If you find health insurance over age 65 to be confusing, you have lots of company. This autumn season with the falling leaves is just the time to reacquaint yourself with Medicare as you approach Open Enrollment, the period from October 15 to December 7. If you are just now approaching age 65, and wonder how your ensuing age works with Medicare, you probably could use some guidance. Here is a basic “cheat sheet” to get you started whether you are a Medicare recipient now or a newbie. Always remember to get separate advice when confused.
1. Basic things to know for persons turning age 65. If you are still employed and receive health insurance through work, whether Medicare Part A that is basically hospital insurance, is primary or secondary to your employer’s health plan could depend on the size of your employer. Medicare B, out-patient doctors and medical supports and equipment, and Medicare D, prescription drugs, may not be needed if you have a creditable plan at work covering these. If you do not know, check with your HR department or resources given at the end of this article.
2. If you need to sign up for Medicare because you do not have equivalent coverage through work and are turning age 65 you have a window of time during which you can make your choices. For people who are turning 65 and do not have employer related health insurance or for those who had employer provided coverage and are no longer covered, it is especially important to make timely choices on Medicare B and Medicare D because there are penalties for late enrollment.
3. Choices you initially make could lock you in later. On turning 65 or on initial eligibility, you might choose a Medicare Advantage Plan (an HMO, PPO, PFFS) or a Medicare Supplement (Medigap) or you could simply have basic Medicare. If you choose a Medicare Supplement at that time, you will not have to go through medical underwriting then or later to see if you are healthy enough for that specific coverage. If you choose a Medicare Advantage Plan and later want a Medicare Supplement, you will probably have to undergo medical underwriting to change. This could be a problem if your health later deteriorates. So the safer choice, if you can afford it, might be to start with a Medicare Supplement. You can switch from a Medicare Supplement to a Medicare Advantage at open enrollment later without underwriting. Retirees who are offered only an HMO or a PPO might not initially have this choice.
4. Open Enrollment is for Medicare Advantage Plans (HMO’s, PPO’s, etc.) and for Medicare D (Prescription Drugs). If you are already on Medicare and want to change your Medicare Advantage Plan or Prescription Drug Plan (PDP), then you basically have from October 15 to December 7 to do it.
5. All Medicare Supplement (Medigap) Plans With the Same Letter Have the Same Coverage. The differences between companies are in the servicing and cost. If you buy a Medicare Supplement Plan from United Healthcare, for instance, and you compare it to a Medicare Supplement Plan from Humana, as long as it has the same letter (Medicare Supplement “F,” for instance, Medicare Supplement “G” or Medicare Supplement “N”), it has the same coverage. Therefore, the differences are whether you believe the company has good customer service and how much it costs. If you want to know what each coverage is by the letter, check out www.medicare.gov.
6. There is a wide diversity of coverage among Medicare Advantage (HMO, PPO, PFFS) plans. If considering a PFFS plan, you should realize that they are not all accepted with all medical providers who take Medicare.
7. It is important to know how prescription drugs and medical coverage work and the differences between Medicare Supplement and Medicare Advantage. Medicare Supplement plans do not themselves have prescription drug coverage but rather are often marketed with a separate PDP or prescription drug plan (look for PDP or Rx on the card). Medicare Advantage plans usually come with prescription coverage.
If you are confused, get help. The Chester County APPRISE program staffed by volunteers, is excellent. It can be contacted at 610-344-6035.
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.