Even if you have an employer plan, you might be at-risk
Don’t miss the enrollment window or you’ll pay lifetime penalties
Here’s what you need to know:
- If you miss the open enrollment period, you may have to pay an extra amount every month – called a late enrollment penalty – added to monthly premiums for the rest of your life.
- Open enrollment lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65.
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Medicare Supplemental Insurance Plans
Even if you are eligible for Medicare, not everything is covered. When a bill for service is submitted, Medicare pays their part (generally 80% of Medicare covered benefits) and sends the remainder of the bill to the Supplement which pays their part (generally 20%). It is important to note that Supplements do NOT include Prescription Drug Coverage (Part D, PDP) and for those that do not get a PDP when first eligible there will be a penalty when they do get a PDP (there are exceptions to this). A Medicare Supplement does not change year to year (although the cost does generally go up, the coverage does not change).
Medicare Advantage Plans
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to Original Medicare. Medicare Advantage Plans are “bundled plans” offered by private companies approved by Medicare and include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).
Medicare Part A
Medicare Part A covers your hospital expenses. This includes hospital stays, skilled nursing care, hospice, and home health-care services. You may have to pay various deductibles, coinsurance, and copayments. You qualify for Part A by paying taxes toward Medicare while working for 10 years (or 40 quarters). If you did not qualify for Part A, you will pay a premium.
Medicare Part B
Medicare Part B covers medical expenses for services such as doctor’s office visits, lab work, x-rays, and outpatient surgeries. It also covers preventive services like cancer screenings and flu shots. Part B also covers medically necessary durable medical equipment such as wheelchairs and walkers to treat a disease or condition. Most people pay a premium for Part B. Even if you are enrolled in a Medicare Advantage plan that provides your Part A and Part B benefits, you will still pay your Part B premium.
Medicare Part D (Prescription Drug Plans)
Original Medicare doesn’t cover prescription drugs. Medicare Part D can be valuable if you take medications. You will pay a late-enrollment penalty if you don’t sign up for Medicare Part D Coverage when you are first eligible. You can get Medicare Part D prescription drug coverage either through an independent Prescription Drug Plan (PDP), or through a Medicare Advantage Plan that includes prescription drug coverage.
Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.
A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier your prescriber can ask your plan for an exception to get a lower copayment.
