(This is an update to post #22 published back in September 2021, adding significantly to the original content.)
One of the certain signs you’re approaching 65 years old- if you’re an American citizen- is the volume of unsolicited Medicare-related mail coming in either via snail mail or email. As my wife approaches the one-year-prior mark, we’re starting to get all the advertisements from service providers, organizations like AARP, and government agencies- including Social Security and Medicare offices. There’s quite a bit of information to take in, and many of the sources explained things quite well. Unfortunately there are a number of Medicare sign up exceptions (whether you/your spouse are still working after turning 65, whether either of you have eligible medical coverage, etc.) which complicates the sign up choices, and that’s when understanding Medicare starts to get confusing. Therefore, what I explain below are simply the basics for understanding the Medicare sign up process.
If you’re like me, you’ll feel an obligation to read all the Medicare material received (FOMO, or “fear of missing out” on something). I found that after reading the third or fourth package, most of it was duplicate information and the FOMO subsided.
As I approached the 65-year-old threshold, I also started searching for Medicare-related podcasts on Spotify (thanks Andrew), and those were helpful. Of course the Medicare.gov website is an excellent source.
Below are a list of highlights related to Medicare to assist as you approach 65- it is NOT intended to substitute for reading Medicare information sources, but hopefully it will give you a jump start on understanding the program and many of your required steps.
- You may have already figured out that signing up for Medicare requires you to have accounts set up on both the Medicare and Social Security websites.
- Mainly, there’s Medicare Parts A, B, C, D. You’ll hear the phrase “Original Medicare” which includes Parts A and B. As you approach 65, you’ll need to sign up for Medicare Parts A and B (more on the timing of that later). However, if you signed up for receiving Social Security benefits before turning 65, you will have signed up for Parts A and B as part of that process– part of the connection between Medicare and Social Security.
- If you are eligible for Social Security benefits (have at least 40 calendar quarters of work in any job where you paid Social Security taxes), you’ll receive Part A without having to pay monthly premiums. As you start the process for signing up for Part A, the website will automatically tell you whether you’ve hit the minimum threshold for receiving Part A without a monthly premium.
- Part A helps cover hospital costs such as inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. To understand exactly what’s covered under Part A, you’ll need to research under the Medicare website as there are numerous “that depends” situations.
- You’ll sign up for Part B at the same time you sign up for Part A. Part B has a monthly premium, roughly $165 in 2023 unless you’re still working and are a high-income earner, in which case you will pay an additional amount (If your Modified Adjusted Gross Income, or MAGI, is over a certain limit, you will have an additional $60-$150 tacked on to your monthly Part B premium).
- Part B helps cover certain outpatient care from doctors or other health care providers, outpatient care, medical equipment, and some preventative services like shots or annual Wellness visits (don’t call it an annual physical). To understand exactly what’s covered under Part B, you’ll need to research under the Medicare website as there are numerous “that depends” situations.
- There are co-pays and deductibles associated with each Part. Given that we’ve paid into Medicare for most of our working life (as have our employers), and we’re going to continue to pay Part B premiums for the rest of our lives, these co-pays and deductibles are rather frustrating. And they’re probably not going to go down as we get older.
- The network of eligible medical offices taking Medicare is rather large.
- If you and your family have been under the Department of Defense’s Tricare medical program, then Tricare becomes your supplemental insurance after you sign up for Medicare (“Tricare for Life” once you turn 65).
- Warning. If you wait until after your actual 65th birthday to sign up for Medicare Parts A and B, you will lose your Tricare drug prescription benefit. I had planned to wait until the month after my 65th birthday to sign up or Parts A/B, but right after my birthday, I learned that I had lost my Tricare prescription benefit, and it took me a couple of weeks to get it restored.
- If you are eligible for Social Security benefits (have at least 40 calendar quarters of work in any job where you paid Social Security taxes), you’ll receive Part A without having to pay monthly premiums. As you start the process for signing up for Part A, the website will automatically tell you whether you’ve hit the minimum threshold for receiving Part A without a monthly premium.
- If you’re approaching age 65 and haven’t started your Social Security benefits, you have a 7 month window to sign up for Medicare Parts A and B under the Medicare website: the three months before your 65th birthday month, your birthday month, and three months after your birthday month. My birthday is in September, so I had from June through December to sign up for Parts A and B. If you don’t sign up for Medicare Parts A/B until after this window, you will pay lifetime penalties.
- If you’re receiving Social Security (SS) benefits, your Part B premiums will be deducted from your monthly SS. If you’re not receiving SS, then you’ll receive quarterly Part B premium bills via snail mail and email.
- Re-read the warning immediately above this section regarding Tricare drug prescription benefits.
- Part C (Medicare Advantage plans, also known as Medicare supplements) and Part D (prescriptions) are optional. If you have Tricare, you won’t need C or D, but it’s worth reading up on these sections.
- If you go with a Medicare Advantage plan, there are some excellent website “support” companies/services available to help you choose one that fits your medical needs (and pocket book). These services are free of charge. If you talk to such a service and they start talking about their fee for working through them, go find another service.
- From the Medicare website: Medicare Advantage bundles your Part A, Part B, and usually Part D coverage into one plan. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
- You join a plan offered by Medicare-approved private companies that follow rules set by Medicare. Each plan can have different rules for how you get services, like needing referrals to see a specialist. Costs for monthly premiums and services you get vary depending on which plan you join (and what state you’re in).
- Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers. Some plans tailor their benefit packages to offer additional benefits to treat specific conditions.
- With Medicare Advantage, you:
- Need to use doctors who are in the plan’s network (for non-emergency or non-urgent care).
- May pay a premium for the plan in addition to the monthly Part B premium. Plans may have a $0 premium or may help pay all or part of your Part B premiums (Mike’s editorial note: I don’t have Advantage Plan cost information for you. The above information makes it sound like it actually costs less to sign up for an Advantage plan than what we pay in Part B premiums, but I find that hard to believe).
- Can’t buy or use separate supplemental coverage (like Medigap).
- You must have both Part A and Part B to join a Medicare Advantage Plan (End Medicare reference).
Important. You can sign up for Medicare Advantage plans during your initial Medicare signup window, or each year between October 15 – December 7. If you go with an Advantage/Supplement plan, their coverage specifics and costs often change each year. You can use the same support service to recommend whether or not you need to switch to a different plan.
This post really just covers the basics to know as you approach your time to sign up for Medicare. Highly recommend you spend time reading and listening to Medicare-related resources to become educated on this since you’ll be doing Medicare for the rest of your life, and your health is probably going to deteriorate from here on out. You want to learn ahead of time what medical services Medicare does/does not cover.
So far Medicare seems to have worked as advertised.
***As you read up on Medicare and come across information which is contrary to what I’ve listed here, please let me know so I can correct this reference.***