During the holiday season, most people are in high hopes, full of laughter and holiday cheer. Families come together, all ages enjoy time together. It’s likely that you’ll be around grandma, grandpa, aunts and uncles who are approaching the eligibility age for Medicare.
Did you know? Many misconceptions exist about Medicare! It can be confusing and hard to understand. Many people are unaware that they are eligible for benefits or that cost savings are just around the corner. In an effort to combat uncertainty and to educate those who are unsure, My Medicare Partners have provided a fun and useful holiday guide on educating others about the many parts of Medicare. Enjoy!
Family members who are unaware of how Medicare works may not know how to enroll. They may think Medicare acts like the Affordable Care Act and Healthcare marketplace. Now would be a good time to inform them of how Medicare enrollment works. At My Medicare Partners we help our clients understand the ins and outs of Medicare.
Uninformed relatives might believe that they must go through piles upon piles of paperwork in order to enroll in Medicare. However, many seniors approaching the Medicare eligible age might not realize how automatic enrollment works.
If your relatives meet one of the following conditions, they’ll be automatically enrolled in what we call Original Medicare (Medicare Part A + Medicare Part B)so long as they meet Medicare eligibility requirements:
- They are already getting benefits from Social Security or the Railroad Retirement Board.
- They are under the age of 65 and have a disability.
- They have ALS (Amyotrophic Lateral Sclerosis, also known as Lou Gehrig’s Disease)
- They live in Puerto Rico and get benefits from Social Security or the Railroad Retirement Board.
Should they satisfy any of the conditions, let them know that they will be receiving their Medicare information around three months before their 65th birthday or on their 25th month of their disability.
Did you know? Medicare doesn’t cover all of your loved one’s medical costs. Medicare Supplement policies (also known as MediGaps) provide additional coverage to help in their time of need. Refer them to My Medicare Partners to talk to one of our licensed agents today. We’ll walk you through the right policy for their needs.
In some conversations with your relatives who are out of the loop about Medicare, you might hear this question:
“What happens if I don’t meet those conditions? I think I may not qualify.”
Ask them if they meet the below criteria. If they satisfy one of them, then they’ll have to sign up for Medicare manually.
- They aren’t receiving benefits from Social Security or the Railroad Retirement Board because they are still working.
- If they have coverage from a current or former employer, then they need to understand how their current coverage works alongside Medicare. They must be informed of this before they begin thinking about enrolling in a Medicare plan.
- They qualify for Medicare because they have an End-Stage Renal Disease (ESRD).
- They live in Puerto Rico and want to sign up for Part B (Part A is automatic). Part A is required for Part B. Because of this, they must fill out and turn in a CMS-40B (a form for applying for Part B).
Signing up can be easy! You can do so in the following ways:
- Online at the Social Security website.
- Visiting their local Social Security office.
- Calling the Social Security Department at 1-800-772-1213.
- If they worked for a railroad, they can call the RRB at 1-877-772-5772.
- Complete and apply for Enrollment in Part B through the CMS-40B form. (Part A is required, even for people who have coverage through their employer or union).
What is Covered in Medicare Part A
In some cases, individuals are confused on exactly what is covered by Part A. Medicare Part A covers medical services and supplies that are considered to be medically necessary to treat a disease or condition. Medicare Part A can cover the following:
- Hospital care
- Skilled nursing facility care
- Nursing home care (non-custodial care, only medically related services in the nursing home)
- Home health services
Medicare Part A would cover treatments at a local hospital like medically reasonable blood tests, surgical procedures, and other services. Think of Medicare Part A as the “hospital room and board.”
To learn more about what the other parts of Medicare cover, please click here.
Enrolling in Medicare Part D
Getting a Part D plan is pretty simple. However, if you declined drug coverage during the time you were first eligibility, there is a small penalty for enrolling late, unless you have other creditable coverage.
To get Medicare drug coverage, you must enroll in a plan that is run by an insurance company or other private company that is approved by Medicare. Each plan is unique when it comes to cost and what prescriptions are covered. My Medicare Partner’s licensed agents are here to help! Give us a call to learn more about your options.
Did you know? Formularies (the list of medications covered by a prescription plan) do change from time to time. This is due to the guidelines set by Medicare. If any current prescriptions are affected, the plan’s provider should do one of the following:
- Provide a written notice at least sixty days before the changes are implemented
- At the time of a refill, provide a written notice of change and a 60-day supply of the drug under the current plan’s guidelines.
If a drug you’re taking is removed from the plan’s formulary, be sure to look into other coverage options! Part D drug plans are not one-size-fits-all!
From our family to yours, we wish you the very best during the holidays! Take this time to enjoy your family and friends, and if the topic of Medicare comes up you’re now better prepared to help!