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Top 5 Things Seniors Should Know About Medicare Before They Enroll

Healthcare in the United States can feel complicated. Many seniors look forward to turning 65 so they can get off of employer or individual health care plans only to discover that they have a lot to learn about Medicare.


There are many different Medicare options for seniors to choose from and the right plan(s) for you will depend on a variety of factors including where you live, what prescription drugs you take, whether you have a chronic illness, your income, and what health care providers you see on a regular basis. As Medicare agents, we love helping seniors transition to Medicare and that means sharing our knowledge.

Top 5 Things Seniors Should Know About Medicare Before They Enroll


1. Medicare isn’t always easy to understand but Medicare agents offer free help


Seniors may be surprised to discover just how many different options there are when it comes to receiving Medicare benefits. On top of that, looking at Medicare options isn’t a one-time thing. Seniors should review their plans every year and may need to make a switch as circumstances and plans change from year to year. One of the best things seniors can do when they are getting ready to transition to Medicare or want to make a change to their existing Medicare plan(s) is to get to know a local Medicare agent. Medicare agents provide free consultations to help seniors make the best Medicare choices for them. A local Medicare agent can:


1. Answer your Medicare questions

2. Review your options

3. Confirm coverage for specific health care providers or services

4. Help you apply for programs like Extra Help that can help you pay for Medicare

5. Provide recommendations


2. Medicare can be expensive


In truth, people are often shocked at the cost of Medicare. There is a perception that Medicare is very affordable and it can be, depending on how much you use the healthcare system and what plan(s) you choose, but it definitely comes with out-of-pocket expenses. Seniors transitioning to Medicare benefit greatly from the advice of a Medicare agent who can direct them to the most affordable plan for their needs that will help them manage their out-of-pocket costs.


3. If you’re already enrolled in Social Security benefits you will be automatically enrolled in Original Medicare


Seniors who have applied to receive their Social Security benefits before the age of 65 will be automatically enrolled in Original Medicare (Part A and Part B). While Part A (hospital insurance) doesn’t come with a monthly premium for most Americans, Part B (medical insurance) does. If you still have group health insurance through an employer or retirement benefits then you can opt out of Part B until those benefits end.


If you are not receiving your Social Security benefits when you turn 65 then you will need to apply for Medicare during your initial enrollment window.


3. Seniors are required to purchase prescription drug coverage


Original Medicare does not include coverage for prescription drugs. Since 2006, Medicare Part D has provided prescription drug coverage options for seniors. Even if you are not taking any prescription drugs when you sign up for Medicare, you should choose a Part D plan or enroll in a Medicare Advantage plan that includes Part D with the help of a Medicare agent. By signing up when you are eligible, you will ensure that you have drug coverage if you need it down the road and you will avoid a Part D late enrollment penalty.


4. Medicare has more than one enrollment window


Before signing up, the most important enrollment window that seniors need to know about is the initial enrollment period that lasts seven months, centered around the 65th birthday month. It begins three months before the birthday month and ends three months after. This is the best time to enroll in Medicare Part B and Part D to avoid paying late enrollment penalties.


The Annual Enrollment Period (AEP) is from October 15 - December 7 every year. This is the time to switch to a Medicare Advantage plan from Original Medicare or to a different Medicare Advantage plan. Seniors can also switch back to Original Medicare. Changes go into effect on January 1 the following year. If necessary, seniors can also switch back to Original Medicare between January 1 and March 31.


Special enrollment periods are provided to seniors with certain life changing situations such as a move or retirement from a job that provides group health benefits. For example, seniors have eight months to sign up for Medicare coverage after their group coverage ends.


5. Original Medicare doesn’t cover all services


Original Medicare covers both inpatient and outpatient care but it does not cover all health care services – the main services that seniors may miss out on are dental, vision, and hearing. In addition, there are out-of-pocket expenses like coinsurance and deductibles that must be met. Seniors have options such as adding a Medigap plan and Part D to Original Medicare or bundling their health coverage in a Medicare Advantage plan (Medicare Part C). Speak to a Medicare agent about which plan(s) may be right for you.


Contact a PBC Agent for Help


Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.


At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.


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