Medicare Minute: New to Medicare

Author

Area Agency on Aging

For more information about the author, click to view their website: Area Agency on Aging for Southwest Florida

Posted on

Dec 12, 2024

Book/Edition

Florida - Sarasota, Bradenton & Charlotte Counties , Florida - Southwest

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If you or a loved one will soon be eligible for Medicare, join us for this Medicare Minute! We’ll go over all the basics you should know—from enrollment periods to coverage choices and beyond.

Some people are automatically enrolled in Medicare. For example, if you are already receiving retirement benefits from Social Security when you become Medicare-eligible, or if you’ve been collecting Social Security Disability Insurance for two years. If you are automatically enrolled, you should receive a package in the mail with your Medicare insurance card telling you so. Otherwise, there are three times to enroll in Parts A and B:

Initial Enrollment Period (IEP): The three months before, the month of, and the three months after your 65th birthday.

Special Enrollment Period (SEP): Allows you to delay Medicare enrollment without owing a late enrollment penalty. You may qualify for an SEP if:

  • You or your spouse (or sometimes another family member) are still working, and you are covered by the employer health insurance. Note that you shouldn’t delay Medicare enrollment if this employer coverage pays secondary to Medicare.
  • You have experienced other exceptional circumstances, like losing Medicaid coverage, being released from incarceration, being misinformed by an employer, or being impacted by an emergency or disaster.

General Enrollment Period (GEP): Every year from January 1 through March 31. You may owe a late enrollment penalty and face gaps in coverage if you use the GEP.

View the full “New to Medicare” handout by the State Health Insurance Assistance Program (SHIP) below.

The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document was supported, in part, by grant numbers 90SATC0002 and 90MPRC0002 from the Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. [April 2024]


New to Medicare

 

Medicare is the federal government program that provides health care coverage, or health insurance. The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs Medicare. The program is funded in part by Social Security and Medicare taxes you pay on your income, in part through premiums that people with Medicare pay, and in part by the federal budget. Some people are eligible for Medicare due to their age, while others are eligible due to having a disability or chronic condition. If you are new to Medicare, there can be a lot to learn around your enrollment and coverage choices.

 

Medicare Part A (inpatient coverage) and Part B (outpatient coverage)

 

Some people are automatically enrolled in Medicare. For example, if you are already receiving retirement benefits from Social Security when you become Medicare-eligible, or if you’ve been collecting Social Security Disability Insurance for two years. If you are automatically enrolled, you should receive a package in the mail with your Medicare insurance card telling you so. Otherwise, there are three times to enroll in Parts A and B:

 

 


Initial Enrollment Period (IEP): The three months before, the month of, and the three months after your 65th birthday.

 

 

 


Special Enrollment Period (SEP): Allows you to delay Medicare enrollment without owing a late enrollment penalty. You may qualify for an SEP if:

·      You or your spouse (or sometimes another family member) are still working, and you are covered by the employer health insurance. Note that you shouldn’t delay Medicare enrollment if this employer coverage pays secondary to Medicare.

·      You have experienced other exceptional circumstances, like losing Medicaid coverage, being released from incarceration, being misinformed by an employer, or being impacted by an emergency or disaster.

 

 


General Enrollment Period (GEP): Every year from January 1 through March 31. You may owe a late enrollment penalty and face gaps in coverage if you use the GEP.

 

 

 

New to Medicare

 

Choosing between Original Medicare and Medicare Advantage is a big choice when you are new to Medicare. Below are some key differences to consider.

 

To discuss your options with a Medicare counselor, you can contact your State Health Insurance Assistance Program (SHIP). Find your local SHIP by visiting www.shiphelp.org or call 877-839-2675.

 

 

 

Original Medicare

Medicare Advantage

Costs

Part A and Part B costs, including monthly Part B premium. 20% coinsurance for Medicare-covered services if you see a participating provider and after meeting your deductible.

Cost-sharing depends on the plan. Usually pay a copayment for in-network care. Plans may charge a monthly premium in addition to Part B premium.

Supplemental insurance

Have the choice to pay an additional premium for a Medigap policy to cover Medicare cost-sharing.

Cannot purchase a Medigap policy.

Provider access

Can see any provider and use any facility that accepts Medicare (participating and non-participating).

Typically, can only see in-network providers. Some plans allow you to see out-of-network providers at a higher cost.

Referrals

Do not need referrals for specialists.

Typically need referrals for specialists.

Drug coverage

Must sign up for a stand-alone Part D prescription drug plan.

In most cases, plan provides prescription drug coverage (you may be required to pay a higher premium).

Other benefits

Does not cover routine vision, hearing, or dental services.

May cover additional services, including vision, hearing, and/or dental (you may owe an extra premium)

Out-of-pocket limit

No out-of-pocket limit.

Annual out-of-pocket limit. Plan pays the full cost of your care after you reach the limit.

 

 

 

 

 

New to Medicare

 

Prescription drug plans: Part D is provided only through private insurance companies that have contracts with the federal government. If you have Original Medicare and want to get Part D coverage, you must choose and enroll in a stand-alone prescription drug plan. Typically, you should sign up for Part D when you first become eligible to enroll in Medicare, unless you have other creditable drug coverage. Most Medicare Advantage Plans include drug coverage.

 

 

Medigaps: Medigaps are health insurance policies that offer standardized benefits to work with Original Medicare, not with Medicare Advantage. They are sold by private insurance companies. If you have a Medigap, it pays part or all of certain remaining costs after Original Medicare pays first. Medigaps may also cover emergency care when travelling abroad. You should usually enroll in a Medigap during your open enrollment period, the six-month period that begins the month you are 65 or older and enrolled in Medicare Part B. Depending on your situation and the state in which you live, you may be able to enroll at other times, too.

 

 

 

My Health Care Trackers

.

My Health Care Trackers are fraud-fighting tools that are free through the Senior Medicare Patrol (SMP) program. My Health Care Trackers include:

 

  • Space to take notes on your medical appointment, including the date, your provider’s name, the reason for your visit, length of appointment, and care received.

 

  • Instructions on how you can compare your notes to what was billed on your Medicare statements.

 

  • Contact information for relevant agencies, such as Medicare, the Social Security Administration (SSA), the Senior Medicare Patrol (SMP) and the State Health Insurance Assistance Program (SHIP).

 

 

Using a My Health Care Tracker and comparing your notes with your Medicare statements is a great way to find potential billing errors, as well as Medicare fraud, abuse, or a stolen medical identity. Ultimately, it can help you reduce your health care costs and protect yourself against potential Medicare fraud, errors, and abuse. Contact your local Senior Medicare Patrol (SMP) to receive a My Health Care Tracker or need assistance with reading your Medicare statements. Contact information for your local SMP is on the final page of this document.

 

New to Medicare

Local SHIP contact information

Local SMP contact information

SHIP toll-free: 1-866-413-5337

SMP toll-free: 1-866-413-5337

SHIP email:  shineinfo@aaaswfl.org

SMP email:  shineinfo@aaaswfl.org

SHIP website:  www.floridashine.org

SMP website:  www.floridashine.org

 

   To find a SHIP in another state:

Call 877-839-2675 (and say “Medicare”
when prompted) or visit
www.shiphelp.org

 

 

 

   To find an SMP in another state:

Call 877-808-2468 or visit www.smpresource.org

SHIP Technical Assistance Center: 877-839-2675 | www.shiphelp.org | info@shiphelp.org

SMP Resource Center: 877-808-2468 | www.smpresource.org | info@smpresource.org

© 2023 Medicare Rights Center | www.medicareinteractive.org  |

 

The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document was supported, in part, by grant numbers 90SATC0002 and 90MPRC0002 from the Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. [April 2024]

 


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Area Agency on Aging for SWFL, The

Senior Organizations & Services 15201 N Cleveland Ave, Ste 1100, N Fort Myers, Florida, 33903

The Area Agency on Aging for Southwest Florida (AAASWFL) is a nonprofit organization serving older adults (age 60-up) and adults with disabilities. We serve Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties. AAASWFL is committed to connecting older adults and adults with disabilities to resources and assistance for living safely with independence and dignity.AAASWFL is also the states designated Aging and Disability Resource Center for Southwest Florida. We provide information and resources for seniors and adults with disabilities. We also help their families and caregivers. AAASWFL can connect you with local resources like elder care, adult day care, housing assistance, home care, meals, housekeeping, legal assistance, personal care, and even volunteer opportunities.Providing Long-Term Care (LTC) services to Floridas most vulnerable citizens is a multi-agency effort. The Agency for Health Care Administration (AHCA) administers the Statewide Medicaid Managed Care (SMMC) Long-Term Care program, sets coverage policy, and gets those eligible for services enrolled in a LTC plan. The Department of Elder Affairs (DOEA) is responsible for determining medical eligibility and level of care needed. We are one of eleven regional Area Agencies on Aging in the state of Florida. Nationwide, there are more than 600 Area Agencies on Aging serving elders and adults with disabilities.Please contact the Area Agency on Aging for Southwest Florida if we can be of assistance to you, a friend or a family member!The AAASWFL Elder Helpline is available between 8:00 am-5:00 pm Monday through Friday:  866-413-5337 (866-41-ELDER)Contact Phones:Telephone: 239-652-6900FAX: 239-652-6989Toll Free: 866-413-5337 (in the State of Florida)Postal address:Area Agency on Aging for Southwest Florida2830 Winkler Avenue, Suite 112Fort Myers, FL 33916Hours of Operation:Monday-Friday: 8am 5pm

Area Agency on Aging for Southwest Florida

Adult Day Services 2830 Winkler Avenue, Suite 112, Fort Myers, Florida, 33916

The Area Agency on Aging for Southwest Florida (AAASWFL) is a nonprofit organization serving older adults (age 60-up) and adults with disabilities. We serve Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties. AAASWFL is committed to connecting older adults and adults with disabilities to resources and assistance for living safely with independence and dignity.AAASWFL is also the states designated Aging and Disability Resource Center for Southwest Florida. We provide information and resources for seniors and adults with disabilities. We also help their families and caregivers. AAASWFL can connect you with local resources like elder care, adult day care, housing assistance, home care, meals, housekeeping, legal assistance, personal care, and even volunteer opportunities.Providing Long-Term Care (LTC) services to Floridas most vulnerable citizens is a multi-agency effort. The Agency for Health Care Administration (AHCA) administers the Statewide Medicaid Managed Care (SMMC) Long-Term Care program, sets coverage policy, and gets those eligible for services enrolled in a LTC plan. The Department of Elder Affairs (DOEA) is responsible for determining medical eligibility and level of care needed. We are one of eleven regional Area Agencies on Aging in the state of Florida. Nationwide, there are more than 600 Area Agencies on Aging serving elders and adults with disabilities.Please contact the Area Agency on Aging for Southwest Florida if we can be of assistance to you, a friend or a family member!The AAASWFL Elder Helpline is available between 8:00 am-5:00 pm Monday through Friday:  866-413-5337 (866-41-ELDER)Contact Phones:Telephone: 239-652-6900FAX: 239-652-6989Toll Free: 866-413-5337 (in the State of Florida)Postal address:Area Agency on Aging for Southwest Florida2830 Winkler Avenue, Suite 112Fort Myers, FL 33916Hours of Operation:Monday-Friday: 8am 5pm

Area Agency on Aging for Southwest Florida

Senior Organizations & Services 2830 Winkler Avenue, Suite 112, Fort Myers, Florida, 33916

The Area Agency on Aging for Southwest Florida (AAASWFL) is a nonprofit organization serving older adults (age 60-up) and adults with disabilities. We serve Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties. AAASWFL is committed to connecting older adults and adults with disabilities to resources and assistance for living safely with independence and dignity.AAASWFL is also the states designated Aging and Disability Resource Center for Southwest Florida. We provide information and resources for seniors and adults with disabilities. We also help their families and caregivers. AAASWFL can connect you with local resources like elder care, adult day care, housing assistance, home care, meals, housekeeping, legal assistance, personal care, and even volunteer opportunities.Providing Long-Term Care (LTC) services to Floridas most vulnerable citizens is a multi-agency effort. The Agency for Health Care Administration (AHCA) administers the Statewide Medicaid Managed Care (SMMC) Long-Term Care program, sets coverage policy, and gets those eligible for services enrolled in a LTC plan. The Department of Elder Affairs (DOEA) is responsible for determining medical eligibility and level of care needed. We are one of eleven regional Area Agencies on Aging in the state of Florida. Nationwide, there are more than 600 Area Agencies on Aging serving elders and adults with disabilities.Please contact the Area Agency on Aging for Southwest Florida if we can be of assistance to you, a friend or a family member!The AAASWFL Elder Helpline is available between 8:00 am-5:00 pm Monday through Friday:  866-413-5337 (866-41-ELDER)Contact Phones:Telephone: 239-652-6900FAX: 239-652-6989Toll Free: 866-413-5337 (in the State of Florida)Postal address:Area Agency on Aging for Southwest Florida2830 Winkler Avenue, Suite 112Fort Myers, FL 33916Hours of Operation:Monday-Friday: 8am 5pm