Q & A: May 2019

Q & A: May 2019

Q:  Help!  I’m turning 65 soon. My daughter says I should sign up for Medicare, but I don’t know what to do or where to begin. I work for a small company with 17 employees, where I get my health insurance now. About $25 a week is currently taken out of my paycheck for premiums. My current health coverage isn’t that good.  It has a $2,500 deductible and, because I’m still in good health, I’ve never been able to benefit. 


A:  Your daughter is giving you good advice.  It is time to sign up for Medicare.  If you are still working, and you aren’t yet getting Social Security, then you won’t get Medicare automatically, and you need to apply by your Initial Enrollment deadline.  It’s important to pay attention to Medicare’s enrollment deadlines in order to avoid permanent late enrollment penalties or a lapse in your health insurance coverage, but there is excellent free unbiased help available to steer you through this, as near as your local agency on aging or senior center.

Here are some important tips to get you started:

  • The number of employees at your company determines whether you must enroll at age 65, or whether you can delay, and keep your employer insurance.  Because you work for a company with fewer than 20 employees, Medicare pays first once you turn 65.  That means, if you miss your initial enrollment deadline, you would not be able to use your former employer coverage, even if you and your employer continued to pay the premiums.  People who work for companies with more than 20 employees may delay enrollment and keep their current coverage as long as they meet certain rules.
  • Your Initial Enrollment Period starts three months prior to turning age 65, includes the month you turn 65, and ends 3 months after you turn 65 Advisor editor Mary Johnson, who has helped dozens of friends and neighbors with their Medicare, highly recommends starting the Medicare enrollment process 3 months before you turn 65, in order to have your new coverage become effective in the month you turn 65.  Enrolling in Medicare is done online through the Social Security website at www.SocialSecurity.gov.  Look for the box that says, “Enroll in Medicare”.  Or you can get assistance to help you with this.
  • You will want to sign up for both Part A (hospital insurance) and Medicare Part B (doctor’s and outpatient insurance.)  Medicare Part A usually does not cost anything since the Medicare payroll taxes withheld from workers’ paychecks pay for Part A.  Currently the base premium for Medicare Part B (for individuals with incomes less than $85,000) is $135.50 per month.  Medicare will send you a bill for three months at a time.  You will need $406.50 for that first bill, and please note how quickly you must send it back (usually before the end of the month you received your bill.)  There are several ways to pay.  If you would prefer monthly billing, you may request that, but after you send in your first payment.  Carefully read the information on your monthly bill to learn what you will need to do in order to request monthly billing.
  • In addition to Medicare Part A and B, you will need additional insurance.  Medicare alone does not cover everything, and there are considerable out-of-pocket costs that would suck your life savings right out of any nest egg you might have.  You will need to decide between a supplemental insurance policy, known as Medigap, and a free-standing prescription drug plan, or to join a Medicare Advantage plan with prescription drug coverage.  TSCL strongly recommends that you get free, unbiased counseling, to learn your options and to find the most reasonably-priced coverage for your needs.  All areas of the country offer this Medicare counseling through State Health Insurance Assistance Programs (SHIP).  Although the actual name of the program in your area may vary, you can find the programs operating through your area agency on aging, senior center, or get contact info here: https://www.shiptacenter.org
  • The cost of additional coverage varies significantly.  There are pros and cons that need to be weighed for the type of selection you make for your additional coverage.  For example, you should ensure that your Part D or Medicare Advantage plan is selected based on the drugs you take, and the doctors and hospitals you actually use.  (A Medicare benefits counselor will check this information for you on the Medicare website.)  While the cost of this additional coverage varies, the coverage offered may be identical, and that is why we recommend getting help from a SHIP counselor, who can help you find coverage to keep your costs to a minimum.  Medigap insurance, for example, costs more for the premium, but you would have minimal out-of-pocket costs.  On the other hand, you might pay less for the premium of a Medicare Advantage plan, and perhaps get some additional benefits like vision care, but you would have co-pays or co-insurance for each service.  In Central Virginia, for example, a Medigap G policy may be found for about $110 per month, and roughly $30 per month for the drug plan (or even less).

Get signed up for Medicare now in order to have your coverage start the month you turn 65!