Open Enrollment - Page 11 - Almost 65?

Open Enrollment
- Page 11
Almost 65?
Time to look at Medicare

By E. Rose Scarff
Contributing Writer

If you are almost 65, it is time to look at Medicare. That means you should start learning about when to sign up and what Medicare covers and what it doesn’t cover. You may need to make decisions about supplemental insurance.

Enrollment in Medicare A and B will be automatic if you plan to retire and take Social Security at age 65. But if you are still working and don’t plan to apply for Social Security yet, you must sign up for Medicare during your initial enrollment period to avoid penalties.

If you are currently covered by health insurance at your work place, you still need to sign up with Medicare and talk to your human resources person about your options for supplemental health insurance through the company.

If you don’t sign up during the enrollment period within three months before and three months after your 65th birthday, there are penalties that add to the cost of your coverage forever. Cost of Medicare? No, it is not free, and it doesn’t cover everything, but more of that as we continue.

So, what are you signing up for? Initially, you sign up for Original Medicare, which is Medicare Parts A and B. Part A covers hospital care and Part B covers outpatient medical care. Enrollment in both are not automatic; you must sign up.

There is no cost for Part A if you have paid into Medicare for at least 40 quarters. If you haven’t worked that long, you must still apply. Based on how long you have paid into Medicare, you will get Part A for a small cost, unless you sign up outside your enrollment period. Then the penalties added on can mount up.

The Part B premium is standard for most of us and is based on a formula set by law. ($134 per month in 2018). You will also pay a share of the cost of most Part B services. If your income is low enough to qualify for state assistance, there is no cost to you. But if your income is over a certain level, the premium will be a little higher than the .

Before going into what Parts A and B cover, let’s mention what they do not cover: vision, hearing, dental, prescription drugs or services like acupuncture or chiropractic. It doesn’t cover nursing home stays unless you have been hospitalized first. It does not cover you when you are out of the United States.

Everything that Medicare covers can’t be addressed in this short article. But the basics are this: Part A is called hospital insurance, but it is really for nursing care. It pays for the nursing care you receive in the hospital, nursing home or rehab center. While you are there it pays for a semi-private room, meals, lab tests, medications, medical appliances and supplies and rehab therapy. It also covers home health care and hospice care. The services that you receive while in the hospital from doctors, surgeons or anesthetists will be billed under Part B.

Medicare Part B will pay for approved medical and surgical services, lab tests, preventive services such as flu shots and screenings, inpatient care and prescription drugs (while in the hospital), some outpatient treatments, therapies and care. It may also cover second opinions for non-emergency surgery and approved home health care not covered under Part A. The list is long, but it does not cover everything.

Although Medicare Part A is free for most of us, all these services are not. You will be responsible for co-pays and deductibles. For Part B services your share of the cost is generally 20 percent of the Medicare-approved cost. For both these reasons it is often a good idea to have Medigap supplemental insurance to cover the gaps in coverage. More on that in a moment.

One supplemental insurance you will want to sign up for is Medicare Part D. This is prescription drug coverage, and it is not offered by Medicare but by private insurance companies. If you take any prescription drugs on a regular basis it is worth your while to shop the various offerings and find the one that covers your drug(s) at the lowest cost and/or out-of-pocket cost to you.

If you decide that having Medigap insurance that covers what Medicare Parts A & B

Medicare continued on page 15