Age 65

 Turning 65 and What Medicare Means to You.

Congratulations!  When you turn age 65 you can enjoy the benefits of a health plan you have been paying towards for many years.  You are entitled to Medicare Part A and are eligible to buy Medicare Part B.  Together these are known as “Original Medicare.” I have been educating new Medicare beneficiaries for 9 years now and these are some of the questions I commonly hear:

How do I get enrolled in Medicare and get a card?

If you currently are receiving social security benefits, or have recently applied for them, Medicare will automatically enroll you and mail you a card. If not, and you want to start using Medicare, you may apply online at www.SocialSecurity.gov or visit your local Social Security office.

Why do I care about Medicare if I already have insurance?

If your and your spouse are not working and are covered by group health insurance (including Cobra), it is essential to enroll so you don’t have to pay a late enrollment penalty and have a waiting period without any coverage.

If you and or your spouse are still working and covered by other health insurance, you need to compare all your options.  You may delay enrolling in and paying the Medicare Part B premium (You will be eligible to apply later.) This could save you money, or it could be that Medicare coverage is better than your current coverage at a lower price.  Every situation is different.

What does Medicare Cover?

Basically, Original Medicare (Parts A &B) is “good” medical insurance. It is very similar to an individual 80/20 health plan. It covers approximately 80 percent of most medically necessary expenses, in the hospital and on an outpatient basis.  It also includes quite a few preventative screenings and tests.  However, there are deductibles and copays and some things like dental and eyewear are not covered.

What choices do I have for additional or alternative coverage?

  • Medicare Supplements also known as Medigap policies
  • Medicare Part D drug plans, also known as Prescription Drug Plans (PDPs)
  • Medicare Advantage Plans also known as Medicare Part C
  • Dental, Vision, Hearing plans
  • Hospital Indemnity Plans

How do I decide which is best for me?

There are many pros and cons with all the Medicare insurance options available to you. I recommend consulting with a professional to help you narrow your choices.

I don’t take any medications, do I still need to buy a Part D prescription plan?

You cannot be “forced” to buy a plan but it is highly recommended that you do so.  If you delay purchasing a plan when you are first eligible, you may have a long waiting period and be subject to a late enrollment penalty.

How do I get a Prescription Drug Plan?

You need to enroll in one that is offered by a private insurance company and that has been approved by the Centers for Medicare and Medicaid (CMS).  Currently in Virginia, there are 32 stand alone eligible plans that vary in premium price, deductibles, co-pays, formularies (list of drugs that are covered), and choices of pharmacy.  Each individual should “shop” for the best plan for them.

Additionally, some Medicare Advantage plans include a Prescription Drug Plan (MAPD).

I am already enrolled in Medicare due at a disability and am now turning age 65.  What should I know?

 At age 65, you have a guaranteed right to purchase a Medicare Supplement policy without going through any underwriting. (That means the insurance company cannot ask you any medical history questions, nor can they deny you coverage!)  But hurry, this enrollment period ends in six months.

I am still confused.  Where do I get additional information and help?

I am glad you asked!  There is a lot more information on this very website.  Please check out my page with the Medicare Chart, my page Medicare Options (to find Medicare Supplement prices), my blogs such as “Medicare Deductibles”, “Confused about Medicare”, and “A Plan F is a Plan F is a Plan F.”

 But most simple of all is to contact me for a no obligation appointment.

Paula Q. Wallace, 757-232-4678 or pqwallace@pqwic.com