:

No. Medicare coverage comes with deductibles and significant co-payments or coinsurance costs for many types of treatments, including hospitalizations. Typically, the deductible amounts are increased each year.

If you’re not prepared to pay these expenses out of pocket, you may want to consider a Medigap policy (a supplemental medical insurance policy). Medigap insurance policies are sold by private health insurers. These policies are standardized and regulated by both state and federal law.

There are 10 standard Medigap plans, although not all are available in all states. These plans cover certain specified services, but offer different combinations of coverages. Some cover all or part of your Medicare deductibles, co-payments, or coinsurance costs.

If you’re covered by an employer-sponsored health plan in retirement, you may not need to purchase Medigap insurance. In this case, your primary insurance coverage continues to be your employer’s health plan; for eligible unpaid expenses, Medicare would provide secondary coverage.

What is Medigap?

Answer:

Medigap is health insurance that supplements the benefits covered under Medicare. It also fills in some of the gaps left by Medicare, such as your deductible and coinsurance contributions. Medigap policies are sold by private insurance companies, and must be clearly identified as “Medicare Supplemental Insurance.” Currently, 10 standardized plans are available (Plans A-D, Plans F and G, and Plans K-N) (except in Massachusetts, Minnesota, and Wisconsin, which have their own standardized plans). Each provides a different level of coverage, but not all plans are available in all states.

Plan A covers the following basic benefits:

  • Part A coinsurance costs up to 365 extra days of hospital care once Medicare benefits are used up
  • Part B coinsurance or co-payment
  • The first three pints of blood you may need in a year (Medicare pays for any additional blood)
  • Part A hospice care coinsurance or co-payment

Other plans cover the same basic benefits, plus some extra benefits that include different combinations of the following:

  • Coverage of your Part A deductible
  • Coverage of your Part B deductible
  • Coverage of the daily co-payment requirement for skilled nursing care
  • Medically necessary emergency care needed during the first two months of a trip outside the United States
  • Medicare Part B excess charges (i.e., the difference between your doctor’s fee and Medicare’s allowance)
  • Medicare preventive care Part B coinsurance costs

Two plans, Plans K and L may have lower premium costs than other Medigap plans because they require you to pay a portion of Part B coinsurance or co-payment costs, and Part A deductible and hospice care coinsurance or co-payment costs. However, they provide protection against catastrophic illnesses by limiting your annual out-of-pocket expenses.

Some of the benefits not covered by Medigap include long-term nursing home care, and vision and dental care. Medigap will follow Medicare in excluding what is unnecessary or experimental.

If you are covered by your former employer’s health insurance plan, you may not need Medigap.

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If I’m covered by Medicare, should I have additional health insurance?

Answer:

It’s wise to purchase health insurance to supplement your Medicare coverage, because Medicare generally won’t cover all of your medical expenses. Usually, you’ll have to satisfy a deductible before Medicare pays anything, and you’ll also pay a co-payment when you visit a physician or are admitted to the hospital.

Fortunately, you can buy supplemental insurance from private companies that will help you plug the gaps in your Medicare coverage. These Medigap plans are regulated and standardized by the federal government. There are 10 different kinds of plans, although your state may not offer all of them (and three states, Massachusetts, Minnesota, and Wisconsin, have their own standardized plans). If premium cost is a concern, you can purchase lower-cost Medigap plans that only partially cover Medicare deductibles, co-payments and coinsurance costs. Conversely, if you want extensive coverage and don’t mind paying more for it, you can purchase a Medigap plan that covers most of the deductibles, co-payments, and extra charges associated with Medicare. You can compare plans at the Health Care Financing Administration’s website (www.medicare.gov).

Whatever plan you choose, you have the right to cancel it within a certain amount of time (usually 30 days, sometimes longer) if you don’t like the policy after you buy it. In addition, the policy must be guaranteed renewable and cannot duplicate existing coverage, including Medicare.

Another way to supplement Medicare is to keep in effect any employer-sponsored health-care insurance you have. Depending on the type of coverage you have, and whether you’re retired, one plan will pay your health-care costs first, and the other plan will cover some or all of the remaining costs. To make sure claims are properly paid, let your health provider know when you have health insurance in addition to Medicare.