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The 411 on Medicare

November 11, 2016

Enrolling in Medicare can be a daunting task.

Enter Vickie Carraher, Ohio Senior Health Insurance Information Programs (OSHIIP) volunteer counselor and senior service coordinator at the City of Kettering. She recently led a Medicare seminar, sponsored by Kettering Health Network, describing in detail the ins and outs of enrollment for one of the most confusing, yet important, programs in the country.

Here is some key information from the seminar:

(*Tip indicates a very important helpful hint)

What is Medicare?

Medicare is a federal health insurance program for people who are:

  • 65 years of age
  • Under 65 with certain disabilities
  • With end-stage renal disease (permanent kidney failure requiring constant dialysis or a transplant)

You have two options for receiving Medicare benefits: either through original Medicare (Part A and Part B) or through a Medicare Advantage Plan (Part C). Different parts of Medicare cover specific services:

  • Part A: covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care (no monthly premium is required)

*Tip:  Carraher explained that, if you find yourself at the hospital emergency room, always ask the question, “Are you admitting me or keeping me for observation?” because your Medicare Part A benefits do not apply if you are not admitted. Think about the “A” in Part A standing for “admission.”

  • Part B: covers certain doctors' services, outpatient care, medical supplies, and preventive services (a monthly premium is required for this)
  • Part C (Medicare Advantage Plans): plans offered by private companies that contract with Medicare to provide your Part A and Part B benefits and, most often, Part D. Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), Special Needs Plans, and Medicare Medical Savings Account Plans. These plans often provide additional benefits, such as coverage for vision, hearing, and dental, though you may have to use plan-specific doctors and hospitals.
  • Part D: is for prescription drug coverage. These plans are offered by insurance companies and other private companies approved by Medicare. 

*Tip: Everyone is required to sign up for Part D or will be charged a penalty of 1% per month unless you have credible coverage.

Applying for Medicare

  • Initial enrollment for Parts A and B is at age 65. You can apply three months before, the month of, and three months after your 65th birthday. If you fail to sign up for Part B during the initial enrollment period, you will be charged a late enrollment penalty.
  • If you didn’t sign up for Parts A and B during your initial enrollment period, you can sign up during the general enrollment period between January 1-March 31 every year.
  • Open enrollment is for those aged 65 and older, or disabled under Social Security Disability for two years, who want to enroll in or change their Medicare Advantage or Medicare D prescription plans. Medicare open enrollment for 2017 coverage runs from Oct. 15, 2016, to Dec. 7, 2016. 
  • You do not need to retire to receive Medicare. However, if you do not retire and are keeping your employer-sponsored insurance, you may not need Medicare Part B and/or D
  • You are automatically enrolled if you are receiving Social Security or Railroad Retirement Benefits before age 65
  • Click here to apply for Medicare online. You also can visit your local Social Security office in person or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.

Have more questions? You’ll find a lot of additional resources at www.medicare.gov or www.ssa.gov.

 

 

 


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