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Medicare 101: What to Do, What to Know, When to Start


M


edicare can seem complicated and overwhelming, but when you learn the most basic elements, it’s much easier to


understand and navigate.


GETTING STARTED Eligibility* to enroll in Medicare starts three months before the month you turn age 65. Coverage goes into effect the first day of the month in which you turn age 65, unless your birthdate falls on the first day of the month, in which your effective date would be the first day of the prior month. The easiest way to enroll is through the Social Security Administration website at SSA.gov. You also may call 800-772-1213. Processing takes 45- 90 days. You’ll need both Part A and Part B.


• Part A covers inpatient hospital care, skilled nursing, hospice and home health care.


• Part B covers physician services, out- patient care, home health care, durable medical equipment and preventive services. Medicare pays for 80 percent of approved claims.


• Part D plans cover prescription drugs. • Something important to note: If you have large group coverage, you may delay Part B until you retire. Small group plans (under 20 employees) are not considered creditable coverage, so the employee would need to come off the plan and enroll in Part B when eligible for Medicare.


PURCHASING SUPPLEMENTS


To qualify to purchase supplements, you are required to have both Medicare Part A and Part B, if you wish to apply for a Medicare Supplement or Medicare Advantage (MA) plan. Part D enrollment requires eligibility for Part A and/or enrollment in Part B.


16 focus | NOV/DEC 2022 | ISSUE 6 COST


Part A is generally free if you’ve worked 40 quarters in your lifetime. Part B premium is based on your last two years of salary. If married, premium is based on household income. For 2023, an individual earning less than $97,000 will have a Part B premium of $164.90 monthly. Higher income earners will experience an IRMAA adjustment (Income Related Monthly Adjusted Amount).


CHOOSING A SUPPLEMENT


Medicare Supplement plans work in con- junction with Medicare and pick up where Medicare leaves off. Supplements can have a very low out of pocket max and a reason- ably low premium. Plan G has become the most popular plan with a max out of pocket of $226 annually for the 2023 plan year. The average premium for a 65-year-old is $135- $165 monthly. With Medicare Supplements, you can see any provider accepting Medicare patients, nationwide. You’ll want to pair a Medicare Supplement plan with a Part D prescription drug plan.


There’s not a one-size-fits-all when choosing a Medicare Supplement or MA plan. Impor- tant things to consider are cost, benefits, prescription drug coverage, access to care and quality of care. Let MDIS help you navi- gate Medicare with the many plan options available to you.


Christy Diehl is MDIS Health Insurance Manager. Contact her at 800-944-7550. *You may also qualify for Medicare prior to age 65 if you have a disability, End-Stage Renal Disease (ESRD) or ALS (also known as Lou Gehrig’s disease).


MA plans take the place of original Medicare and are managed by private insurance car- riers. MA plans have a low-to-no premium; however, the plans have a higher out-of- pocket for utilization. Expenses can include copays, deductibles and coinsurance on services. MA plans can be good for individu- als living in highly populated areas or who don’t visit the doctor often, Medicaid eligible individuals and veterans with creditable drug coverage through the VA.


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