You have to be a rocket scientist to figure out Medicare — and even then, a rocket scientist might need help. That’s where people like Yvette McVey, a board-certified social counselor with the Area Agency on Aging of the Capital Area and the Capital Area Council of Governments, come to the rescue.
Medicare is health insurance for everyone 65 years of age or older, or for people with certain health conditions, regardless of age, such as B. end-stage kidney disease or amyotrophic lateral sclerosis.
Many health insurance companies offer Medicare seminars, but attendees should understand that they are selling their insurance plans and are not recommending what might work best for each individual.
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AGE of Central Texas is offering a free web seminar Saturday to help.
Annual enrollment in Medicare runs from October 15 through December 7 for coverage beginning January 1. When you turn 65, your enrollment period begins three months before your month of birth and ends three months after your month of birth. If you register before the month of your birth, it usually comes into effect on the first day of the month of your birth.
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Part A is hospital insurance, which also covers skilled nursing facilities, hospice care, and home health care.
Part B is for doctor appointments, preventative measures such as vaccinations, outpatient care and some home care.
Part D is for prescription drugs.
How much does Medicare cost?
Most people don’t pay a Part A premium because they or their spouse have contributed to Medicare through paycheck deductions for at least 10 years or 40 quarters. For 2023 there is a $1,600 deductible. Patient hospitalization costs range from zero in the first 60 days to 100% after 150 days.
For Part B, most people pay $164.90 per month in 2023. There is a $226 deductible before Medicare begins paying. Participants usually pay 20% of all costs. Medicare doesn’t have maximum out-of-pocket expenses, so costs can add up.
For Part D, the cost varies depending on the plan you choose and your income.
With Medicare.gov, you can enter your zip code and find plans, including Part D and Medigap (we’ll get to that below), and see what’s available and in what price range. We found Part D plans from $6.60 per month to $81.70 per month and deductibles from $100 to $505 in the 78704 zip code.
What happened to Part C?
Well, that’s a whole different ball of wax. Part C is also known as the Benefit Plan. It most closely resembles your employer-paid or private insurance. You sign up with an insurance company like Humana or Aetna, which covers everything from hospital stays to doctor visits to prescriptions. It’s like having Part A, B, and D in one plan, but instead of covering 80% of everything, you have co-payments, deductibles, and maximum out-of-pocket expenses. The benefit is that you know how much you could possibly spend in a year.
All plans are different, but Medicare.gov has a great resource that allows you to look up your zip code and compare plans based on what they cover, monthly costs, deductibles, and expenses. You can also enter your prescriptions and indicate which pharmacy you use to ensure each prescription is covered.
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Medicare.gov lets you select a few plans and compare them directly. Using Medicare.gov, we found a $0 monthly premium plan that had a $750 deductible for health and a $505 deductible for medication and a maximum of $6,700 on the network. We also found a monthly deductible of $88 with a deductible of $0 for health, $300 for medication, and a maximum of $6,050 on the network. Additionally, there are differences in your co-payments for doctor visits, ranging from $0 to $50 per visit.
Similar to employer insurance, there are network-internal and network-external doctors. You should make sure that all your doctors are on the network.
What is Medigap?
When signing up for Medicare, it’s a good idea to sign up for Medicare Supplement Insurance, also known as Medigap. This covers the 20% that Medicare doesn’t pay, as well as help with deductibles. You pay a monthly premium to your Medigap insurer, and each insurer differs in cost and coverage. Remember, Original Medicare doesn’t have a maximum deductible.
It doesn’t cover everything. You still typically pay extra for long-term care that doesn’t consist of qualified nursing, eye, dental, hearing aids, glasses, and private nursing.
If you enroll in “Original” Medicare—that’s A, B, and D—you should receive your Medigap policy at the time of initial enrollment. The cost of these policies cannot increase even if you become ill, and the insurer cannot turn you down because of previous health problems. If you sign up afterwards, you must go through a qualification process and may be billed based on your age and current health status.
Medigap is only for people with A, B, and D Medicare, not for people with Part C or a benefit plan. If you start with an Advantage plan and decide to switch to an “original” Medicare A, B, and D strategy and attempt to purchase a Medigap plan, you will also need to qualify and pay more.
You may also not need a Medigap plan if your employer offers supplemental insurance for retirees that covers the 20%.
What are the biggest mistakes people make?
The biggest mistake people make when choosing their coverage plan is forgetting to get all the different parts of Medicare. You could take part A, which is the hospital part, but then forget to get part B, the doctor visits, or part D for prescriptions, McVey said.
If they didn’t get Part B, they would pay in full for everything except hospital stays. There are penalties for not receiving Part B if they enroll at age 65. It’s about 10% for every year they don’t sign up.
There are also penalties for not signing up for Part D – 1% extra every month you could have signed up. That’s 12% more per year.
The penalties last for the life of the plan, so signing up for B and D is important if you’re signing up for A for the first time.
The second biggest mistake is taking traditional Medicare without taking out a Medigap plan when you first sign up. People end up paying more for it when they sign up, and their health and age are factored into the cost.
The third mistake is not picking a plan that actually covers you in your zip code. For this reason, it’s important that you use Medicare.gov to choose your plan, whether Part A, B, and D or Part C (Benefit), since it begins with your zip code.
The final mistake is not signing up for utilities. In Texas, support is available through two programs for individuals earning less than $1,133 per month or couples earning less than $1,526 and have resource limits of $7,970 for individuals or $11,960 for couples. In another program, the monthly limits are $2,265 and $3,052.
You can call 800-252-9240 to speak to someone in the state who can help you qualify, or go to hhs.texas.gov/services/health/medicare.
Where to get help
Area Agency for Aging of the Capital Area: 512-916-6178capcog.org/divisions/area-agency-on-aging/ or by email to firstname.lastname@example.org.
AGE of Central Texas Medicare 101 online workshop10 a.m. Saturday, Free but you must register: 512-600-9275 or online at TinyURL.com/AGEoctober2022.