If you’re turning 65 and are new to Medicare, congratulations! You now have the opportunity to have Medicare coverage. There are different coverage options out there for you, so how do you decide? To make things easier, we’ve put together a list of six questions to ask if you are new to Medicare.
1. What type of Medicare coverage do you get automatically?
Some people get Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), also known as Original Medicare, automatically and other people have to sign up for it. This depends on whether or not you’re getting Social Security Benefits. Visit Medicare.gov to learn more. Unless you choose otherwise, you will have Original Medicare, but you can also decide to get your Medicare benefits from a Medicare Advantage (MA) Plan, also called Part C, provided by a private, authorized health plan.
2. How’s your health?
If you are new to Medicare and consider yourself to be in good health, you may think that Original Medicare is enough. Just keep in mind that Original Medicare has no out-of-pocket limit meaning that there’s no limit on the amount you may have to spend. If you have a lot of doctor’s visits, frequent hospital stays or need help managing a chronic condition then you may need to consider purchasing Medicare supplemental insurance plan (aka MedSupp or Medigap) or enrolling in an MA plan. (We compare the two in a previous blog post.)
3. What extra benefits do you want?
Original Medicare is great basic healthcare coverage for adults ages 65 and older, but it does leave significant coverage gaps. MA plans deliver Medicare Part A and Part B benefits, but many go beyond what Original Medicare offers. MA is generally the only way to get dental services covered under Medicare and some plans include vision and hearing enhancements. They also might include extra benefits that can save you money and help you stay healthy such as transportation to appointments, meal deliveries, routine chiropractic services, routine acupuncture and fitness benefits. We suggest that you take a look at MA plans available in your area to see compare what they offer.
4. Do you need prescription drug coverage?
Original Medicare does not cover prescription drug medications and only covers certain drugs in limited situations. Consider your own (and your family’s) health history and whether you need (or might need) prescription drugs to treat specific health conditions. If you choose to stick with Original Medicare, you’ll also need to enroll in a Medicare Part D prescription drug plan when you’re first eligible for Medicare. You could face a late enrollment penalty if you decide to enroll later. Or, you can enroll in a Medicare Advantage plan with Part D coverage (an MAPD plan). All Aspire Health Plan HMO and HMO-POS plans include prescription drug coverage. Visit our plans & rates page for more benefits highlights.
5. What if you still have coverage by an employer’s plan?
If you are still working passed age 65 when you are first eligible for Medicare, or if you have healthcare coverage under your spouse’s plan, what coverage you want to use is entirely up to you. But we recommend that you do your research. Talk to your HR department or health plan administrator and ask how your health insurance works with Medicare. From there, you can make a decision whether or not to delay signing up for Medicare Part B and/or prescription drug coverage while avoiding a Part B late enrollment penalty.
6. What resources are there to help you navigate Medicare?
Of course, we know that navigating Medicare can be complicated, but there are a variety of trusted sources can help you navigate your rights and coverage options. Aspire Health Plan Advisors are on hand to offer no-obligation, no-pressure support and guidance. Give us a call at (855) 378-9680. (TTY users call 711.) Additional resources include:
- Medicare Counseling (HICAP) – California
- Medicare Rights Center
- Social Security Administration