Turning 65 in SC? Finding the Right Medicare Supplement Plan

The Baby Boomers are moving in and they’re bringing friends, lots of them. In fact, according to the Census Bureau:

36.3 Million – The number of seniors who were age 65 and older in the United States on July 1, 2004.

86.7 Million – Projected number of people who will be 65 or older in the year 2050.

If you are one of these individuals who is turning 65 in the next couple of years, you are among the fastest growing population known in American history.  You may have questions about what to expect from government programs like Medicare and Social Security. What you need to know about these programs and how they operate is even more of a concern than ever before. Add in the mix the new Health Care Reform and the end result can be overwhelmingly confusing.

There are ways to solve some of the confusion by learning a little as you go. Picking up information from your local Social Security Office and materials from government websites such as www.medicare.gov and www.healthcare.gov can lead you to the path of less confusion. Taking advantage of free seminars through your local college or senior center can be great ways to find reliable information that you can trust.  Things to keep in mind as you approach Medicare age:

1- At age 65 you will be considered ‘aging in’ to Medicare. The majority of seniors will receive Part A of Medicare-Hospitalization (automatically). However, there are exceptions that must be considered before enrolling.

2- You will be automatically enrolled in Part A but most likely will need to set up your part B of Medicare through Social Security. You can set up an appointment to meet with a Social Security representative by the nearest Social Security office near you. If you are already receiving social security, you will automatically be enrolled in Medicare Part B. You should receive your red, white and blue Medicare card no later than 90 days before you actually eligible. If you choose to not enroll in Part B you will have to request in writing or over the phone to Social Security. If you do not want to keep Medicare you can indicate on the back of the card and mail back to the address provided by Social Security/Medicare. If you wait to enroll in part B you could incur a late penalty unless you are consider in an SEP or Special Enrollment Period. For example, if you’re past age 65 still working and decide that you no longer want to work full time and request retirement, you most likely will receive a Special Enrollment. If you are losing your insurance because of a change in employment to retirement status, you will be eligible to enroll in part B of Medicare and apply for secondary insurance. You may at that time decide on a Medicare Supplement or a Medicare Advantage plan. Part B of Medicare has a premium amount that is taken from your monthly Social Security check. This amount is determined by your income. The average cost for part B premium is $104.50, this amount has the potential to change based on CMS and Social Security. You must have Part A an be enrolled in Part B in order to enroll in a Medicare Advantage Plan or apply for a Medigap (Medicare Supplement) policy.

3- Part A of Medicare is your Inpatient/Hospital coverage and includes a $1184 deductible (this is not an annual deductible).

4- Part B of Medicare is your outpatient services, doctors’ visit etc.—you have a $147 deductible under Part B of Medicare. (This is an annual deductible)

5- You are considered to be in your ‘open enrollment period’ or OEP. This means that you can apply for a Medigap or Medicare Supplement without completing any of the health history questions. You cannot be denied coverage because of pre-existing conditions. You are also not required to provide a list of your  medications.

6- You have a 6 month Medigap policy enrollment period which starts the first month you’re both 65 and enrolled in Part B of Medicare.

7- You can enroll in a Medicare Advantage Plan when you first become eligible for Medicare (7 months period that begins 3 months before the month you turn 65 and includes the month you turn 65, and ends 3 months after the month you turn age 65).

8- If you choose a Medicare Supplement you will need to shop for a stand-alone Part D prescription drug plan. Medicare Supplement do not provide or offer Part D plans for prescriptions.

9- If you choose a Medicare Advantage Plan most likely the plan will include your Part D prescription drug planIf you choose a Medicare Advantage Plan please make sure that your current Primary Care Physician, specialists, and hospitals accept the plan and/or payment from the plan (Most plans have a PPO network0. If you fail to research this information prior to enrolling in the plan you could be stuck with paying more for your medical care.

10- Medicare Advantage plans take the place of your Original Medicare. They must be as good as Original Medicare or better. To be competitive they often incorporate dental, vision and preventive benefits not picked up by Original Medicare.

11- If you choose Original Medicare you can purchase a Medigap (Medicare Supplement) policy. This is private insurance and does not operate in place of Medicare. You will KEEP your Original Medicare and the supplement will help pay when Medicare does not pay but, approves.Example: Original Medicare has a $1184 deductible under Part A-The supplement you choose may pick up 100% of this deductible, leaving you with zero out of your pocket. A Supplement plan may help pay for 20% where Medicare is paying 80%- This is considered your co-insurance.

12- With Original Medicare and a Medigap policy you can choose any doctor or hospital that accepts Medicare. There is no PPO networks to choose from. You can receive care from anywhere in the nation as long as that facility or doctor accepts Medicare.

13- Original Medicare pays first and your Medigap policy would pay secondary. If fact, depending on the plan you choose most likely you will have very little out of your pocket, if any at all.

14- Keep in mind, Medicare Supplement policy can increase after the first year. Most companies will lock in an annual rate. After the anniversary year, rate increases will occur. Unfortunately, there is no way to predict the increases from year to year. Its determined by the costs incurred on the policy, increases in healthcare, technology and the area in which you live. Unfortunately, there is no way to counter every circumstance in one article. If you feel there is more to your story and would like further clarification please feel free to contact our agency office in Conway at 843-488-1172.