Are you caring for a loved one who is approaching their 65th birthday? If so, you’ll probably want to help them enroll in Medicare. The federal government’s healthcare program can offer your loved one substantial savings on everything from hospital stays to doctor’s office visits to prescription drugs. However, it can be a confusing labyrinth of forms, procedures, and policies that may overwhelm your loved one with complex choices and dense information.
Enrollment is generally the first step. You don’t need to wait until your loved one turns 65 to start researching the various Medicare programs available. You and your loved one have a seven-month window to complete the appropriate applications. Medicare’s initial enrollment period starts three months prior to the month that your loved one turns 65 and ends three months after the month they turn 65. So if your loved one turns 65 in April, you may enroll them in Medicare beginning in January and no later than July.
Medicare Parts A and B
Medicare coverage is divided into various parts. The most common are Parts A and B. If your loved one received Social Security benefits before turning 65, they will automatically be enrolled in Parts A and B. These parts are often referred to as Original Medicare. The federal government will mail the enrollment information to your loved one approximately three months prior to their 65th birthday.
Original Medicare Parts A and B cover many hospital and outpatient services, respectively. If your loved one is still covered by an employer health plan (or their spouse’s employer health plan), you may not need to enroll them in Original Medicare. The government has created Special Enrollment Periods that allow employed beneficiaries age 65 and older with employer health coverage to delay their Medicare enrollment until their retirement without being subjected to the usual late enrollment fines and penalties. If you’re unsure as to the coverage or quality of an employer health plan, you should seek out the administrator of said plan. It’s also a good idea to consult with a Medicare counselor at your local Medicare office before delaying your loved one’s enrollment.
If your loved one hasn’t received Social Security benefits prior to age 65, you’ll need to sign them up for Medicare Parts A and B during the seven-month window around their 65th birthday. The government will bill your loved one on a quarterly basis for their Medicare Part B premium costs. If you are caring for your loved one, you should make sure these premiums are paid, otherwise your loved one will lose their Medicare privileges. The sign-up process can largely be done online. The government’s Social Security website is the best place to start. Once you’ve signed them up, your loved one will receive hospital visit coverage with a deductible. They will also receive doctor’s visit coverage with a deductible and 20% co-payments.
If your loved one goes to the doctor regularly, you should consider extra coverage beyond Medicare Parts A and B. Medicare supplemental insurance, also known as Medigap, is provided by third-party health insurance companies on a fee-for-service basis. Medigap plans, as the name implies, are designed to fill the gaps in Medicare’s Part A and Part B coverage. You may also want to consider a Medicare Advantage plan, also known as Medicare Part C. These plans offer managed care and extra services beyond the typical Part A and Part B plans. The costs and availability of these plans vary based on your state of residence. In general, most health care experts will tell you that a Medigap policy combined with Medicare’s Part D prescription drug plan is the best option for supplementing Part A and Part B coverage to cover all of your loved one’s potential medical costs.
To learn more about Medigap plans, you can request to speak to one of our representatives here on the website or by calling 1-(855)-MEDIGAP. You may also wish to contact your local State Health Insurance Program (SHIP) and speak with a counselor. They will give you advice about initial Medicare enrollment as well as whether Medigap or Medicare Advantage will best suit your loved one’s needs.