If you are over 65 and uninsured or unable to obtain coverage through work or a family member, it’s essential that you learn about the Medicare options and how to sign up for coverage.
What Is Medicare?
Medicare is a federal health insurance program for people age 65 or older. In addition, people of any age can receive Medicare if they have specific disabilities, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS). Although it does not cover all medical bills or most long-term care costs, the program will assist with healthcare costs. When you apply for coverage, you’ll choose from several Medicare options. The option you choose will determine your out-of-pocket costs, which doctors you can see, and whether you’ll need supplemental coverage for prescription drugs, vision, hearing, or dental.
What Are Medicare Options?
The Medicare options you need to know about are Original Medicare (Part A, Part B), Medicare Advantage plans (Part C), Part D (prescription drug coverage), and Supplemental or “Medigap” policies. The coverage included in each Part depends on federal and state laws, national determinations by Medicare, and local determinations in each state.
Original Medicare (Part A and Part B)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home healthcare. Part B covers medically necessary services, supplies, and preventive services, including mental health. You can use any doctor or hospital anywhere in the country that takes Medicare. Original Medicare does not include coverage for most prescription drug costs.
Before Medicare pays its share, you’ll have to pay a certain amount for your care. This amount is called your “deductible.” Then, Medicare pays its portion for covered services and supplies, and you pay your share. Your share is referred to as “coinsurance” or your ”copayment.” The program does not have a cap on how much you might pay out of pocket. Most importantly, Part B usually requires you to pay a monthly premium for coverage.
Medicare Advantage Plan (Part C)
A Medicare Advantage (MA) plan is an “all in one” alternative to Original Medicare. As a type of Medicare health plan offered by a private company that contracts with Medicare, MA plans ordinarily have lower out-of-pocket costs than Original Medicare. Known as “bundled” plans, MA plans must cover all of the benefits ordinarily covered by Part A and Part B. Additionally, MA plans include prescription drug costs. In many cases, you’ll need to use doctors in the plan’s network. Each plan charges different out-of-pocket costs and has different rules for how to get services, so you’ll need to shop around. Different types of MA plans include:
- Health Maintenance Organizations (HMOs),
- Preferred Provider Organizations (PPOs),
- Private Fee-for-Service Plans,
- Special Needs Plans, and
- Medicare Medical Savings Account Plans.
In addition, the plan you choose may include other types of coverage, such as gym memberships, dental, hearing, and vision care.
Medicare Prescription Drug Coverage (Part D)
Medicare Part D provides prescription drug coverage through federal government subsidies. You must be entitled to benefits under Medicare Part A or be enrolled under Part B to be eligible. You must pay a monthly premium to obtain coverage. If you have limited income and resources, you may get this coverage for little or no cost by applying for the Low-Income Subsidy. To secure Part D coverage, you can sign up with a Medicare Prescription Drug Plan to cover prescription drugs while maintaining Original Medicare (Medicare Part A and B). Or you can enroll in a Medicare Advantage Plan that includes prescription drug coverage.
Medicare Supplement (Medigap) Insurance
Private insurance firms sell Medigap insurance to cover some of the “gaps” for services not covered by Medicare. Your Medigap policy can help you pay coinsurance, copayments, and deductibles. It might help cover other benefits like overseas travel emergency coverage. You must be enrolled in both Part A and Part B to be eligible for a Medigap policy. New Yorkers have 12 different Medigap plans to choose from in 2022.
What Should I Know When Applying for Medicare Plan Options?
When you’re turning 65, you can enroll in Medicare up to three months before your 65th birthday, during the month of your birthday, and for three months after. If you get Social Security Benefits, Social Security will automatically enroll you for Original Medicare when you turn 65. If Social Security doesn’t automatically enroll you, you’ll need to sign up using the Social Security Administration’s online application. It’s important to sign up for Medicare prescription coverage or Medigap when you first become eligible, or you may have to pay extra later. You might even pay a premium penalty for your Medicare medication coverage for the rest of your life. Once you’ve enrolled in Medicare, you manage your services online.
How Can An Elder Law Matters Attorney Help With Understanding The Importance Of Medicare Options?
Many people feel intimidated or overwhelmed by health insurance options. When you turn 65, it’s time for you to retire and relax—you shouldn’t be worried about how to shop for health coverage. The good news is that as your Long Island elder law matters lawyer, we understand health insurance and Medicare options for those over 65. We’ve helped many aging New Yorkers make a plan to pay for their medical care. When you contact the Law Office of Andrew M. Lamkin, P.C., we’ll review your financial situation, walk through your eligibility for Medicare, and explain the application process. We’ll discuss possible solutions for how you might pay for your future care while preserving your assets for your family.
Andrew Lamkin is principal in the law firm of Andrew M. Lamkin, P.C., where he focuses his practice in the areas of elder law, estate planning and special needs planning, including Wills and Trusts, Medicaid planning, estate administration and residential real estate transactions. He is admitted to practice law in New York and New Jersey.
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