Baby boomers are turning 65 and becoming Medicare eligible at a rate of 8,000 a day. That’s one every eight seconds and a mass of heartburn when it comes to signing up for Medicare.
That is the federal government’s health insurance plan, which President Lyndon B. Johnson signed into law in 1975, or 50 years ago in July.
As insurance plans go, it’s great.
Medicare is available to anyone who’s eligible for Social Security. What a lot of people who haven’t signed up yet don’t know is that Medicare isn’t free.
Repeat, Medicare is not free.
And what people who aren’t eligible for Social Security retirement benefits may not know is that they can still buy into Medicare for a reasonable price by private insurance standards.
It is also available to someone who hasn’t paid into Social Security or Medicare but whose spouse – or a divorced spouse – has.
Turning 65 is easy, but enrolling in the Medicare plans A, B, D, F and getting it all right the first time is not.
There’s also a variety of supplements you can sign up for, including Plan C or Medicare Advantage. It’s an HMO-style policy that can consolidate Medicare benefits and offer additional coverage, such as vision and dental, not available under Medicare.
Don’t worry about forgetting to enroll.
Starting about six months before that magic birthday, you’ll start getting mail, lots of mail – postcards, pamphlets and letters from insurance companies – reminding you.
They know who you are, where you live and exactly when you turn 65, stuff even your friends don’t know. That’s life in the USA. Don’t freak out.
The most important mail you shouldn’t trash is what comes from the Medicare folks themselves – especially the half-inch-thick manual that covers everything. Keep that and don’t ignore the letters from Medicare.
One good thing is there’s lots of time to sign up for Medicare.
You’ll have seven months to register for benefits and set up your plans: three months before and after your birth month, and your birth month itself.
Still, anyone who has gone through the sign-up process would probably offer this advice: Don’t procrastinate, dilly-dally or lollygag.
Sign up with Medicare before your birthday. That’s the easy part. It will get you started with Plan A, Medicare’s basic hospitalization policy.
“You have a seven-month window,” said Ray Vigil, Social Security’s public affairs officer in El Paso. “Ideally, you want to do it before your 65th birthday, so it kicks in right away.”
You can call Medicare at (800) 633-4277 and speak to a representative for help or visit www.medicare.gov. The system will walk you through the sign-up.
“Medicare does not have local offices,” Vigil said. “It’s simple to sign up by phone or online, but if an individual’s not tech-savvy and needs a real person, then call (800) 772-1213 to make an appointment.
“We still extend people the privilege of walk-in, but if they come without an appointment, they’ll sit here a couple of hours before anyone can get to them.”
Be aware, he said, the Social Security office only offers basic sign-up assistance, not advice or information about supplemental plans.
“If Medicare A and B is the only coverage you have, you will be responsible for tremendous out of pocket charges for an extended hospital stay,” Vigil said.
A Plan F policy will coordinate with Medicare and can greatly reduce that cost.
“There are other supplemental plans available, as well – G, M and N – that will cover costs that Part A and B don’t cover,” he said. “Then, you have Plans K and L, which cover 50 to 75 percent.
“You’re looking for the supplemental plan that costs the least but will cover most of out-of-pocket charges that Plans A and B don’t cover,” he said.
Plan A helps pay hospital bills for people who worked and contributed to Social Security and Medicare for 40 quarters or 10 years. For them, Plan A is free.
People who haven’t paid into Social Security and Medicare, such as teachers, police and firefighters, are eligible for Medicare benefits if they’re married to someone who has paid in for 40 quarters, Vigil said.
And someone who is 65 but has never paid in and isn’t married to a spouse who has can still buy into Plan A. It’s just like buying health insurance.
“You can purchase the insurance for $407 a month,” Vigil said referring to Medicare Plan A coverage. “Not very many people do it. Those who do are usually from foreign countries who are pretty well off.”
Plan B goes with Plan A and helps cover the cost of outpatient surgery, doctor visits, screenings, equipment like walkers, therapy and more. It’s not free.
The standard cost of Plan B coverage is $104.90 a month, but people with a high income will pay more. But even with Plan A and B, you may still run into deductibles and copayment charges that can run as high as 20 percent of the cost of services.
If you have retired and are receiving Social Security payments, the Plan B premiums will be deducted from monthly payments automatically.
But if you have reached 65, enrolled in Medicare and are not taking Social Security yet, you’ll have to pay the Part B premiums by check or automatic debit on a monthly or quarterly basis.
Again, people who are not eligible for Social Security at all but are 65 or over, can buy into Plan B, Vigil said, for the same $104.90 a month.
There is help for people with low incomes who can’t afford the premium, copayments or deductibles.
“Medicare Savings Plans the state offers through Health and Human Services can help you pay the premiums and other costs,” Vigil said.
A savings plan can also help people who are limited in income and resources to include those who may have worked but didn’t accumulate 40 paid quarters of contributions to Medicare.
People who are eligible for Medicare but are working past retirement age and still have health insurance through their employer should still sign up for Medicare Part A, but may not need to enroll in Plan B.
Then, the private insurance will provide primary coverage and Medicare, secondary coverage. If that describes your situation, you will have eight months to sign up for Plan B when you retire.
Plan C is where Medicare goes private. Medicare Advantage Plans, as it they are known, are very similar to private insurance plans in that they may cover hospital and doctor bills, doctor visits and drug prescriptions.
Medical Advantage Plans offered by Blue Cross, Humana and many other insurers also offer coverage for dental work, eye exams, vision care and other services Medicare doesn’t cover.
“Before an individual switches form traditional Medicare to Medicare Advantage or back, you have to do a lot of homework,” Vigil said. “You should never pay more than $104 plus a month for Medicare, but under Medicare Advantage, you have to decide what you want to sign up for.
Part D is the prescription drug coverage that President George Bush established in 2003.
“This is very complicated,” Vigil said. “There are 30 different plans that people can select from, and what’s best depends on which has the drugs you need.”
Monthly prescriptions can range from as low as $15 a month for someone who, say, has only one prescription for an anti-cholesterol drug, or may go as high as $152 a month for multiple prescriptions, Vigil said.
Monthly premiums also depend on income.
Copayments can range significantly for the same medicine between two companies charging virtually identical monthly premiums.
Choosing the wrong policy can cost hundreds of dollars extra annually, so you have to be sure what you’re getting.
Medicare can help you find the right policy over the phone. In El Paso, there’s another option for people looking for more personalized assistance.
“The Area Agency on Aging can guide you through the process and help you sign up with one of the prescription programs,” Vigil said. “That’s about the only organization that can do it here in El Paso.”
Their phone number is 533-0998.
Plan F is an option that, for not much cost, can make the pain and uncertainty of medical coverage go away by guaranteeing the policyholder will not have to fork out additional money for copays or deductibles.
Insurance companies offer the coverage, which makes Medicare the primary insurer. The combination of Medicare and the private coverage means you will hear a medical provider say you have “no financial responsibility” when scheduling surgery or some other pricey medical service.
Plan F and other supplemental plans can also help reduce long-term hospitalization costs.
Plan A’s hospitalization coverage has a $1,260 deductible for the first 60 days in the hospital, $315 for days 61 to 90 and $630 a day after that.
Email El Paso Inc. reporter David Crowder at email@example.com or call (915) 534-4422, ext. 122 and (915) 630-6622.