Medicaid Medicare Social Security Your Coverage Options

Enrolling in Medicare? Here’s a checklist

Most people get Medicare just before they turn 65 (though people with disabilities get Medicare after they receive SSDI for 24 months and people with ALS get Medicare the first month they receive SSDI). As a general rule, you are way better off with Medicare, public health insurance, than with private health insurance. But, figuring out when to enroll in Medicare and what to do can be daunting. And, each fall, you need to revisit your options because they can change significantly from one year to the next. Here’s a checklist:

  • Do you have health care coverage from a current job, either yours or your spouse’s?
    • If you do not, you likely want to sign up for Medicare in the three months before your 65th birthday month, so that your Medicare coverage begins on the first day of your birthday month.  (Your current health insurance in most cases will no longer be your primary coverage after your birthday month.)
    • If you have health care coverage from either your or your spouse’s current job, click here for advice on whether you should sign up for Medicare. Depending upon the job, you may need to enroll in Medicare in order to avoid penalties. Note: COBRA does not count as insurance from your job.
  • Have you already signed up for Social Security?
    • If not, you can sign up for Medicare online through the Social Security Administration. You do not need to sign up for Social Security to enroll in Medicare. Keep in mind that when you sign up for Social Security affects the amount of your monthly check. Click here for advice on when to claim Social Security benefits.
    • If you’ve already signed up for Social Security, you will get Medicare automatically. You should receive a notice in the mail about your automatic enrollment in Medicare Part A (hospital insurance) and Part B (medical insurance), both of which you need whether you enroll in traditional Medicare or a commercial Medicare Advantage plan. The Medicare Part A premium is fully paid for if you or your spouse worked for at least 40 quarters and paid taxes; if not, there’s an additional premium. The Medicare Part B premium, which you must pay no matter which Medicare plan you choose, will be deducted from your Social Security check automatically.
      • You will be automatically enrolled in traditional Medicare, government-administered insurance.
      • You can choose to join a Medicare Advantage plan (Part C), instead of traditional Medicare, by signing up with a Medicare Advantage plan; you will be automatically switched out of traditional Medicare.
  • Key differences between traditional Medicare and Medicare Advantage commercial health plans
    • A Medicare Advantage plan, commercial insurance that contracts with Medicare to offer benefits, is often a lot more expensive and a lot more complicated than it at first may seem. Deductibles, coinsurance and copays can be extremely high, and you cannot buy supplemental coverage to cover these costs as you can with traditional Medicare. At the same time, unlike traditional Medicare, Medicare Advantage plans limit your choice of doctors and hospitals to their network. Your annual out-of-pocket costs for in-network care can be as high as $6,700 and, if you need to go out of network, your costs can be far higher. Here are four key differences between traditional Medicare and a Medicare Advantage plan.
    • If you choose traditional Medicare, as 70 percent of people do, Medicare will cover your care from almost all doctors and virtually every hospital in the US. You will want supplemental insurance to fill gaps in traditional Medicare and prescription drug coverage. With that, all or nearly all of your costs for medical and hospital care should then be covered, so you can budget for your care. And, it will be simpler to access care when you need it.
  • What do you need to consider each Fall, during the Medicare open enrollment season?  Each Fall, you will be able to switch Medicare plans. Because Medicare Advantage plans and Part D drug plans can change significantly from one year to the next, you will likely be better off if you do some homework. Here are two questions you should answer during the Open Enrollment Period.
    • If you’re in traditional Medicare, you can assume your coverage will remain the same in terms of access to doctors and hospitals. So, no homework there. But, you will need to check into your Medicare Part D drug plan options, which can change dramatically from one year to the next. (Here’s a Medicare tool to help you choose.)
    • If you’re in a Medicare Advantage plan, you cannot assume your coverage will remain the same each year. The network doctors and hospitals can change at any time, and the premiums, copays and deductibles can change each year. You will need to do some research around costs and to ensure you are in a Medicare Advantage plan that allows you to see the doctors and hospitals you want to use. You can switch to traditional Medicare. But, if you do not have Medicaid or retiree coverage to fill gaps, you will need a Medigap policy.

For more about Medicare benefits, Medicaid, Social Security and long-term services and supports, click here. 

To understand when Medicare is the primary payer and when it is secondary, click here. 

If you have Veterans’ or other military benefits, learn how they work with Medicare.


1 Comment

  • It is a shame that people who paid into Medicare all their working lives can be forced out of Traditional Medicare and into a Medicare “Advantage” plan simply because they may need Medicaid or because their former employer has chosen this cheap and nearly worthless form of private, for-profit insurance as their retiree plan instead of a supplemental Medigap plan. This must stop! Medicare Advantage must be a choice!

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