So, it’s time for Medicare — how does that all work?

Medicare in general - people are eligible for Medicare the 1st of the month they are turning 65 generally. Unless their birthday is the first of the month, then it’s the first of the preceding month. 2-3 months before you want to start on Medicare, contact Social Security to enroll in Medicare — you can go online, at www.ssa.gov, you can call at 800-772-1213 or you can go into a local Social Security office. Most of the time people will automatically be enrolled in Part A when turning 65 but you want to be sure that’s happening, especially if you’ve delayed going on to Medicare because you’ve been working and are on a group plan. Social Security in that case will require proof of that group plan coverage to avoid late enrollment penalties. Part A takes care of the bigger things, like hospitalization. Part B theoretically is elective, but if you don’t have it you have only half a plan. It takes care of more ‘outpatient’ types of services. Part A you’ve been paying for your entire working life. Part B you pay for, it’s around $134/month, usually deductible from your Social Security check.

Once you are enrolled in Parts A and B we can look at ‘add on’ coverage. There are two ways to go:

Medicare Advantage - These are also referred to sometimes as Part C. These are plans that usually fill in the gaps on your Medical coverage, and include your Part D drug coverage. Depending on where you live, these may be HMOs or PPOs, they may or may not have a monthly premium in addition to your Part B premium. These can be very good options, again depending on where you live. If you are used to an HMO, and your preferred doctor is participating, you might want to consider one of these.

Medicare Supplements and Part D drug plans - F plans are currently the highest level of coverage you can have in a supplement. G plans are a really close second, the main difference being it doesn’t cover the Part B deductible, which to me isn’t a huge selling point, since that is just $183 for 2018. And it’s a calendar year deductible, not ‘per incident of care’ like the Part A hospitalization deductible. And as of 2020, F plans are going away, and G plans will then be the highest level of coverage. People who have F plans at that time will be allowed to keep them if they want to. N plans also make a very good option, especially if you are trying to keep costs down. With those you have office visit copays of $20, ER copays of $50 which you don’t have on an F or G. It doesn’t cover the Part B deductible, but probably the biggest difference from the F and G plans, Ns don’t cover Part B Excess Charges — this is the approximately 15% that physicians are allowed to bill over the ‘maximum’ allowed amount by Medicare. Only the government could come up with something like this.

With Supplements, in California, every year around your birthday you can change to a plan of equal or lesser benefits without going through underwriting. What you also need to know, is that if you had a lower level plan and wanted to upgrade, you would always have to go through underwriting which is why most of my clients start off with an F plan. But really, F, G or N can all be good choices.

Part D drug plans - plans really vary in cost, and ‘more’ isn’t always better. To make suggestions on which plans to consider, we need a list of your current medications, including dosage and frequency, and your preferred pharmacy to see what should be a good fit for you.

To review, all drug plans are structured the same, but the benefits/copays within can vary. And the amounts listed here are re-evaluated annually and usually change. Here’s how these work:

• Deductible - some plans have them, some don’t and for 2018, the maximum deductible is $405
• Initial Coverage Level - after the deductible has been met, when between what you pay and the insurance company pays, up to $3750, you are paying copays for most drugs.
• Coverage Gap - also known as the donut hole -- once you go over the $3750, then you are in ‘the gap’ where you get a discount on your drugs, until you get to $5000. You will pay about 44% for generic drugs, and about 35% for brand. And for most of the brand drugs, it’s percentage of a discounted rate.
• Catastrophic coverage - Once you go over the $5000, you will either pay approximately 5% of a drugs cost, or a copay, depending on the drug.

What I base my suggestions on is the ‘estimated annual retail cost’ which includes the premium, the deductible if there is one and the estimated cost for one’s meds.

So there’s a lot to consider, but no need to ‘go it alone’ — give us a call, let us make it easier for you!