Medicare Basics For Boomers

by Barbara Nevins Taylor

You get Medicare when you turn 65. Seems simple enough. But how we wish that Medicare were really simple, clear and easy to navigate. Many of us find it too complicated and feel confused and frustrated by the choices and the sign-up procedures.

All of the above was true for me when I signed up. That’s why I began to research and we laid things out here to provide clear Medicare basics for Boomers and everyone.

Even if you are signed up already, you continue to have choices and you may want read on.

Medicare runs open enrollment periods when you can change your plans without any kind of penalty. It’s important to review your plan every year to make sure you are getting what you need. Every year’s open enrollment period begins October 15th and ends December 7th.

Most of us get Medicare Part A at 65

Part A covers:

Hospitalization
Nursing Care
Nursing Home Care
Hospice
Home Health Services

That’s the easy part. It gets complicated because anyone who doesn’t have a full-time job with health insurance needs to sign up for Medicare Part B within three months of turning 65.

Part B covers:

Doctor Visits
Routine Medical Care
Preventive Care
Ambulance Service

If you don’t sign up for Part B within three months of your 65th birthday, you won’t be able to get insurance immediately and you’ll have to pay a monetary penalty. The Medicare Rights Center’s Joe Baker explains, “If you don’t enroll in that initial enrollment period, you have to wait for January or March of that particular calendar year that you enroll in Medicare for coverage that begins on July 1st of that year. And you would have a 10 percent premium penalty for every year that you could have, or should have, signed up for Part B.” We explain more about this in ConsumerMojo.com’s video and post Boomers, Medicare Part B and Costly Mistakes.

Once you sign up for Part B, you confront a range of options because Medicare only covers 80 percent of your health care costs. Jennifer Cohen Smith of United Healthcare says, “When you buy additional insurance, it will cover that 20 percent.”

One of the options is Medicare Advantage. This plan coordinates basic Medicare Part A and Part B and it’s referred to as Medicare Part C.

Generally, you pay about $35 a month. Diane Wenzler of the Benefits Plus Learning Center at the Community Service Society says, “One of the good things about Medicare Advantage is that there is typically no premium, or there’s a low cost premium, and a co-pay.

Medicare Advantage is run by insurers like United Healthcare. An analysis by the Kaiser Family Foundation shows that 15.7 million signed up for Medicare Advantage plans in 2014. Insurers offer HMO plans where you get all your health care from their doctors, hospitals and providers. They also offer PPOs or Preferred Provider Networks where you have a wider choice of doctors, hospitals and the rest.

UHC’s Jennifer Cohen-Smith points out, “With every single Medicare Advantage plan there is a maximum out-of-pocket limit. It will vary by plan. But there is a dollar limit that you can count on that will the very most you can spend.”

Medicare Advantage plans generally include:

Dental
Vision
Hearing
Some offer gym memberships and more

They may offer access to a 24-hour nurse helpline and disease management program to help you manage chronic conditions. But your pool of health care providers is still limited and you may want more. That brings us to Medicare (original) with the Medicare Supplement, or Medigap. It’s call Medicare Part F. You pay a higher monthly premium in addition to the basic Medicare fee, but there’s generally no co-pay.

Diane Wenzler says, “With a Medicare Supplemental plan you can go to a provider that accepts Medicare and see the doctors of your choice.

So who should sign up for Medicare Supplemental?

Medicare Rights Center’s Joe Baker says if you are somebody who travels a lot, or has a second home in another state, you might want to think about original Medicare with Medicare Supplemental because that has no geographic limitations. It covers 90 percent of the doctors across the country.

Medicare Supplemental also includes travel abroad in some plans.

If you take Medicare Supplemental you also need prescription drug coverage. That’s called Plan D, and you’ll pay an additional monthly fee for that. Still, when we asked Joe Baker what he’d advice he’d give his father he said, “I have advised my father. He’s in the original Medicare program with the Supplement and the Part D plan. He travels a lot. He want to have access to as many providers as possible.”

But United Healthcare’s Jennifer Cohen-Smith has a different take for her family. She says, “I do advise my mom and I suggest a Medicare Advantage plan. We’ve grown up in the era of HMO’s and PPO’s and it’s a form of health care that people are comfortable with.” She also likes the fact there are extra benefits that include vision, hearing and wellness coverage.

TIPS TO FIGURE OUT WHICH MEDICARE PLAN WORKS FOR YOU

Make a list of your priorities.

Do you travel? If you do a Supplemental Plan might be best.
Check the plans to see which include your doctors, hospitals and prescription medications.

INSIDER’S TIP

Diane Wenzler of the Community Service Society offers an insider’s tip. “With a Medicare Supplemental, even if they don’t accept Medicare you can ask them if they will accept Medicare for you because doctors can accept Medicare patients on an individual basis.”

WATCH: Our video Figuring Out Medicare Choices. It breaks everything down and walks you through the options.