5 Pro Medicare Enrollment Steps for Success
3 months before your 65th birthday you should be aware that your time is now! Time to enroll into Medicare! But how do you do it and where do you start?
You will first need to reach out to the Social Security Administration. They run Medicare.
FAQ: I don’t want to sign up for my social security benefit. I want to wait to my full retirement age or later. Do I have to sign up for my benefit when I enroll in Medicare?
TS: NO. You do not need to sign up for your social security benefit. You could enroll in Medicare which will be your insurance coverage only. There are three ways you can start the process with the Social Security Administration. Important SSA runs Medicare so regardless of if you want to start your SS benefit or not you will need to communicate with SSA.
- Set an appointment with an agent in your local SSA office to see in person.
- Call and set a phone appointment with an agent in your local SSA office.
- **Easiest** go to https://www.ssa.gov/benefits/medicare/ to enroll in Medicare benefits.
It is important that you start these steps three months before your effective date of Medicare. You want to give the government time to process your application. Note: you will not be able to start your application any earlier than three months. This is an administration rule. There are 11,000 Medicare beneficiaries that turn 65 a DAY so you can imagine the flow of applications and processing timelines.
FAQ: My birthday is on the 17th of the month so that is my effective date?
TS: NO. Your effective date of coverage is the 1st day of your birthday month. Unless you are born on the 1st of the month. Your effective date would be the month BEFORE your birthday month. Example you are born 4/1 your effective date would be 3/1.
FAQ: What am I applying for?
You are applying for government run original Medicare. There are two parts that will take care of your medical needs.
- Part A (Hospital)
- Part B (Medical / Doctor)
Medicare Part A will cover you when you are in the hospital. There are deductibles and co-insurance that you would need to pay the hospital. I have that included below. Most will enroll in a Medicare supplement policy or medi-gap policy (same thing) which will pay for the deductible and co-insurance and leave you with no cost.
|Part A Deductible and Coinsurance Amounts for Calendar Years 2021 and 2022
by Type of Cost Sharing
|Inpatient hospital deductible||$1,484||$1,556|
|Daily coinsurance for 61st-90th Day||$371||$389|
|Daily coinsurance for lifetime reserve days||$742||$778|
|Skilled Nursing Facility coinsurance||$185.50||$194.50|
There is no premium cost associated with this benefit if you have worked a minimum of 10 years or 40 working quarters. This is your entitlement or “free benefit.”
Medicare Part B will cover everything outside of the hospital. That means doctors visits, outpatient procedures, MRI’s, scans, blood draw. The benefit is 80% coverage leaving you with a decision on how to fill the gap for the additional 20%. You will have to decide do you want to leave original Medicare and enroll in a Medicare advantage plan through a private insurance carrier or stay on original Medicare and enroll in a Medicare supplement plan. For purposes of this article, we are going to show examples of an individual enrolling in a Medicare supplement plan.
Medicare Part B does have a premium associated with your enrollment into Medicare. The base premium for 2022 is $170.10 a month. This premium can be collected a few different ways depending on you.
- Quarterly paper bill sent to your household.
- Monthly bank draft from your checking account after you setup an account on mymedicare.gov.
- Or if you are already enrolled in Social Security and are getting a benefit the administration will withhold the Part B premium from your check. (Eventually when you decide to take the benefit however you were paying prior will switch to a deduction from your Social Security Check.)
FAQ: Is there a deductible that needs to be satisfied for Part B?
TS: Yes for 2022 the deductible amount is $233. When you see a doctor, this will be paid first, after that depending on what Medicare supplement plan you have enrolled in there may be no cost for utilization for the rest of the year! Great news and that will allow you to budget for your healthcare costs!
FAQ: Can the administration determine that I must pay more for my Medicare Part B premium?
TS: YES. When you enroll into Medicare the administration will connect with the IRS and look at your tax return from 2 years prior. If you were considered a higher earner, then you will have to pay an additional premium on top of your base Medicare Part B premium of $170.10. This is called Income Related Monthly Adjustment Amount or IRMAA. If they find that you will have to pay additional premium the administration will send you a letter to your household explaining what you will have to pay. The IRMAA amounts are below.
If you disagree with the letter that you have received, you have the right to appeal. Many people do. The system is flawed. The administration is looking at your tax return two years prior. But now you are retired and no longer earning that income. To appeal there will be directions in the letter that you receive.
You can also appeal here: https://www.ssa.gov/forms/ssa-44-ext.pdf
You will need to decide on a private Medicare Supplement carrier to close the gaps that you have. Medicare does not pay for all your care. Depending on the state that you live there are many options of plans and carriers. Regardless of the plan options the private insurance carriers all offer the same plan benefits but the prices are different.
FAQ: Being that all the carriers offer the same coverage I should just enroll in a plan the is cheapest right?
A: WRONG. This is where you should lean on your trusted Medicare Supplement insurance broker and his / her knowledge of the market. Just because the rate is lowest does not mean the premium will stay low for the life of the plan that you are enrolled with that carrier.
There are some carriers that keep their rates low in the market because they are trying to gain quick market share. When that is obtained and the beneficiaries that are enrolled in that plan start using the coverage there could be a spike in premiums.
FAQ: So, if that happens I can switch plans?
TS: The answer is it depends. Are you healthy because depending when you enrolled in your supplemental plan you may have to go through medical underwriting to move to another carrier or plan. You should not have to take that chance. That is why it is important that you go with a carrier that has been in the market for a long time, is A rated and has a history if keeping their premium rates lower for longer.
So, at this point in the process have you applied for Medicare Part A and Part B. You have identified what Medicare supplement plan you need to fill the gaps. The last step is to purchase a stand-alone drug plan. This is Part D of Medicare.
FAQ: Will Medicare Part A and B and my supplement policy pay for my maintenance medication?
TS: NO. You will have to enroll in a stand-alone drug program. This can be accomplished on your own or with broker assistance at Medicare.gov. I have included the link below.
Once you have looked up your RX or we have done that for you we will have a good idea of what insurance carrier will be best for you for the year you enroll.
**Reminder it is always good practice to review your maintenance medications annually during the Annual election period (AEP). ** The time to do this is 10/15 – 12/7 every year.
FAQ: I am not on any medications currently. I do not want to enroll in a drug plan. Can I skip it?
TS: Not a good idea. Once your enrollment period closes you will not be able to obtain a RX plan until the following year. Not only that Medicare will penalize you a late enrollment penalty for not enrolling into your RX plan when you were first eligible for Medicare. That late enrollment penalty gets charged monthly for the rest of your time on MEDICARE! This could be a very costly mistake.
In review you have enrolled in Medicare Part A and Part B. You have obtained a Medicare Supplement policy and based upon your RX needs you have enrolled in a drug plan.
Make sure to look over your Medicare ID card to make sure you have the correct effective dates on it when it comes in the mail. You also want to ensure you have enrolled in the correct Medicare supplement plan when it arrives in the mail. Lastly for your RX review the drug plan and see if it matches what you enrolled in when that comes in the mail.
When you go to use your Medicare, card make sure you reach out to your doctor and ask them one question. Do you take Medicare? Most doctors will answer yes. If they do, they will automatically take your Medicare supplement policy.
FAQ: How do I know if my doctor will take my supplement? Are they in my network?
TS: Original Medicare is your primary insurance now. The Medicare supplement is your secondary. You no longer have any networks, co-pays, max out of pocket costs, pre-approvals, or prior authorizations. You have left managed care net behind! Remember when you had to look up in a directory to see if your doctor participated? That is a frustration of the past! You are free to see any doctor you want! The secondary coverage even know it is a private carrier cannot dictate what it will pay for. If Medicare deems the procedure medically necessary Medicare will pay and then the supplement will pay. This process is called auto adjudication. You the consumer are not involved in this process and that is a good thing!
Most doctors might not even be contracted with the supplemental carrier. They are contracted with Medicare. So, when you see the doctor and they file a claim on your behalf to get paid, Medicare will pay its portion then ask the supplemental carrier for the rest. The private carrier will pay Medicare and then those funds will be paid to the doctor or hospital.
Congratulations you have fantastic benefits! You earned this!