Your Introduction to the Medicare and You 2020 & 2021 Book, and where to get a copy.

The Medicare and You 2021 Guidebook details what you need to know about Medicare benefits for the current year. In it you will find the basics of Medicare, how to get it, and what changes the program is implementing in the calendar year.

However, it is 120 pages long and very detailed. It is also very dry and technical.

So, if you are trying to learn more about Medicare – without falling asleep in the process – we have on-topic website article suggestions for you here that follow the elements of the Medicare and You 2020 Guide.

Where to find the guide

• If you would like to follow along with the Guide itself, you can find it online here: Medicare & You Handbook 2021

• If you need a physical copy of the Medicare and You 2020 guide, you can request one here: 1-800-MEDICARE (1-800-633-4227)

What is included in the Medicare and You 2021 Guidebook?

Here we will outline the sections of the guidebook and give you relevant articles that discuss the various Medicare elements and benefits.

What are the Parts of Medicare?

Intro Section (page 5)

The Medicare and You book starts out with summarizing parts A, B, and D and what they include.

• Medicare Part A – Hospital Insurance
• Part B – Medicare Insurance
• Part D – Drug Coverage

Medicare Part C is discussed in the next section.

Related Article: For an illustrated overview of the four parts of Medicare, visit our medicare parts infographic and article “Medicare Parts A B C D.”

What are my Medicare options?

Intro Section on Original vs Medicare Advantage (pages 6-8)

Many online comparisons are between Medicare Supplements and Medicare Advantage plans as those are the additions that are in your hands to choose.

However, all these comparisons are in their simplest form between having Original Medicare vs Medicare Advantage. This section does a side-by-side comparison of the two (with or without a supplement).

Related Article: For a more in-depth discussion to help you decide what Medicare options are right for you, please read the “Medicare Advantage vs Medicare Supplements” article here.

How do I get Medicare?

“Section 1: Signing up for Medicare” (pages 15-24)

People get Medicare in different ways. Some are signed-up for it automatically if you are already receiving Social Security or Railroad Retirement. Some people must sign up for it when they turn 65 (or delay it if they are not ready at 65).

This section gives you people to call (Social Security at 1-800-772-1213) and places to visit (online at ssa.gov/benefits/medicare) if you need to sign yourself up.

Other topics covered include, when to sign-up, what to sign-up for, and what does each part cost?

Related Articles:

• Read this article to discover what Medicare will cost you.
• Also, read this article to learn more about any Medicare Late Fees and Penalties.
• If you need help in deciding what to sign-up for, we suggest this article on speaking with a licensed insurance professional.
• Finally, if you want to learn more about the Annual Enrollment Period, please see this article.

Hey, Medicare and You 2021, Will Medicare Cover My…?

“Section 2: Find out if Medicare covers your test, service or item” (pages 25-50)

This section lists all Medicare Benefits you will receive if you are signed-up for both Medicare Parts A and B. These benefits are universal, meaning they are the standards of care you will receive whether you are receiving Medicare from the federal government or through a private carrier with a Medicare Advantage Plan.

If you are looking to see if a specific benefit is included in Medicare, this is the section to search for it.

This section also reminds you of what is not included in Medicare, such as Long-Term Care insurance. In addition, Original Medicare does NOT include many services that ARE covered by Medicare Advantage Plans. These include dental care, eye exams, hearing benefits, and fitness programs.

2020 New Offering Alert: One interesting change noted in the Medicare and You 2020 book is that many Medicare Advantage programs are now offering “telehealth” benefits where you can see a provider at home instead of at their facility. The guidebook notes that this is typically beyond what Original Medicare can offer.

Related Article: To see the basics of what Medicare Covers, please see our article “Medicare Parts A B C D.”

What exactly is Original Medicare?

“Section 3: Original Medicare” (pages 51-54)

The Original Medicare section explains how our Federal Health Insurance for Seniors works. If you have Original Medicare, with or without a supplement, you are a beneficiary of a nationalized health care system and the government is the primary payer of your health benefits.

Read this section to learn how that works and how to use your benefits once you are on Medicare.

Related Article: Read “What is Medicare?“

What is Medicare Advantage?

“Section 4: Medicare Advantage Plans & other options”

The other option than being on Original Medicare is to be on a Medicare Advantage Plan. In this case, a private insurance company becomes your primary payer and main contact. Medicare Advantage (MA/MAPD) Plans are called “bundled plans” because they combine parts A, B and D to form one “Plan C.”

They often have reduced costs for premium payments, with some of them even offering “$0” monthly premiums. In addition, they often include extra benefits, not included by government Medicare, such as dental, hearing and eye care. ““Silver Sneakers” and similar fitness/wellness programs are also often an included benefit.

Related Articles:

• To read more: “What is Medicare Advantage?”
• Plus, to read about when you can join an MA/MAPD plan, please read here about AEP.
• Finally, if you would like to compare Original Medicare + Medigap and MA, please read this.

What is a Medicare Supplement / Medigap Plan?

“Section 5: Medicare Supplement Insurance (Medigap) policies” (pages 69-72)

When you opt for keeping Original Medicare (instead of a Medicare Advantage Plan) you will most likely want to pair that with not just a stand-alone drug plan, but also with a Medigap Plan. These plans are also called Medicare Supplement Plans.

They are supplemental insurance plans that pick up paying where Original Medicare leaves off – such as with the 20% coinsurance, co-pays and deductibles.

The government sets the requirements for each supplement plan and then the private insurance companies decide what price they can offer for each plan in each market they are in. These plans are labeled with letters, and offer the exact same benefits no matter what private insurance company you choose.

Related Article: For more information, please read this article on Medicare Supplement Insurance.

What is Part D?

“Section 6: Medicare Prescription Drug Coverage (Part D)” (pages 73-82)

Read this section to learn how Medicare Drug Plans work, where to get one, and when you can get one / switch them.

Remember, that if you opt for a Medicare Advantage Plan, you will most likely have your drug plan included (which is called a MAPD plan).

Related Articles:

• Please visit this article on Part D Prescription Drug Insurance.
• Or to learn about the various costs, click here.
• Finally, if you are worried about Part D late enrollment penalties, please read this.

Can I get help paying for medical costs?

“Section 7: Get help paying your health & prescription drug costs” (pages 83-88)

The government has set up several ways for Medicare Beneficiaries to get help in paying for their health insurance. Read this section to see if you qualify for the various tiers of assistance.

How can I protect myself?

“Section 8: Know your rights & protect yourself from fraud” (pages 89-100)

The U.S. government understands that health insurance can be confusing, and there are people out there that will try to take advantage of this confusion. Read this section to know how to protect yourself from health care and insurance fraud.

In addition, Section 8 also explains your rights under Medicare and how to make an appeal if you decide your rights have been violated. The Medicare and You 2020 book defines an appeal as “…the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan.”

How do I get my questions answered?

“Section 9: Get more information” (pages 101-112)

Next, if you have questions related to Original Medicare, the handbook offers you the following numbers to call:

1-800-MEDICARE (1-800-633-4227)
TTY users call 1-877-486-2048
Get information 24 hours a day, including weekends

Medicare and You 2021

Additionally, for questions regarding insurance plans like Supplement (Medigap) or Medicare Advantage (MA/MAPD) then we suggested talking to a licensed insurance professional.

If you are lucky enough to live in our headquarters of Nebraska or our neighboring state of Iowa, you can contact us here.

Related Article: Please see our Frequently Asked Questions page, and if you have a question, please leave it in the comments section or email us. Thanks!

What does this word mean?

“Section 10: Definitions” (pages 113-116)

Do you just live to read a good glossary? Well, here you go. You will find here definitions to all the health care and insurance lingo you need to know to navigate your health care effectively.

Related Article: Feel free to look through all our Medicare Articles. They are all listed on this page.

Medicare and You 2020/2021 Handbook Review

We hope our review of the 2020 & 2021 Medicare and You Book has been helpful.

Our one hope for next year is that the book might be more helpful in pointing beneficiaries towards ways to find LICENSED independent insurance professionals that can help them in making decisions. These agents are the only ones required to stay licensed, tested and up to date on the plans that are out there. Moreover, this applies especially for the Medicare Advantage approved agents as they have to be re-tested every year on changes.

Finally, we are MedicareLifeHealth.com just don’t understand how people can be offering advice on plans – that change yearly – they have not be certified to explain.

Our advice? Find yourself a good agent, and make them work for you.

Further Medicare and You 2021 Topic Relevant Reading

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Best Hearing Aid Alternatives

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What is MAPD? There are a lot of acronyms in Medicare, and even more in insurance. We know, it can ...

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The post Medicare and You 2020 & 2021 appeared first on Medicare Life Health.

Medicare costs can be different person to person, depending on which type of plan you choose. After you have a basic understanding of Medicare and it’s basic components, you will want to know how much does Medicare cost? The answer is, it depends on how you structure it. Let’s break down what you could be paying.

Medicare Costs Broken Down & Made Simple

When you set up your Medicare, you will decide if:

• You just want Original Medicare (Parts A & B) and a Prescription Drug Plan (Part D).
• You want Original Medicare plus a Medigap Plan (Aka a Medicare Supplement) and a Prescription Drug Plan.
• Or you want a Medicare Advantage Plan (Part C) that may or may not include a Prescription Drug Plan.

Your costs will also be different if you get help in any way from any state or federal programs.

How Much Original Medicare Costs

• Medicare Part A – For most people, there is not a cost or premium you pay for Part A. Your Part A is premium free if you worked in the US and paid Medicare taxes for at least 30 quarters. (You will pay up to $471 a month depending on your work history for Part A if you do not meet the premium free requirements in 2021).
  • There is also a $1,484 yearly deductible for Part A services and coinsurance tiers on hospital stays.
• Medicare Part B – You will pay a premium for Part B. In 2021, the standard premium is $148.50 per month. If you make more than $85,000 a year in retirement, you will pay more on an income dependent scale.
  • There is also a $1203 Part B deductible and a 20% coinsurance (co-pay) for most approved services.
  • Late penalties may also apply to Part B (and less commonly, Part A) if you do not sign-up when you are first eligible.

How Much Prescription Drug Costs

Medicare Part D – Prescription Drug Coverage needs to be obtained from a private insurance company. Each company will price their service differently and you can shop for the best plan and price for you. In addition, you will pay more for your Part D coverage, on a sliding scale, if you make more than $85,000 a year while on Medicare.

• Other costs to consider with your Part D coverage are co-pays and coinsurance, in addition to deductibles.

• Click here to learn about “What is the Medicare Donut Hole?“

• There are also late enrollment penalties associated with not signing up for Part D coverage when you are first eligible if you do not have “credible coverage.”

How Much Medicare Supplements or Medicare Advantage Plans Cost

On top of your Original Medicare, you will need to make a decision to either participate in a Medicare Advantage (Part C) plan or to consider having a Medigap (Medicare Supplement) Plan. If you need help deciding on which one is best for your needs, please read our article on Medicare Advantage Vs. Medicare Supplements.

• Medicare Supplement Plan Costs – Medicare Supplements will each have a different cost depending on the Letter Plan you choose and the company you go with. The government decides what benefits are offered by each letter plan. Then, each private insurance company decides what price they can offer for each plan in each market. It is a good idea to compare multiple plans by multiple carriers (insurance companies) in your area before choosing a plan. An independent insurance agent will be able to help you do this.
• Here are a Few Medigap Articles to tell you more:
  • What is Medicare Plan F?
  • Is Medicare Plan F Going Away?
    
• Medicare Advantage (MA/MAPD) Costs – Part C, or Medicare Advantage Plans are also offered by private insurance companies and stand in place of Original Medicare. In addition, they often include Part D Prescription Drug Coverage. Some of these plans have low or zero premium plan options. A few even cover Part B premiums. All of them are required to have max out of pocket expenditures and deductibles. It is a good idea to talk to an independent insurance agent on MAPD plans in your area to help you choose your best option.

Coverage Questions

If you are considering a specific procedure, you many have questions about what Medicare covers, and what costs are associated with each service or procedure. Here are a few health care costs to consider in regards to how Medicare will cover them:

• Ambulance Rides

• Chiropractic Care

• Acupuncture

• Dentures

• Cataracts

• Rehab

Medicare Costs Summary

In summary, Medicare will cost you something, unless you are on full benefits from Medicaid. Moreover, you have already been paying into the Medicare system during your working career with Medicare taxes. Common set-up for Medicare beneficiaries include:

• Having Original Medicare, Part A Premium Free, Part B Premium at $135.50 /month and a stand alone Part D Premium to pay. Then, adding on a Supplement Plan to cover the expenses Original Medicare does not pay.
• Or having a Part C Medicare Advantage Plan that includes a drug plan with a premium to pay (sometimes a $0 premium). Most commonly, you will still pay your Part B premium with Medicare Advantage.

Get More Help Understanding How Much Medicare will Cost You

One good resource for learning more about the costs of Medicare is the Medicare and You Book published by the government every year. It is a large book, so please star with our Medicare and You User’s Guide to learn what it offers and to get a copy if you need one.

In addition, finding the best Medicare options for your budget can be a lot to take on, but hopefully this breakdown is helpful. I strongly suggest talking to a professional to help you in setting up your Medicare plan. As an independent agent myself, I suggest using an independent agent. They are not tied to one company, so they work for you, not one carrier and can help you in considering many different carriers and plans.

As always, if you live in Nebraska or Iowa, please give me a call, and I can help you out either in person or over the phone.

Carly Cummings, NE/IA Licensed Independent Insurance Agent for Life and Health.

The post How Much Does Medicare Cost? appeared first on Medicare Life Health.

I am a firm believer that there is a good Medicare health plan out there for everyone. Moreover, there might even be more than one good choice out there for your situation. If there is more than one good choice available to you, you might be weighing your options right now – Medicare Advantage vs Medicare Supplement.

First, Let’s review your Medicare options:

Original Medicare (no supplement)

Certainly, stand-alone Medicare coverage is an option. You would still want to get Part D Prescription coverage. (There are penalties down the road if you do not get Part D or have credible coverage already and then want to get it later.) However, you would then be left paying your deductibles and 20% coinsurance out-of-pocket.

For example, with ONLY Original Medicare and NO supplement or MA plan, if you ended up having a major health event like a surgery, the 20% left that medicare doesn’t pay could still be thousands of dollars.

You would also have to go through medical underwriting with a private insurance carrier if you later want a supplement and you have missed your Guaranteed Issue time frame. You can always join a MA plan later, but only during a special enrollment period or during the Annual Enrollment Period (Oct. 15 – Dec. 7).

Original Medicare with a Supplement

With this option, you keep Original Medicare and add on a Supplement (Medigap) Policy with a private insurance company to help you in paying the pieces that Medicare does not. These costs can become large if you have a big medical event or a chronic illness. In this instance, a Supplement would protect you from “losing the shirt off your back”! You would also have a stand-alone Part D Prescription Drug Plan (or a plan that is considered “credible coverage”).

Medicare Advantage (MA/MAPD)

Finally, with a MA/MAPD plan you would replace Original Medicare with a bundled plan offered by a private insurance company. These often include a Prescription Drug Plan. (These are called MAPD plans, which are most the common plans). You still “have Medicare” with these plans. However, they are run by private companies who put together networks of providers and health facilities. (For example, HMO, PPO and PFFS networks.)

One question we hear a lot is, “can I have both Medicare Advantage and a Medicare Supplement?” No, you have one or the other. Not both, they do not work together and it is illegal for anyone to sell you both.

What are the Differences Between having a Supplement (Medigap) and having Medicare Advantage (MA/MAPD)?

Now, let’s do a breakdown of Medicare Advantage vs. Medicare Supplements. First, let’s look at the difference in care and the differences in cost. We are assuming you either have Medicare Advantage or Original Medicare with a Supplement (aka Medigap Plans).

Making Your Choice between Medicare Advantage vs Medicare Supplement

Now that you understand the basics of Medicare Advantage Plans and Original Medicare plus a Medigap (Supplement) Plan and know the significant differences between the two, it’s decision time.

First, I always recommend speaking with a licensed, independent agent that can help you in assessing all the various plan types available in your area. Every county has different options for MA/MAPD plans, and insurance carriers have different prices on the supplement plans you may be considering.

Second, it’s good to have an idea of what is important to you. You should be thinking specifically in regards to money and lifestyle when choosing a path.

Consider these questions when choosing between Medigap and MA Plans:

Do you plan on living in another place for a significant period of time during the year?

If you are a “snowbird” or are planning a longer vacation where a routine doctor visit may be necessary when away from your primary residence, then a supplement may be your best choice. Remember though, emergency / urgent care visits are covered with both types of plans.

However, if your travel happens to be international, Both Original Medicare and MA plans do not cover foreign travel, but some supplement plans (plans C, D, F, G, M & N) have 80% foreign travel exchange limits that will help off-set some costs.

What is (or will be) your cash flow situation in retirement?

Some retirees have pensions, social security and other payments (like annuities) that come to them automatically each month. Other retirees have less of these automatic infusions or smaller required distributions and prefer to leave as much of their cash in investments as possible. Finally, some retirees are on a smaller, fixed income. This might require them to consider cash flow very carefully.

In each situation, you will need to review how you are paying for your health services, as each plan offers different payment options.

Cash Flow with a Supplement:

With a supplement, you will have a set amount of money (that could be a larger sum than an MA plan) come out of your bank (and/or S.S./R.R. check) each month. This can add up when you consider it includes Part B premiums, Part D Prescription premiums, and your supplement premiums. However, if you chose a plan that covers everything Original Medicare leaves out, then you would not pay any other out-of-pocket fees for Medicare covered services.

Cash Flow with a MA/MAPD Plan:

With a Medicare Advantage plan, you will most likely have a smaller amount of money coming out of your wallet each month. You will most likely have an MAPD plan that includes your drug plan, as stand alone MA plans are becoming much more rare, and some plans even include Part B premiums. So, with a MAPD plan, you would be paying a MA premium and maybe your Part B premium each month. Moreover, there are sometimes zero dollar per month ($0/month) premium MA plans available. The costs then to consider and maybe budget for with MA plans is if there are any co-pays, co-insurances and deductibles with the plans. Each plan will be set-up differently, and each plan will also have a max yearly out-of-pocket limit.

Just like in any kind of insurance, Medicare plans are set-up to allow you to choose how much out-of-pocket expenses you incur versus monthly premiums you pay.

Looking at your budget and then talking through your options with a licensed agent will allow you to make the best choice for your situation.

How interested are you in extra benefits being included?

Finally, one more consideration is the other elements that round out your health insurance plan, such as dental, vision, hearing, etc. If you have a supplement plan, you will need to decide if you need these services, and if you do, are you wanting to take on insurance plans for them. You might decide to add on a stand-alone, or a plan that includes any or all of these common services (dental, vision, hearing).

Often times, Medicare Advantage plans will include these services as a part of their plan as an additional benefit which might save you money if you were planning on getting a stand alone plan or paying cash for these services.

Moreover, many MA plans will offer fitness or wellness services that are included at no additional cost. Sometimes this means you will not have to pay for a separate gym membership. Silver Sneakers is one example of a national program that is used by many MA plans to provide fitness and wellness services.

The Next Steps for Choosing Your Medicare Plan

As you can see, developing your Medicare Health Insurance Plan can be very involved, but I am confident you can do it! Having a professional to help you through the process is important. Please reach out to an independent insurance agent to review what is available in your area. They will be able to explain plans in specifics and answer your questions about Medicare Advantage vs Medicare Supplement.

Finally, Medicare.gov is also a good tool for answering your broader questions, and we also encourage you to comment on this page or contact us directly with any questions. Thanks!

Other Topics Related to Medicare Choices:

• Medicare Supplement Basics
• Medicare Advantage Basics
• Prescription Drug Plan Basics

The post Medicare Advantage vs Medicare Supplement appeared first on Medicare Life Health.

What are Medicare Supplements? First, Medicare Supplements have many names: Medigap Policies, Med Sup, Medicare Supplement Insurance. However, they all refer to the optional insurance coverage taken on by Original Medicare participants.

Medigap or Medicare Supplement coverage helps them in covering costs that the Medicare does not pay. For example, Medicare Part A leaves 20% of costs to participants as coinsurance. Co-pays or coinsurance is an out-of-pocket expense.

There is no penalty to not having a supplement. (Unlike not having a Medicare Part D Prescription Drug plans, which does have penalties down the road if not adopted right away.) However, most seniors will opt to have a Medicare Supplement Plan with Original Medicare. This is because, out-of-pocket expenses can get, well expensive, as we get older each year.

What are Medicare Supplements Letter Plans?

Next, let’s look at what a Medicare Supplement Policies cover.

The U.S. government standardizes Medicare Supplement Policies. (This means every insurance company will offer the same benefits for each plan.) In addition, the government differentiates each plan with Letters (i.e. Plan F, Plan G, etc.). They all cover a different combination of benefits including coinsurances, copayments and deductibles.

Notes on What are Medicare Supplements Letter Plans

• According to Medicare.gov, Plan F also offers a high-deductible plan where you pay for Medicare-covered costs up to the deductible amount of $2,300 before your Medigap plan pays anything.
• Note, with Plan N pays 100% of the Part B coinsurance, except copayments apply.
• Beginning January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. In addition, if you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.
• Finally, if You live in Massachusetts, Minnesota, or Wisconsin, plans are different, please visit this page.

What are the most popular plans?

Medicare Supplement Plans definitely have a few winners for the most popular category. First, for people that have turned 65 before January 1, 2020, Plan F has historically been the most popular. However, people that turn 65 on or after January 1, 2020, cannot get Plan F. As a result, Plan G is now gaining in popularity. You can read these articles to learn more:

• What is Medicare Plan F?
  
• What is Medicare Plan G?
  
• Is Medicare Plan F Going Away?

What Doesn’t a Medicare Supplement Policy Cover?

In addition to asking, What are medicare supplements? We also hear, the question – What doesn’t a Medicare Supplement Cover?

Typically, Medicare Supplements do not cover long-term care (nursing home), vision or dental, hearing aids, eyeglasses, or private nursing. If you are interested in Medicare Plans that offer these extra benefits, please read about Medicare Advantage Plans here.

How to Get a Medicare Supplement Policy

• First, you must age into Medicare and apply for Original Medicare. Learn how to apply here.

• Then, you have a window of time where you are guaranteed to be accepted into a Medigap Plan. We call this window your Medicare Supplement Open Enrollment Period (SEP).

• In addition, there are special enrollment times for retirees coming off of another plan. One example is if you are over 65, but still employed. In this instance, you would wait until you end your employee health plan to sign-up for Medicare and a Supplement.

• Finally, Open Enrollment guarantees private insurance company cannot decline your application during this time. This period starts “the first day of the month in which you’re 65 or older and enrolled in Part B” (Medicare.gov). (Note that some states may have additional Open Enrollment Periods as well).

Who can Help You with a Medigap Policy

You can compare these plans online, but I suggest you talk to a professional, independent insurance broker that can help you compare prices and help you understand each plan option. It won’t cost you any more money to use a professional, and Medicare is an ever-changing landscape that independent brokers can help you navigate.

Brokers work for you (not the carriers). As a result, you gain the valuable ability to communicate through them to insurance companies. In addition, your broker will keep you updated on any changes each year. This is something you do not get if you sign-up directly with a company online.

With government plan changes and carrier price changes, it makes sense to stay on top of things and to “shop” your supplements while you are still healthy enough to get through medical underwriting if you want to change policies or companies when you are not in an Open Enrollment. As an Independent agent myself, I make sure to stay on top of what my clients are paying and what the market has available so that my clients are always getting a good value with their supplements.

If you are in the state of Nebraska and you are looking for an agent to help you in any area of Medicare, Health or Life Insurance, please get in touch with me here.

Visit our FAQ’s for Other Topics Related to Medicare Supplements:

The post What are Medicare Supplements? appeared first on Medicare Life Health.

A Simple Guide to the Basics

Who is Eligible for Medicare?

You are eligible if:

• First, you are 65 years old or older.
• Second, you have End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant) at any age
• Finally, you are classified as disabled by the Federal Government, at any age.

When do I sign-up?

If you are mentioned in the above paragraph, you might be ready to sign-up. We are going to assume that you are in the senior category for simplicity’s sake. Turning 65 is the catalyst for many people to join the program, but if you are still working and covered by an employer’s program, you may opt to defer this start date. (Just remember to tell the government if you are opting to defer.)

Open enrollment starts 3 months before your 65^th birthday and ends 7 months after that start (so 3 months after your 65^th birthday month). If you do not have “credible coverage,” such as an employer plan, in place after this window, you could incur penalties from the government.

How do I Sign-up for Medicare?

• First, you may be automatically signed-up if you are already receiving Social Security (SS) or Railroad Retirement (RRB).
• Second, if you are not already receiving SS or RRB benefits, you must sign up for it when you turn 65 years old.
• Conversely, if you are not ready for Medicare when you turn 65, you must notify the government that you want to delay your benefits. If you do delay, it must be because you have credible coverage in place. An example of this would be an employer plan.

Where do I Sign-Up?

• BY PHONE: If you need to sign-up for Medicare, you can call Social Security at 1-800-772-1213.
• ONLINE: Additionally, you can also visit CMS online at ssa.gov/benefits/medicare if you need to sign yourself up.
• IN PERSON: Please read our article on How to Apply for Medicare to learn about the in person sign-up process including finding a location.
• RAILROAD: Finally, if you are on Railroad Retirement Benefits, you will need to notify the local Railroad Board (RRB) office before you turn 65 that you would like to sign-up for Medicare. You can sign-up 3 months before you turn 65 even if you are not planning on retiring at 65. You can read more about Railroad requirements in our article here.

Medicare Easy Pay Information can be found here.

What am I getting with Original Medicare?

Original Medicare, the national health care program sponsored by the US government, provides you with two points of coverage: Part A Hospital Insurance and Part B Medical Insurance.

In addition to these two basic parts, you have to option of adding on a Part D Prescription Drug Plan. These drug plans are not administered by the Federal government, but instead by private insurance companies, and you must sign-up for them individually.

The last part is Part C or Medicare Advantage. This is a second route you can take to manage your health care that replaces Original Medicare with a “bundled” program that rolls your Parts A, B and D all into one plan. These plans (also called MA or MAPD plans) are provided by private insurance companies. We will discuss how this works more after we look at the basic parts.

Let’s look at each part:

Part A

First, Part A, also known as “Hospital Insurance,” helps with coverage regarding:

• Inpatient care
• Skill nursing facility care
• Hospice care
• Home health care

Part B

Second, there is Part B, also known as “Medical Insurance.” Part B helps with coverage related to doctor and other provider services, including:

• Outpatient
• Home health
• Doctors
• Health care providers
• Durable medical equipment
• Prevention

What Part A & B Don’t Cover

When you visit the hospital, Part A pays for most of the costs associated with these services. In addition, your doctor and medical costs will mostly be covered by Part B. However, Part A and Part B do not pay for all of it. There are co-payments, coinsurance, or deductibles that may apply to covered services.

Typically, Medicare pays for about 80% of the costs. Most beneficiaries will supplement Original Medicare with either a Medigap plan or choose a Med Advantage Plan instead. Very few people just have the Original Parts A & B alone.

Finally, there is no part that covers Long-Term Care costs such as Nursing Home or Assisted Living Expenses. Skilled nursing, yes, but nursing homes no.

Next, there is a third part called…

Prescription Drug Coverage

Part D

Finally, you need Part D, also known as “Prescription Drug Coverage.” Private insurance companies provide Part D coverage rather than the government.

Consequently, if you decide not to take on Part D coverage right away, you might incur a penalty if you try to join later. This is if you do not have “credible coverage” (such as with an employer or union). Therefore, please make sure you are signed-up for a drug plan, not just Parts A and B. This is important if you ever suspect you will need this benefit in the future.

Part D plans are regulated by the US government and have many parts in common across the board, including the infamous “Donut Hole” in coverage. You can read more about that here.

The Two Paths of Coverage

You can be covered one of two ways: Original Medicare / Medicare Advantage.

Original Medicare

Medicare Advantage

Medicare Supplements vs Medicare Advantage

Not everyone will make the same choice on what plan is best for them. Both paths are good options and have many advantages. If you would like to read about the advantages and disadvantages to both, please read this article.

What is Open Enrollment?

Also called AEP – The Annual Enrollment Period is the time of year beneficiaries can make changes to their Medicare Advantage Plans and Part D Prescription Drug Plans. Conversely, you can change your Supplement (Medigap) Insurance any time of the year.

Information for new plans starts to become available each year on or around October 1st. However, changes can not be made until AEP actually starts on October 15th. AEP then ends on December 7th each year.

How Much Does Medicare Cost?

How much you pay for your insurance depends on how you set-up your plan. As for the basics. Most people receive Part A at no cost, and everyone pays a Premium for Part B. To learn more about who pays what, please read our article here.

Part A & B Cost Summary:

• In 2020, the Medicare Part B Deductible will be $198
• In 2020, the Medicare Part B Monthly Premium will be $144.60.

Click here to learn more about who pays the Part B Deductible and about income adjustments to these numbers.

Drug Costs

You will buy Part D, Prescription Coverage from a private insurance company. Each company will price their service differently. Additionally, you can shop for the best plan and price for you.

There is also an income adjustment for Part D coverage. This adjustment is on a sliding scale, and affects those that make more than $85,000 a year.

Part D also has co-pays and deductibles that raise your out-of-pocket expenses.

The Medicare and You Guidebook

Every year the Center for Medicare and Medicaid Services publish a guidebook that details out the Medicare Program: Medicare and You. In addition, this book outlines changes for the upcoming year.

The guide is helpful, but it is often way to long to capture most people attention long enough to get a full understanding of the program. For this reason, we at Medicare Life Health Co. produced a User’s Guide for the Medicare and You Guidebook, and you can find it here.

Where to find the guide

• Again, you can start with our user friendly guide here.
• Second, if you would like to download the guide for reference, you can find it online here: Medicare & You Handbook 2020
• Finally, if you need a physical copy of the Medicare and You 2020 guide, you can request one here: 1-800-MEDICARE (1-800-633-4227)

What are My Next Steps?

• Knowing which plan will be right for you circumstance is beyond Medicare 101, but you can start this journey by clicking here to read our article “Medicare Supplements vs. Medicare Advantage Plans.”

• Talking to a licensed, independent insurance agent at any stage of your planning is a good idea. Agents know your area market and can tell you what the best options are for your unique circumstances.
  • If you are in NE or IA, you can contact us for more information here.
  • If you are in any of our other fine states, you can find an agent here.

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