Are you Medicare Ready?
Turning 65 is a major milestone in anyone’s life. It marks the beginning of a new chapter – one where you can finally start enjoying the fruits of your labor and spend time doing the things you love.
This exciting new phase also comes with some important decisions and preparations, from enrolling in Medicare to planning your retirement. In this article, we’ll guide you through everything you need to know about Turning 65.
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Understanding Medicare Benefits
One of the most important things to consider when you turn 65 is enrolling in Medicare. Medicare is a federal health insurance program that provides coverage for millions of Americans, including those over 65 and people with certain disabilities.
There are four parts to Medicare:
- Part A (Hospital Insurance)
- Part B (Medical Insurance)
- Part C (Medicare Advantage Plans)
- Part D (Prescription Drug Coverage)
Each part offers different types of coverage, and it’s essential to understand what each one covers to make an informed decision.
Understanding Medicare in Oregon
According to the Centers for Medicare & Medicaid Services (CMS), the following is an overview of Medicare enrollment in Oregon for 2022.
- Oregon has a total of 899,748 people registered in Medicare.
- The average Medicare Advantage monthly premium declined somewhat from the previous year.
- In 2022, Oregon will have 132 Medicare Advantage plans available, up from 128 in 2021.
- There are 12 different Medigap plans available for 2022.
Turning 65 : Your First Step
How Medicare Works
If you’re turning 65, you might be curious about how Medicare works, what it covers, and how much it will cost. Medicare enrollees in Oregon (and elsewhere in the United States) have three options for receiving their benefits:
What does Medicare cover?
Medicare has four basic parts that cover all the health care and services that are necessary and reasonable.
Here is a quick recap of each part and what they cover.
Part A is typically is premium free.
Part B covers most Outpatient Medical expenses including: DoctorVisits, Surgery, E.R., Ambulance, Radiology, and Labs.
The premium for Part B in 2022 typically is $170.10, although you may pay more depending on your income.
Medicare supplement plans, also known as Medigap plans, supplement your initial Medicare coverage. They might be able to assist you in saving money on out-of-pocket expenses when you go to the doctor. Medicare Supplements will cost an additional premium on top of your Medicare Part B.
This is where we come in, which one will work best for you? You can choose to either enroll in Medicare Advantage or stay in original Medicare or Original Medicare plus Medicare Prescription Drug Plan plus Medicare Supplement. We can discuss pros and cons of each option and see which one will work best for you.
Am I required to get Medicare?
Although Medicare is not required, it can be costly if you do not enroll at the age of 65 and do not qualify for a Special Enrollment Period later on. Late enrollment penalties apply to Medicare Parts A, B, and D, and they can be spendy because the penalty lasts a lifetime. If you’re debating whether or not to enroll in Medicare, take some time to evaluate your options. If you don’t qualify for a Special Enrollment Period, enrolling at 65 is usually a good choice. Feel free to contact us and we can help you.
I am Turning 65, When does my coverage begin?
The month you sign up during your Initial Enrollment Period(IEP) determines when your coverage begins. The first of your birthday month is normally the start of coverage.
If you are eligible for premium-free Part A, your coverage will begin when you turn 65. (If you turn 65 on the first of the month, coverage begins the month before your birthday.) Part B Coverage begins in the month you sign up.
Take a look at the table below:
Other Insurance Plans To Consider
Hospital Indemnity Plans
We recommend Hospital Indemnity plans to cover hospital copayments associated with Medicare Advantage plans. These plans pay you cash per day you are in the hospital that you can use towards your hospital copayments.
Critical Illness Plans: Heart Attack, Cancer, & Stroke Plans
When you experience a major medical emergency, you have more costs than just medical expenses. There are also the expenses of travel, lost work, modifications to your home, and so much more. These critical illness plans that cover heart attack, cancer, and stroke plans pay you a lump-sum amount if you experience these medical conditions. And you can use the cash for whatever you need.
Short Term Home Health Care
“Seven in 10 turning age 65 can expect to use some form of long-term care during their lives.”
*76.3% are six months or less
*82.4% are twelve months or less
Long-term-care plans are expensive if you haven’t started one yet. Short-term-home-healthcare plans offer flexibility and coverage for healthcare so you can recover in your own home.
How much would Medicare cost me?
Medicare requires premiums, deductibles and other cost-sharing for certain services.
Listed below are the basic costs for people with Medicare: Most people won’t need to pay a premium for Medicare Part A as long as you’ve worked for at least 10 years or earned 40 credits based on your Social Security record. Medicare Part B costs $170.10 per month for most people.
When is the best time for me to enroll in Medicare?
Let’s determine your employment status first.
Are you retired?
Now is the best time to take the first step! You can begin the enrollment procedure three months before your 65th birthday. It is the start of your enrollment period. It then lasts for three months following the month you turn 65.
If your birthday is April 22, your enrollment window runs from January to the end of July. If you enroll in Medicare during the three-month window before April, your coverage will start April 1. On the other hand, if you enroll in May, your coverage starts in June.
Are you Still Working?
If you are still covered by your employer’s group insurance. That’s fantastic! You may wish to put off enrolling in Part B or any supplemental coverage if you or your spouse opt to continue working and qualify for employer-sponsored coverage. Make sure that you’re enrolled in creditable coverage before you opt out of Medicare Part B otherwise you may be charged a penalty later on when you decide to enroll on Medicare Part B and Prescription Drug plan.
But if you’re enrolled on creditable coverage, you’ll be eligible for a subsequent special enrollment period in such circumstances.
What are Special Situations?
Here are some examples of special situations:
You have health insurance through your employer and are still working — You can enroll in Part A and Part B at any time as long as you meet the following criteria
- You’re covered by a group health plan.
- You or your spouse work for the company that offers your health insurance (or a family member if you’re handicapped).
Remember: After you or your spouse (or a family member if you’re disabled) stop working or lose group health plan coverage, you have another eight months to join up (whichever happens first). Even if you choose COBRA or other non-Medicare coverage, your 8-month Special Enrollment Period begins when you stop working.
- You’re serving as a volunteer in a faraway country.
- Certain circumstances for TRICARE recipients
Do I need to be on Social Security to get Medicare coverage?
Most seniors rely on Medicare for health benefits in retirement and depend on Social Security as a key income source. These two programs are interrelated. However, engagement in one doesn’t necessarily link to being signed up for the other.
Call Social Security to make sure: 1-800-772-1213 between 8:00 a.m. – 7:00 p.m. Wait times are typically shorter Weds and Fridays or later in the day.
When should I start my Part B?
If you are turning 65, but planning on continuing to have employer coverage through work, you postpone your Part B until you retire, but start your Part A when you turn 65. If you aren’t working or have some type of health coverage, you will want to start your Part B at the same time you start your Part A.
If I'm a veteran, should I get part b?
Do I need to cancel my individual-market coverage?
Yes, if you currently have private coverage in the under-65 market, you’ll need to cancel your previous coverage once you’ve enrolled in Medicare. We are here to help you make sure that you don’t double-pay for coverage you don’t need and make sure you don’t inadvertently cancel your coverage too soon and end up with a coverage gap.
Note that if you’re receiving a premium subsidy in the Health Insurance Marketplace, your eligibility for the subsidy will end when you transition to Medicare.
What If I missed my window, will there be a late enrollment penalty?
There’s a penalty for late enrollment in Medicare Part B, amounting to a 10% premium increase for each full 12-month period that you could have been in Medicare-but did not sign up. Open Enrollment for Medicare Part B from January to March 31 and it takes effect July 1.
Most of the time, you won’t be charged a premium for Part A if you or your spouse paid Medicare taxes for at least 10 years. But if you do not qualify for premium-free Medicare Part A, then your monthly premium increases by 10%, and you have to pay it for twice the number of years that you could have had Medicare Part A-but did not enroll. For example, if you were eligible for Part A for two years but didn’t sign up, you have to pay the higher premium for 4 years.
Your monthly premium for Part D may increase if you go 63 or more consecutive days without prescription coverage.
How does Medicare calculate your late enrollment fee?
1% Penalty rate of the “national base beneficiary premium” X the number of full uncovered months you were eligible for Medicare Part D, but did not sign up. Note that: National Base Beneficiary Premium is $33 in 2022, but may go up each year, meaning your penalty amount may also go up each year.
Do I have to sign up for Medicare again every year?
No, Medicare automatically rolls over every year, unless you decide to change it. You have the option to change from Original Medicare to Medicare Advantage and vice versa, during Annual Open Enrollment.
I have a limited income. Is there anything I can qualify for to help me?
If you have a lower income, you may qualify for your Part B premium to be paid for by the state, and for help lowering your prescription drug costs. Reach out to us and we can help you see if you will qualify.
Can I be enrolled in both Medicare and Medicaid at the same time?
Some seniors may qualify for both Medicare and Medicaid, and when this happens, it usually means they don’t have any out-of-pocket healthcare costs. Ask your trusted local insurance agent, we can let you know if you’re eligible for both.
Can I contribute to my HSA?
The short answer is you cannot contribute to an HSA 6 months before your Medicare Part A begins. If you currently have an HSA, you may withdraw funds to use towards medical expenses even after your Medicare is in effect.
I'm a recent immigrant to the United States. Can I get health coverage if I'm over 65?
Through ACA, seniors who aren’t eligible for Medicare – including immigrants – can purchase guaranteed-issue private Health Insurance Marketplace. They’ll receive income-based premium tax credits to offset the cost if they don’t qualify for particular other government- or employer-sponsored coverage. It is better to speak with our representatives to discuss this concern further.
Will Medicare cover my over-the-counter COVID-19 test?
Medicare does not currently pay for over-the-counter COVID-19 tests. However, Medicare Advantage Plans may cover and pay for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits.
What are the Medicare Enrollment Periods?
Annual Enrollment Period
You can modify an existing original Medicare plan or enroll in a variety of Medicare plans for the first time. During the Annual Enrollment Period, (AEP) which runs from October 15 through December 7.
Open Enrollment Period
You can switch from a Medicare Advantage Plan to a different Medicare Advantage Plan at this time. This runs from January 1- March 31.
General Enrollment Period ( GEP )
If you missed enrolling in Medicare part B, you can enroll from January through March 31 of each year. Enrolling during GEP means your coverage may start July 1. Until then you won’t have Medicare Part B. Most cases if you’re enrolling during GEP, you may have to pay a part B premium penalty.
Medicare Special Enrollment Period
You can change Medicare Plans all year round if based on special qualifying event such as losing coverage, gained or lost Medicaid / Oregon Health Plan or extra help on prescriptions, eligible for Medicare and Oregon Health Plan, moved to a different address, have some chronic conditions or switch to 5 Star review Medicare Plan.
Tips for enrolling in Medicare in Oregon
Here are some tips to remember:
When looking for Medicare plans in Oregon, keep in mind that:
- Private insurance carriers have more flexibility in terms of how they organize their benefits.
- Your plan choice depends on your situation and preferences.
- Allowing Medicare enrollment to creep up on you is a bad idea.
- Plan ahead and start studying the basics of Medicare so you can make an informed decision when the time comes.
Do I have to enroll in Medicare when I turn 65? Yes, it’s essential to enroll in Medicare when you turn 65 to ensure you have access to health insurance coverage.
Can I still work after I turn 65? Yes, you can still work after you turn 65, and there is no age limit for working and earning income.
Do I have to pay for Medicare coverage? Yes, you will have to pay a premium for Medicare coverage, but the amount you pay depends on the type of coverage you choose.
What is the deadline for enrolling in Medicare? You have a seven-month enrollment period to sign up for Medicare, which starts three months before your 65th birthday and ends three months after.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
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*By completing this form, you agree that an authorized representative or licensed insurance agent may contact you by phone,email,text, mail or face to face to answer your questions or provide additional information about your Medicare plan options. Not affiliated or endorsed by Medicare or any state or federal governmental agency.