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Medicare Issues

Those under age 65 (unless you have been on SSDI for two or more years) need to purchase regular health insurance coverage (either through an employer, on the open market, or through a state or the Federal ACA exchanges).  Those 65 and over who have worked and paid into the Medicare system can get their primary health insurance through Medicare (a few people may have employer retiree coverage). Medicare Part A (which pays for hospital care) was paid for during your working years so costs nothing more in retirement. Part B pays for outpatient care and you have to sign up and start paying when you are 65 (usually through a deduction from your social security payment). Part C, or Medicare Advantage Plans, are a hybrid kind of plan where you get A, B and D coverage put together. Part D plans are prescription drug coverage.

Every year, in late fall-early winter, you can change your options for Part D and C if you want. You should keep track of how things are going this year and consider changing if it’s not working well for you. For instance, if your Part D plan isn’t covering some drug that you take regularly, look for a plan that does cover that medicine. If you have an Advantage plan that isn’t covering your preferred doctor or specialist, consider switching plans or going back to standard Medicare. Things change yearly too, so even if your Advantage plan is working great, pay attention if your chosen provider says they are leaving that plan.

If you sign up for regular Medicare, you will want to buy a “Medigap” plan too. That’s a policy that pays for the deductibles and other things that Medicare won’t cover. Even a small medical issue can cost you thousands if you don’t have supplemental insurance. It’s annoying to have to buy another plan, but that’s the system. You can change these plans yearly too, so review how your policy is working with your particular situation and change if it makes sense.

If you somehow failed to pay premiums and had your coverage terminated during the year, you can still sign up for a new plan for next year. Then you should set up some system for making sure your bills are paid. That’s especially important for those elders who may have memory issues or trouble dealing with paperwork. Try to set everything up so bills are automatically paid. Losing coverage during the year could cost you thousands.

The new generation of retirees won’t get to collect Social Security at age 65. Their retirement age is higher. But, they still have to sign up for Medicare at age 65. Those on Social Security get signed up automatically, those not on benefits have to sign up. Make sure you don’t forget. You don’t have to sign up for Part B if you are still working and covered by some other comparable plan, but when you do retire you have to sign up for part B right away or face a penalty when you sign up late.

One nasty new rule is a financial penalty of higher Part B and D premiums if you make too much money. You wouldn’t think it could happen to you, but certain one-time events, like cashing in an IRA (even if you had to for some other financial reason) can boost your income and force you to pay a higher premiums. Be careful and thoughtful when considering big changes that might be countable as income.