New to Medicare? No Worries
What you need to know to get started properly!
Congratulations! You’re turning 65 and all those years of hard work are behind you. You’re looking forward to retirement and want to make sure your healthcare needs are taken care of, at the best price and service, so you can be healthy and have the money to enjoy it.
A few things you need to know…
Initial Enrollment Period (IEP)
There are some important dates coming up. They include:
- Your date of eligibility for Medicare (your start of IEP)
- Your birthday (YAY!)
- How long you have to change your mind if you made a mistake (the end of your IEP).
Let’s look at each one.
Your Eligibility Date: the start of your IEP
Your date of eligibility is on the first day of the month, three months prior to your birthday month. So, for example, if your birthday was May 17th, then your eligibility date would be February 1st. It ends three months after your birthday month, or in this scenario, on August 31st. Your IEP window is a total of seven months.
This is the time to start making some key decisions:
Will I just enroll in Medicare Part A (the hospital portion of Medicare), because I am covered by health insurance provided by my spouse, or I am still working and have health insurance?
Will I be enrolling in Original Medicare (Parts A and B)? Part B is for medical services (doctor appointments, surgeries, diagnostics, durable medical equipment, etc.). If so, which Part D prescription drug program should I buy?
If I go with Original Medicare, which MediGap plan would be best to cover the 20% Medicare doesn’t pay?
Or, will I enroll in Medicare Part C (known as Medicare Advantage), which includes all the above and may have additional benefits, like dental, vision, hearing and others for no additional cost other than the $164.90 (for 2023) deducted from my social security check (some plans may have a premium)?
Whichever you choose, you want to ensure you are enrolled by your birthday month to avoid any penalties.
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What Penalties Can I Incur?
Great question! It all depends on your circumstances. Let’s look at a few scenarios.
I still receive health insurance through an employer or a spouse’s employment that is group health.
If you still receive your health benefits from another source (group insurance from an employer with 20 or more employees), then you don’t have to enroll. However, since Part A is premium-free (if you’ve worked 40 quarters/10 years, paying FICA taxes), enrolling for Medicare Part A is smart. Moreover, if you enroll for both Parts A and B, Medicare will pay first, and your other coverage will pay second. However, you can wait on Parts B and D until you lose the creditable health insurance coverage and creditable prescription drug coverage due to retirement or other conditions.
Once your coverage ends, you must enroll in Medicare Part B within 8 months to avoid the penalty, and Part D within 63 days of losing your creditable prescription coverage.
If you have health insurance that IS NOT group health coverage or the group is fewer than 20 beneficiaries, then you need to enroll in Parts A and B during your IEP. As above, Medicare will pay first and your other insurance will pay second.
What are the penalties?
The penalty for Part B is 10% for each 12-month period you go without it, and 1% for each month you go without Part D or creditable prescription drug coverage.
For example: In 2023, the Part B premium is $164.90 for the average Medicare beneficiary. If you enrolled in Part B 12 months after your birthday month (12 months late), you will pay an additional $16.49, for a total of $181.39. This penalty will never go away. If you are 24 months without coverage, it would be 20% or $32.98, for a total of $197.88, and so on. When the premium increases each year, the penalty will also, since it’s whatever percentage incurred multiplied by the premium amount (penalty % X premium $ = penalty + premium for TOTAL PREMIUM.
Which Plan Should I Choose?
Okay, you now know by when you need to enroll, but what should you choose? Should I enroll in:
- Original Medicare with a PDP (Prescription Drug Plan or Part D)?
- Part C (Medicare Advantage without Part D – more for veterans who receive their prescriptions through the Veterans Administration)?
- Part C (Medicare Advantage plan which includes Part D) and manage my care all under one plan?
These Short Videos Below Will Clarify Your Options!
What Should I Do Next?
Now that you have a better understanding of your options, fill out our questionnaire and we will provide you with a FREE, NO OBLIGATION CONSULTATION on your options in Florida or South Carolina for:
- Medicare Advantage
- Medicare Advantage with Part D
- Prescription Drug Plans (if you choose Original Medicare)
- MediGap Supplements (if necessary)
- Whether you qualify for Extra Help, which provides an additional $5,000 for prescription costs and other savings.
- Whether you qualify for Part-B premium assistance or a Part-B Credit, reducing or eliminating what Medicare deducts from your social security check.
- And any other question you may have.
If you understand Medicare and Medicare Advantage well, and feel confident you can choose the best plan and options for yourself, you can self enroll by click on the SELF ENROLL button below.
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