What You Need to Know about Medicare Health Coverage

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What You Need to Know about Medicare Health Coverage on avanteinsurance.com

Important Medicare enrollment deadlines you can’t miss

If you are 65, or you’ll be turning the big 6-5 this year, you have a lot of decisions to make, especially about your healthcare. There are important deadlines you need to keep in mind when it comes to enrolling in Medicare or changing your existing coverage. For instance, did you know there is a specific timeframe to sign up when you turn 65? Plus, you can only change existing coverage at certain times of the year. We offer a brief overview about Medicare, the type of coverage offered, and the deadlines you need to know about.

What is Medicare and what does it cover?

Medicare is a U.S. federal health insurance program for certain people, including those over age 65 and certain younger individuals with disabilities. Medicare includes several different parts, which each cover different things.

Medicare Part A (Hospital Insurance) – This helps cover inpatient hospital visits, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance) – Part B helps pay for things like doctor services, outpatient care, medical supplies, and preventive services.

Everyone over age 65 must enroll in Medicare Parts A and B unless you are still working, and your employer offers group health insurance.

There is also additional coverage you can add at your own cost, including:

Medicare Part C (Medicare Advantage Plan) – These are plans offered by private companies with a Medicare contract. The plans include Medicare Parts A and B coverage, plus additional benefits. A Medicare Advantage Plan might be in the form an HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), Private Fee-for-Service, Special Needs Plans, or Medicare Medical Savings Account.

Medicare Part D (Prescription Drug Coverage) – As you know, medications can be expensive, especially if you have a chronic health condition. Part D plans, which are also offered by private companies, include Original Medicare benefits as well as prescription drug coverage so you can buy medications at a lower cost.

When should you enroll in Medicare?

If you have recently turned 65, or you will soon, there are strict guidelines mandating when you must enroll. According to Medicare.gov, “When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.” That 7-month period begins 3 months before you turn 65 and ends 3 months after you turn 65.

If you are over age 65, but you still have health insurance through an employer, you are not required to enroll. However, if you retire, you will need to sign up within 8 months of leaving your job to avoid paying a penalty.

“Individuals who are receiving Social Security benefits may be automatically enrolled in Medicare Parts A and B, and coverage begins the month they turn 65,” according to a U.S. News and World Report article.

If you miss the deadline to sign up during the Initial Enrollment Period, you can still enroll during the General Enrollment Period, which runs from January 1st – March 31st each year. However, you could still be charged with a late enrollment penalty.

When can you change Medicare coverage?

If you’re over age 65 and already enrolled in Medicare, you can only change plans during Medicare Open Enrollment, also known as the Annual Enrollment Period (AEP), which runs from October 15th – December 7th each year. This is the time when you can add additional coverage such as a Medicare Advantage Plan (Part C) and/or a Prescription Drug Plan (Part D) or switch to another plan if you already have one.

Why would you choose to switch plans? According to the Centers for Medicare and Medicaid Services (CMS), “Medicare health and drug plans can make changes each year – things like cost, coverage, and what providers and pharmacies are in their networks.”

If you’ve determined that your current plan costs too much, doesn’t offer the benefits you need, or doesn’t include the doctor you want, you are free to look for another plan during this period. However, you can only do so from October 15th – December 7th.

Here are those Medicare health insurance dates again:

• Initial Enrollment Period – 7-month period to sign up, beginning 3 months before you turn 65 and ends 3 months after you turn 65

• If you are still employed and receive insurance coverage from your employer – You have 8 months to enroll after you leave your job (retire)

• General Enrollment Period – Runs from January 1st – March 31st each year

• Medicare Open Enrollment or AEP – Runs October 15th – December 7th each year

If you have questions about Medicare health coverage or how to enroll or change coverage, contact Avante Insurance, and we can help.