Medicare Minute: New to Medicare
Area Agency on Aging
For more information about the author, click to view their website: Area Agency on Aging for Southwest Florida
Dec 12, 2024
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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: [email protected] |
SMP
email: [email protected] |
|
SHIP
website: www.floridashine.org |
SMP
website: www.floridashine.org |
|
To find a
SHIP in another state: Call 877-839-2675 (and say “Medicare” |
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 | [email protected] SMP
Resource Center: 877-808-2468 | www.smpresource.org | [email protected] © 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] |
|
- To view the original version of this article visit aaaswfl.org/medicare-minute-new-to-medicare/
- Seniors Blue Book was not involved in the creation of this content.
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Area Agency on Aging for Southwest Florida
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Area Agency on Aging for Southwest Florida
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