Medicare Has Many Moving Parts

Medicare Made Easy

When and how to sign up for Medicare can be confusing. Your Medicare plan options can feel overwhelming. The experts at Imagine Insurance Advisors can help you navigate the process or do a full review of your options with you.

Medicare is the federal health insurance program for U.S. citizens age 65 and older, people under age 65 on disability for at least 24 months, and anyone with End Stage Renal Disease (ESRD) or ALS. You do not need to draw Social Security to receive Medicare. Most people receive premium-free Part A by way of having paid Medicare taxes. Part B has a premium and can vary for high-wage earners (IRMAA) or those with limited income and assets (Medicaid).

Know Your Medicare Enrollment Responsibilities

With the age of full Social Security extending beyond age 65, it is important to know that you are still eligible for Medicare at age 65 regardless of your full Social Security eligibility date or if you plan to draw or not. It is critical you understand this to avoid penalties for Part B and protect your Guarantee Issue eligibility for a Medicare Supplement, or Initial Enrollment Period for a Medicare Advantage plan or Part D drug plan. If you are drawing Social Security when you turn 65, you are automatically enrolled in Medicare Part A & B effective the first of your birth month. If you are not drawing Social Security when you turn 65, then your Part A & B enrollments are not automatic and you need to take action with Social Security to apply for Part A & B.

If You Continue Working Past Age 65

There are special considerations for people who continue working past age 65. It may not be necessary to sign up for Part B if you are actively working and have credible insurance through your employer that has more than 20 employees. If your employer has more than 20 employees, then there is no need to sign up for Medicare as your employer insurance would be primary. It is critical that you sign up for Medicare when you stop working or leave employer insurance, whichever happens first. If your employer has less than 20 employees, then Medicare is primary, and you must sign up for Part A & B or you will accrue a penalty.

Signing up For Medicare

• If you are drawing Social Security when you reach age 65, then your Part A & B enrollment is automatic and you should receive your Medicare card 3 months before your birth month. There is nothing else you need to do except work with an agent at Imagine Insurance Advisors to decide which avenue of coverage you want to take.

• If you are not drawing Social Security when you turn 65, you are not automatically enrolled in Medicare Part A or B. You must contact Social Security to sign up for Part A & B, if you will not continue to work and have employer insurance based on active employment which could be yours or your spouse's. Failure to do so may result in a delay in Medicare taking effect and you may incur a penalty. If you do not sign up for Part B when you should have, there is a 10% penalty for every 12 months you go without coverage and that penalty stays with you for life. If you delay, you may not be able to sign up when you need insurance, leaving you in a difficult situation.

Your Medicare Coverage Options

Once you are enrolled in Medicare, you have choices in how you complete your coverage because Part A & B are only the beginning. Having multiple options empowers you with choice and flexibility, but the abundance of options and vague advertising makes it hard to choose which one is right for you.

Only one of these three avenues is the one that you will choose to complete your Medicare coverage:

• Original Medicare (Part A & B) and a Part D drug plan (PDP)
• Original Medicare, a Medicare Supplement and a Part D drug plan
• Medicare Advantage-Prescription Drug Plan (Part C MAPD)

Each one has its own pros and cons, and in many cases, they are subjective. We will help you decide what fits your budget and healthcare needs the most appropriately. We may ask voluntary needs-based questions so that we know what areas of care you need more focus on. There are special cases where your coverage may be something other than the three above.

Original Medicare, Part A & Part B

Original Medicare is a government managed fee-for-service plan that covers most medically necessary healthcare services. You can go to any doctor or hospital that accepts Medicare. Part A is your in-patient hospital, skilled nursing care and hospice coverage. Part B is your out-patient treatment/doctor visit coverage. Original Medicare does not cover prescription medicine (outside of a hospital stay), dental and routine vision, or long-term care over 100 days at a time.

• Part A, Hospital Coverage – Most people will pay $0 for Part A because they paid Medicare taxes while working or by having a spouse that earned premium-free Part A. It covers in-patient hospital, skilled nursing care and hospice coverage.

• Part B, Medical Coverage – Everyone must pay a premium for Part B unless you are approved and re-certify annually for Medicaid through your state. High wage earners pay a higher Part B premium. This is called the Income Related Monthly Adjustment Amount (IRMAA) and is based on your MAGI on your tax return, always on a two-year look back. If you have limited income and assets, you may qualify for a level of Medicaid that pays your Part B premium. See our FAQ page for more information on Part B premiums, IRMAA and Medicaid. Part B has an annual calendar-year deductible and covers doctor visits, diagnostic tests, outpatient surgery and treatment, physical and mental therapy and durable medical equipment. Part B is what people use the most.

You can find out what Medicare covers by going to www.medicare.gov, or by using the Medicare & You Handbook which can be downloaded (or by requesting a hardcopy) from the site. They update the Medicare & You Handbook every October.

Avoid Making Mistakes! Have An Agent On Your Side!

We know the enrollment rules can be confusing for you and the potential for delayed coverage or penalties can be stressful. Let us assist you in understanding what you need to do and when. Whether your 65th birthday is coming up, you're over age 65 and retiring soon, or you are getting Medicare due to a disability, we understand your coverage options and enrollment periods. Call us as soon as you know when you plan to retire, so we can set up a timeline of action for you to ensure a smoother transition to retirement. Delayed action can have negative consequences. We also specialize in Medicare options for beneficiaries under 65 on disability. Read our FAQ page for more information.

Don't make a mistake; get the help you need to navigate Medicare for the first time or re-evaluate how you are covering yourself after having made your initial decision. The friendly agents at Imagine Insurance Advisors take their role in informing you of your choices in easy-to-understand terms seriously. Contact us for a complimentary, confidential, no-obligation appointment to discuss your Medicare options.

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