older couple on swing

Navigating the World of Medicare

Written By: Jacob Bobick, Account Executive

Few topics garner as much attention for new (or experienced) retirees as the federal Medicare program. When I got my start in the financial services world over 20 years ago, my firm specialized in helping people transition into their “non-working” years. We set up pensions, rolled 401(k)s, managed IRAs, that type of thing.

The number one question I got, without fail, was: “what am I going to do about my health insurance?” I realized early on that I had better learn the ins and outs of Medicare to help my clients figure this out!

A New Generation of Retirees and Insurance

It used to be common for a retiree to secure lifelong healthcare benefits for themself, their spouse, and their dependents upon retirement – often after decades of diligent service. Few careers or companies offer that type of retirement package these days. There are several reasons for this, but the most common one is simple: expense.

We have all seen the skyrocketing costs of healthcare, and simply put, employers are no longer interested in footing this bill. That leaves retirees looking at $1,000 or more every month in health insurance premiums. A husband and wife can easily be over $2,000/month just to cover the two of them. Enter, Medicare.

Happy 65th Birthday!

It is a funny thing about birthdays… we all look forward to them every year, as it is our special day. But what we do not look forward to is that number climbing as we get older! I can remember as a kid being excited about my 16th birthday so I could get my driver’s license, then turning 18 so I could stay out a little later, and of course many look forward to turning 21 for obvious reasons… but after that, there aren’t really any more numbers we’re excited about hitting – except, maybe, 65.

Age 65 is generally the trigger for Medicare eligibility so that’s one birthday which sometimes can’t get here soon enough because it saves us money on our health insurance costs.

All the Parts to Medicare

There are four parts to Medicare: Parts A, B, C, and D. Part A covers hospitalization, part B covers doctor visits, and part D covers prescriptions. Most people with “original” Medicare have those three parts. But what about part C? Part C is a managed-care option and does not mix with the others – more on that soon.

If you have a Medicare card, look at it. It will show the dates that parts A and (if applicable) B became effective. Commonly, they are the same date. It is often the 1st of the month in which you turned 65 so if it is your birth month, that is not a coincidence! Sometimes, the part B date would coincide with your retirement, especially if you continued your “work coverage” after turning 65.

If you do not have Medicare yet, there are a few things you will need to consider soon, but the most important is this: it is imperative to start the process before or during the “Initial Enrollment Period”. This seven-month window includes your birth month and the three months immediately before and after. Failure to do so can cause delays, gaps in coverage, and even penalties.

If you are still working and not collecting Social Security, there is some wiggle room, and there will not necessarily be penalties, but I have seen many cases where people waited too long to get the ball rolling and had to go without coverage. That is not something you want to start your golden years with.

If you are unsure about any of this, give us a call! It is something you only get one crack at, so we want to make sure you get it right the first time. I hate to be the bearer of bad news when someone must pay a penalty and/or is going to have coverage denied. For people who get a late start, there are “special enrollment” periods, “general enrollment” periods, and “open enrollment” periods. That is a little too technical for our purposes today, but it is something we are always willing to discuss!

Does Medicare Cover Everything?

Not exactly. Just like they did not intend Social Security to be a sole source of retirement income, they did not design Medicare to be an all-inclusive healthcare plan. There are certain gaps, deductibles, and copays that the participant must pay. That is where Medicare Supplement plans and the Medicare Advantage plans come in.

This is another topic that is technical, so I will give you the basics as we circle back to the “parts” mentioned above. Remember, I said people with original Medicare had parts A, B, and D. That is where a Medicare Supplement plan generally makes an appearance.

If your doctor accepts Medicare, he must accept your supplement plan regardless of the provider. This option is the ultimate in flexibility because there is no network; the coverage works anywhere that Medicare does. Depending on the specific plan, your supplement will pay some or all the deductibles and co-insurance amounts.

A Medicare Advantage plan, on the other hand, comes with a “network” which is a list of participating providers. There is no guarantee that your doctor will accept the plan, even if they accept Medicare patients. That is where it can get a little sticky, as networks can add/drop physicians at any time.

Typically, the premiums are a little more favorable with the Advantage plans, but they have that specific network of providers. This can be especially troublesome for snowbirds who may spend time in different states at different times of the year. Sometimes the copays can exceed the costs saved with the lower premium. As is often the case, “cheaper” is not always better.

Which Plan Is Best For Me?

I hate to say it, but it depends. Everyone’s situation is a little different, and many variables will come into play. Your health, finances, geography all are part of the equation when figuring out what is best.

What I can tell you is that we are here to help! I have been working with my clients on these decisions for over 20 years, and I’m happy to evaluate your situation and give you my advice. Even if you are in a plan that you think you like, but you are not sure, we can review that for you and compare it to what else is out there.

If you have original Medicare with a supplement, you do not even have to wait until the open enrollment period in October to make a change. You are free to explore changes at any time of the year!

Do Not Wait to Start the Process

Especially if you have a triggering event coming up (retirement, turning 65, etc.), make sure you look into this as soon as you can. As mentioned, it is important to have your proverbial ducks in a row. Sooner is always better than later with Medicare!

Do not hesitate to give us a call if you have any questions at all, regardless of age. You could be a Medicare veteran at this point; it still makes sense to review your current plan from time to time- just like any other type of insurance.