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Eligibility

You are first eligible for Medicare at age 65 or after you have been receiving Social Security disability income for 24 months. Your initial enrollment period starts 3 months prior to your birth month and continues 3 months after your birth month. It’s a good idea to start planning 5-6 months prior to your start date.

Enrolling


If you are receiving your Social Security benefits you will be automatically enrolled and your Medicare card will arrive about 90 days prior to your start date which is the first day of the month you turn 65. If you are not receiving Social Security then you will have to actively enroll at a Social Security office or by applying online at SSA.gov. You can enroll in Medicare up to 90 days prior to your start date. The first decision you have to make is whether to keep Original Medicare or take a Medicare Advantage plan.


Original Medicare


With Original Medicare you can see any Doctor anywhere in the U.S. without the concern of out of Network charges. Generally referrals are not required. There is usually no charge for part A but there is a monthly premium for part B that starts at $144.60. Part A (hospital stays) and part B (Medical-Doctor services) covers about 80% of the approved charge. The remaining 20% is an uncapped amount.

People often purchase a Medicare Supplement plan to fill in the 20% gap and to cover the cost of the part A deductible and co-insurance. As an example with Supplement plan G your annual deductible is just $198. After you have met the deductible, you would have no other co-pays or co-insurance. Most of the Major Carriers (Aetna, United Healthcare etc.) offer Supplement plans. If you want Nationwide coverage and a wide choice of Doctors consider staying with Original Medicare.

Part D: If you stay with Original Medicare you will want to consider purchasing a part D prescription drug plan to help reduce your out of pocket costs for medications. There are currently over 20 plans available and I can help with your plan search.

Part C Medicare Advantage

Part C Medicare Advantage: These are managed care plans that are often HMO’s. You would need to see Doctors who are In-Network and generally a referral is required to see a Specialist. They provide a cap on annual spending, often have a $0 premium, include prescription drug coverage and can offer added benefits like Dental and Vision. If you don’t mind Network restrictions and like the idea of managed care this may be a good fit for you.