New to Medicare: Checklist

Understanding how Medicare works six months before your 65th birthday. 

There are 4 parts of Medicare:

Part A – This is part of “Original Medicare,” generally provides inpatient medical services. For instance, a hospital stay or nursing facility stay can also cover home care and hospice.

Part B – This is also part of “Original Medicare,” covers outpatient services, treatments, and medications. Such as doctor’s visits, lab work, chemotherapy, diagnostic tests, and prescription medications.

Part C – This is an alternative to original Medicare and provides emergency care and urgent care.

Part D – Optional but is available through private insurance companies that work with Medicare. It provides prescription drug coverage. 

If you decide to stay in original Medicare… you must know that there are some drawbacks.

The main drawback to just having Original Medicare is that you have to pay the 20% co-insurance and there is no cap.

So you have 2 options to help you cover the 20% coinsurance. First you either choose a Medicare Supplement or you choose a Medicare Advantage plan.

Choosing a Medicare Supplement:

There are many reasons why people choose a Medicare Supplement. Here are some reasons why you should go the Medicare Supplement route:

1. I live here 6 months and 6 months away. This mostly applies to people like Winter Texans.
2. I am too sick, or afraid of getting sick. (You have Gauranteed Issue to get a Medicare Supplement). So people who already have a strong disease or condition…a Medigap plan is the best choice. You would have everything covered minus the part B deductible.
3. I travel too much or I work away from home. Again, people who travel a lot need to be covered with a supplement.
4. I want the freedom to see any Doctor I want. Some people don’t like asking doctors for referrals to go see a specialist. Going the Medigap route would avoid asking referrals.
5. If I get cancer, I want to go to the best Cancer Center in USA. Md Anderson loves Medicare Supplement plans. It is also the best choice to have since everything is covered.
6. I don’t want unexpected costs. I don’t want to pay co-pays. Copays mostly deal with Medicare Advantage plans. The only cost that most people pay on the Supplement is the premium and the part B deductible.
7. I want one. I have Money. This is great. But sometimes, most people who retire lose 60% of their income. So if you don’t have money for a Medicare Supplement plan, maybe a Medicare Advantage plan is better for you.

Choosing a Medicare Advantage plan:

Everyone can get into a Medicare Advantage plan. But you must make sure it is the best plan for you. Here are the things to look out for.

• You can enroll into a Medicare Advantage plan three months before your 65th birthday
• Avoid penalties by enrolling in your initial enrollment window
• Use your local insurance agent to determine your estimated costs for Medicare
• Look at any assistance programs if you qualify, such as Medicare extra help or the Medicare Savings program to help pay for the Medicare Premiums 
• Learn how to pay for Medicare
• Decide which plan is best for you (Medigap or Medicare Advantage)
• Sign Up for a Medicare.gov account once you received your Medicare card
• Are your doctors in Network
• What additional coverage and benefits are being offered
• What is the monthly cost
• What are the out of pocket limit
• What is the Medicare Advantage plan star rating