UNITED STATES—Dear Toni, I am a confused Baby Boomer who needs to make my Medicare decision in November when I turn 65. I do not know where to start or what to do. Can you please help simplify this ordeal? Thanks Stephanie from Phoenix, AZ.
Hi Stephanie: Don’t feel alone, because there is a person entering Medicare every 8 seconds every day for approximately the next 10 years. Most “Boomers” feel an urgency to learn all their Medicare options – and are completely stressed over getting it right, because they know that one wrong move can jeopardize their retirement savings, they worked so hard to build.
Below are some facts that those entering Medicare need to know:
1) Enroll on time: The only way Medicare is automatic for those turning 65 is when one is already receiving a Social Security check. If you are not receiving your Social Security check and not working full time with employer benefits from either your or your spouse’s work, then you will want to enroll in Medicare Parts A and B via online at https://www.ssa.gov/medicare/sign-up Those working full-time with employer benefits or are covered under their spouse’s benefits may want to delay enrolling in Medicare Part A (if an HSA is your employer’s benefit, important Medicare rules apply) and Medicare Part B until they retire or lose their benefits for any other reason.
2) Medicare is NOT free: Medicare covers a lot and there is a cost associated with Medicare Parts A and B. You have been paying tax dollars for Medicare and the premium for Part A is at no cost. Medicare Part B has a premium which means if tested depends on how much you have earned for that year. In 2023, an average Medicare beneficiary pays $164.90 each month for Part B premium. The 2023 Medicare Part A (hospital) deductible is $1600 not once a year but is every 60 days or 6 times a year. The 2023 Medicare Part B deductible is $226 once a year, with Medicare paying 80 percent of the Medicare approved amount and you paying the remaining 20 percent (and many individuals purchase insurance to cover this 20 percent “gap”).
3) Learn Medicare’s alphabet soup…Parts A, B, C & D: Medicare Parts A and B cover hospital, medical and provider expenses. Medicare Part C, known as Medicare Advantage plan, is another way of receiving your Medicare benefits. Part D is Medicare Prescription Drug plans that can be enrolled as a stand-alone plan with a Medicare Supplement with Original Medicare or bundled in a Medicare Advantage plan.
4) Medicare covers a lot: Medicare Part A covers in-patient hospital, skilled nursing facility care, home health and hospice care. Medicare Part B covers physicians’ services, outpatient surgery/services, lab/X-rays, MRIs, durable medical equipment, and preventative services, etc.
5) Medicare doesn’t cover: Medical services not covered under Medicare include vision, hearing, or dental expenses as well as Long Term Care.
6) No Network with Original Medicare (with Medicare Supplement/Medigap): Your healthcare profession or facility bills Medicare directly.
7) Medicare Advantage May Be a Good Option: Know that you can choose between Original Medicare (Parts A & B), or Medicare Advantage plans offered by private insurance companies.
8) Medicare Also Serves Under 65 Also: Those under 65 on Social Security Disability or ESRD (end stage renal disease) qualify when they meet Medicare’s requirements.
When one visits the Toni Says office for a Medicare consultation, we tell them to forget everything they know about their old health insurance plans because Medicare is totally different!
Remember, with Medicare what you don’t know WILL hurt you! Need Medicare help, Toni’s book “Medicare Survival Guide Advanced” edition is offering a $10 discount available to the Toni Says® readers and their friends at www.tonisays.com and www.seniorresource.com. Visit www.seniorresource.com/medicare-moments/ to listen to Toni’s Medicare Moments podcasts.