Are you an engaged consumer? If you spend Sunday mornings searching the newspaper for coupons or searching movie theaters for senior discounts, chances are you are an avid consumer who can maximize the use of his or her Medicare benefits.
Reassessing your plan annually is vitally important, since costs and benefits can shift over time. Here are four tips to make the most of Medicare benefits.
Check Your Eligibility
Medicare’s program helps millions of people across the United States access healthcare they require. To maximize these benefits and save money, it’s essential that you understand their available to you, as well as ways you can maximize them to your own advantage.
As your first step, the initial step should be confirming whether or not you qualify for Medicare. If not, open enrollment periods offer the chance for early enrolment – typically beginning three months prior to your 65th birthday and continuing three months thereafter. Failure to enroll within this window could incur late fee penalties.
For eligibility in Medicare, individuals must be citizens or permanent residents of the US, have worked ten years and contributed into the system; you may also qualify if either yourself or your spouse are currently receiving Social Security disability payments or have end-stage renal disease or amyotrophic lateral sclerosis.
As soon as you’re eligible, you have two choices for healthcare coverage: traditional Medicare Parts A and B or Medicare Advantage Plans from private providers – most include traditional Medicare parts A and B while also offering additional benefits like vision or dental coverage. Furthermore, there’s the option to add prescription drug coverage through Part D.
Though all these choices may seem daunting, tools exist that can assist in finding your ideal plan. For example, Medicare and Medicaid Services has an easy-to-use searchable online tool which allows you to narrow plans by location, cost, benefits as well as star rating.
Additionally, it’s wise to consult your employer’s benefits administrator about how your current health coverage interacts with Medicare. For instance, if you still work and are insured through your employer’s plan, Medicare Parts A and B registration could potentially be delayed, with monthly premiums increasing 10% each time an eligible person fails to enroll when eligible.
Medicare enrollees receive an annual wellness visit designed to identify any serious health problems before they occur and enjoy access to free preventive services like mammograms. Plus, Medicare offers discounts for medications.
Shop Around
Making the most out of Medicare requires taking an approach similar to any other product purchase: actively compare costs and benefits before signing on with any plan. By spending some time searching, you could save thousands annually by finding one that meets all of your requirements.
One key way to save on health costs is with private Medicare Part D plans. These plans allow you to purchase prescriptions directly from drug companies at significantly reduced costs than what doctors charge, but keep in mind that pharmacies may or may not participate in your network plan. Tatiana Fassieux, a self-employed Medicare education and training specialist affiliated with California Health Advocates a nonprofit advocacy group notes it’s essential to check provider networks as visiting nonparticipating pharmacies could add significant medical bills if your medication is costly.
Another way to save is by considering how your income affects your premium. Typically, those with higher incomes pay more each month in Medicare premiums compared with those with lower incomes; if your income may fall nearer the higher-income threshold it is worthwhile researching whether you qualify for the Medicare Savings Program (MSP).
Most Medicare enrollees typically experience their Initial Enrollment Period (IEP) around their 65th birthday month; if this window passes you by, another Special Enrollment Period (SEP) is still open to enroll in coverage.
SEPs refer to an 8-month window beginning when your employer coverage terminates and ends when you turn 66, that you can use to make changes to Medicare Advantage/Part D plans, Medigap policies or Medigap supplements as needed. You should also take advantage of yearly opportunities like fall open enrollment to review and compare options available to you.
Consider Medigap
With Medicare Plan G coverage plans, you have an extra layer of coverage beyond what’s covered by original and Medicare Advantage. It also offers some assistance for out-of-pocket expenses not covered by these programs. There are 10 Medigap policies organized alphabetically (Plan A through Plan F), all standardized by the federal government with similar benefits across companies; costs will depend on which option you select.
Some companies provide additional benefits like vision and dental care as well as wellness programs. Furthermore, certain insurers offer Medigap policies with annual out-of-pocket expense caps to give peace of mind should you require costly procedures or treatments in the future.
Medicare Advantage plans offer comprehensive Medicare Part A, B and D coverage rolled into one plan. You must utilize doctors and hospitals within their network; however, out-of-pocket expenses may be lower compared to Original Medicare coverage. It’s important to carefully consider which coverage option best meets your needs as once selected it cannot be changed back later if desired.
To minimize higher future premiums and gaps in coverage, it’s a good idea to sign up during your open enrollment period and buy either Medigap coverage or Medicare drug coverage as soon as you become eligible.
Before choosing a plan, make sure you set aside plenty of time for shopping around and asking questions. Also check with your state insurance department regarding which information is necessary for purchasing Medicare supplements and whether customer service complaints exist with insurance carriers. Finally, inquire as to whether your premiums are issue-age rated or attained-age rated; this may impact future premium costs.
Enroll on Time
The ideal time and way to enroll in Medicare is three months before turning 65; this period is known as Initial Enrollment Period; there are no penalties associated with early enrollment. If you currently work and have group health plans, consult with your benefits manager about how to proceed with enrollment process.
There are also other opportunities to enroll in Medicare. If you miss your Initial Enrollment Period (IEP), or don’t meet eligibility for Special Enrollment Periods (SEP), another enrollment window exists between January 1 and March 31 each year: General Enrollment Periods (GEPs). These enrollment windows open for anyone who did not sign up during an Initial or Special Enrollment Period and don’t qualify for SEP coverage – when enrolling through GEP your coverage will start July 1.
This Special Enrollment Period may also apply if you were recently informed of your Medicare entitlement but denied Part B by Social Security for reasons such as an overpayment, but were then refused Part B by them due to being active with volunteer service abroad for 12 months or longer for tax-exempt organizations, for which premium Parts B or A weren’t signed up at first eligibility. You will have six months from being notified to use this special enrollment period to enroll either part.
You could also qualify for an SEP if you recently lost a job with a large group employer and had your Medicare eligibility terminated as a result of this change in status. An SEP will last six months from when you lose the job; any individuals not enrolling during an SEP later lose Medicaid eligibility will incur a late enrollment penalty that applies throughout their lives; even if they sign up later on.
No matter if you are trying to optimize your Medicare benefits or simply improve the current plan, taking time and considering all available options carefully before selecting one could make a substantial impactful difference on both your health and finances in the long run. Finding the appropriate plan could make all the difference!
