Twists and turns of Medicare apps and myths: how you navigated the recorded roads

In January, my husband Darney and I started to consider everything we needed financially to prepare for the age of 65 later this year. In March, I wrote about Step 1 on Next Avenue: Cost Savings. This month I started entering Stage 2, a minefield called Medicare.

Darney will be 65 in November and I will continue in December. So I started my Medicare homework in April. Under Medicare rules, you can enroll from 3 months before to 3 months after your 65th birthday. Or you will be fined for delay.

Since Darney and I turned 64, we have received at least four health insurance related emails a day selling us a variety of plans that can be considered by private health insurance companies. With so many twists and turns and myths about Medicare, it’s almost paralyzed to poke fun at all the information to figure out what’s best for us.

Husband’s employer coverage and health insurance

As a freelance writer for over 30 years, I have always relied on health insurance coverage from Darney’s employer plan as part of my educational work in public schools. Fortunately, in April he decided to continue teaching beyond his 65th birthday, so he will have access to his employer’s coverage throughout the year. But when he retires, he won’t be interviewed, so I won’t.

To begin the Medicare enrollment process, we first looked at our health goals and financial realities, and how they affect our lifestyle and retirement income. I feel like every day I can have a new pain, pain, or diagnosis. We knew we didn’t want to bet on less health insurance than today.

I made a list of all the health issues we face and our family’s medical history and was able to get a glimpse of what lies ahead.

I manage high blood pressure through monitoring, prescription drugs, and lifestyle adjustments. My husband has not been diagnosed with a chronic illness, but as a man who will soon be 65, he needs preventive health care.

Overall we’re in pretty good shape with the exception of the looming dance with age-related back and knee issues. Our goal is to stay mobile as much as possible. Therefore, we want to make sure that we can cover physiotherapy as needed.

However, we have both seen costly medical needs that deceased parents and grandparents faced, such as breast cancer, ovarian cancer, and prostate cancer. Alzheimer’s disease Diabetes; Glaucoma and Cataracts – This can be a predictor of the future. We already wear glasses.

Required coverage

I’m the only one who has a prescription between them, and luckily it’s cheap. But that can change. We’ve all heard the horror story of the choices some bonded seniors have to make between drugs and expensive foods.

Once I had a list of what I found medically necessary, I researched Medicare coverage to make it happen.

I was always overwhelmed after being drowned in leaflets, articles, and advice from friends enrolled in Medicare. So I decided to call the Federal Medicare Hotline (800-633-4227, also 800-MEDICAR). It was the best decision I made in this process.

I worked with Medicare specialist Edward McFarland. Edward McFarland answered all of my questions over the phone. It only took two minutes to get to a real person.

How Medicare Works

Before explaining what I heard and decided, let’s briefly explain how Medicare works.

learn more: Guide to Medicare Open Registration: How to Buy, Switch, and Compare Plans

As you may know, Medicare has two basic components called Part A (Hospital Insurance) and Part B (Medical Insurance), which are sometimes referred to as the original Medicare. Part A is the no premium coverage required by the government at age 65. It covers the costs of hospitalization and hospitalization, as well as acute care in a qualified nursing facility, generally at 80% of the cost, after initial deduction of approximately $ 1,400. Day of care, according to McFarland.

The important thing is to purchase Part A coverage as soon as you are authorized to do so. This avoids penalties for late registration. In our case, McFarland maintains us employer sponsored compensation for hospitalization and hospital expenses, so McFarland starts with us on Medicare compensation as secondary compensation if needed. He said it would be done.

“Part B covers medical consultation, preventive care, including screening and treatment, and medical devices. Standard premiums start at around $ 148.50 per person per month, ”McFarland said. Declared.

I decided to wait for Medicare Apartment B to get health insurance while Darney is working. Make sure the insurance starts when Darney’s insurance ends. General registration for Part B is from January 1 to March 31 of each year.

Therefore, Darney and I finally considered considering a monthly premium of just under $ 300 in Part B. McFarland explained that these premiums come directly from Social Security checks when they start claiming benefits. social security pension. The US government changes the premiums every year, but 2022 will be pretty close to 2021.

One of the important things you should know about Medicare Apartment B is to pay only for procedures that you feel are medically necessary. No Covers dental, vision and hearing care.

See also below. Health insurance premiums can be tripled without knowing it – here are a few things to keep in mind:

Medicare benefit plan

If you don’t want to enroll in the original health insurance, you can enroll in the Medicare Advantage plan. It is becoming more and more popular with private health insurance companies. Medicare Advantage, sometimes referred to as Medicare Apartment C, is a one-time purchase plan that covers Medicare Apartment A and Part B, except for palliative care.

Often, these plans include additional benefits that were not included in the original Medicare. For example, dental care and glasses. In most cases, it also includes prescription drug coverage (known as Medicare Apartment D).

Exact Medicare Advantage Plan coverage depends on the benefits you choose and how much you can afford. However, there is a big caveat here. Most Medicare Advantage plans require you to see a doctor in your network at the lowest cost. Some do not cover any plan network service and providers outside of the service area.

While doing my homework, I was able to see the benefits of a Medicare Advantage plan that works like an HMO or a PPO. However, McFarland says if you travel a lot and have a Medicare benefit, you can incur significant medical bills if you need care and are out of the network.

That’s what Darney and I have to think about.

In terms of prescription drug coverage, most Part D plans have an annual deduction, which is less than $ 445 this year. However, there is a limit to the amount that can be covered by the Part D plan.

see: How to Reduce the High Costs of Medicare Prescriptions

In 2021, by spending $ 4,130 on the drug that you and your plan cover, you are in what is known as the “Donut Hall” coverage gap. Then pay less than 25% of the cost of the prescription and brand name drugs covered by the plan until the donut hole ends at your cost of $ 6,550. (In 2022, the donut hole starts at $ 4,430 and ends at $ 7,050.)

Scope and rules of prescription drugs

McFarland saw the need for medication and suggested comparing Part D options. You can change the Part D option every year by signing up open every year.

My blood pressure medication, lisinopril, costs $ 4 per month under my current insurance policy. I will be back next year when employer based compensation ends.

So, for now, you need to sign up for Medicare Apartment A right away, but as long as you maintain Darney’s coverage for another year, or as long as he works, you need to make a big decision about Part B or Part B. part D. there is no. Medicare Advantage plans and providers change every year, so we’ll start comparing as we get closer to when registration is required.

Shortly before October 2022, when Darney’s coverage is expected to end, we take a deep breath and resume the hunt for Medicare. But if he continues to work, we will remain in employer’s coverage and re-enroll in Part A for another year.

Read more : Are you planning to retire? Here is a list of at least 14 things to explain first

How to Make Smart Health Insurance Choices

Here are my tips for where to get the best information for making health insurance choices:

Start by calling Medicare (800-772-1213). You will get a knowledgeable person on the phone who can walk you through your options depending on your situation. This hotline calls 24 hours a day.

Visit the Medicare website and It explains well how the program works and what is needed.

Check out our state’s Free Health Insurance Assistance Program (SHIP). For Medicare and Medicare Advantage plans available in your state, please call or visit our website. Similar to the Medicare hotline, a SHIP advisor will walk you through the process. You can find your state’s website at the state’s National Health Insurance Support Program Network website.

And if you really want to wrinkle weeds, you could buy a 2016 book.Get Yours for Medicare: Maximize Your Coverage and Minimize Your Costs.. ” By Philip Moyler, Medicare Maven. Moeller website, Get yours. There are current figures for Medicare premiums and deductions and his frequent blog posts.

Andrea King Collier is a journalist and writer based in Lansing, Michigan.

This article has been reprinted with permission from, © 2021 Twin Cities Public Television, Inc. all rights reserved.

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Twists and turns of Medicare apps and myths: how you navigated the recorded roads

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