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  • Writer's pictureZSS CPAs

Know the Basics of Medicare

Updated: Apr 25

When you turn 65, you will not get a letter announcing that it's time to start making decisions about Medicare. But there is a timetable — you can start signing up three months before you turn 65, and you have three months after your birthday month to enroll.

You missed the deadline? You may end up paying higher premiums. But if you're still working and have employer-sponsored health coverage, you probably can wait to sign up.

Here's some help on assessing options and picking plans:

  • Make a list of your doctors and decide how important it is to continue seeing them once you are on Medicare.

  • Make a list of medications you take so you can choose a prescription drug plan that meets your needs.

  • Consider your lifestyle — do you stay at home or travel in multiple states or even internationally?

  • Your financial situation — Medicare helps pay for medical care. but it's not free. Choose an option that works for your needs and budget. You might be eligible for federal help.

The Four Parts of Medicare Medicare comes in four parts, and this is where it can get confusing.

Part A is hospital coverage — you are automatically enrolled in Part A when you apply for Medicare.

  • Covers hospital stays, hospice care and some skilled nursing care at a rehabilitation facility.

  • Not totally free — there's a deductible for hospital stays, which tends to go up each year. But you can buy a supplemental or Medigap policy to cover that deductible and some out-of-pocket costs for the other parts of Medicare. Medicare pays for most hospital services for the first 60 days you're in the hospital.

Part B — Doctors and outpatient services

  • Covers doctors' visits, lab tests, diagnostic screenings, medical equipment, ambulance transportation and other outpatient services.

  • Involves more costs, so you may want to defer signing up for part B if you're still working and have insurance through your job or are covered by your spouse's health plan.

Part C — Medicare Advantage

  • A private insurer bundles together parts A and B and frequently part D (see below) into one comprehensive plan.

  • If you decide on a Medicare Advantage plan, you'll still have to enroll in parts A and B and pay the part B premium. In addition, you'll have to choose a Medicare Advantage plan and sign up with a private insurer.

  • Can include dental and vision care, wheelchair ramps, shower grips for your home, meal delivery and transportation to and from doctors' offices.

  • Many Medicare Advantage programs also include prescription drug coverage.

Part D — Prescription drugs

  • You buy a part D plan through a private insurer.

  • There are some premiums and other out-of-pocket costs, either flat copays or a percentage of the prescription costs.

  • There may be an annual deductible.

  • Have very high prescription drug bills? Think Medicare coverage gap, known as "the doughnut hole." Once you've paid a certain amount for your drugs, you'll have to pay no more than a certain percentage for your prescriptions.

There are a lot of moving parts to Medicare, so check to make sure the medicines you take are on the covered lists called formularies. Making the wrong choices can be expensive. You can get phone or in-person help from your State Health Insurance Assistance Programs. The National Committee for Quality Assurance also provides ratings of Medicare Advantage plans. Finally, we're here to help as well.

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