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Understanding Medicare
If you are retired or approaching retirement, it’s important to understand the details of Medicare so you can plan accordingly. Review this infographic to gain insight into Medicare basics, Medicare eligibility requirements, the differences between Medicare and Medicaid and more. An Ameriprise financial advisor can also provide guidance based on your health care needs in retirement and help you make the most of your Medicare benefits.
Age 65 or older qualify for full Medicare benefits if:
- You are a U.S. citizen or permanent resident for the past five years.
- You are receiving or are eligible for Social Security benefits or Railroad Retirement Benefits.
- You or your spouse is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.
Under age 65 or older qualify for full Medicare benefits if:
- You are entitled to Social Security disability benefits for at least two years.
- You receive a disability pension from the Railroad Retirement Board and meet certain conditions.
- You have Lou Gehrig’s disease (ALS).
- You are a kidney dialysis or kidney transplant patient.
Medicare parts A-D
What are the differences between the four parts of the program?
Part A: Hospital insurance
- Covers care you receive while you are inpatient at a hospital or skilled nursing facility.
- Most people pay no premium for Part A. But you will pay a deductible and co-pays.
- In 2023, the deductible for hospitalizations is $1,600. Coinsurance range from $0 to $800, depending on the length of your hospital stay.
- If you are currently saving in an HSA make sure to discontinue contributions 6 months before applying.
Part B: Medical insurance
- Covers doctor visits, routine medical services such as flu shots and emergency medical services.
- You pay a $226 deductible and 20% co-pay for most services provided.
Part C: Medicare Advantage
- Provided by private insurance companies, Medicare Advantage plans provide Medicare Part A and Part B coverage, often along with additional benefits including some preventive services, vision and dental coverage.
- Premiums vary by insurer, benefits offered and where you live.
- Rates are regulated by the government. Often premiums can be lower than Medicare Parts A and B.
- Plans can have more barriers to care and may be more restrictive on provider access.
Part D: Prescription Drug Plan (PDP)
- Provides prescription drug coverage.
- These plans are administered by private insurers and can be purchased in tandem with Original Medicare or bundled into your Medicare Advantage plan choices.
- Coverage and costs vary by plan.
- Note: Starting in 2023, Medicare participants will see more comprehensive vaccine coverage as well as the cost of insulin capped at $35 per month.
Medicare Supplemental Insurance (Medigap)?
- Because original Medicare does not cover every healthcare expense, many people elect to buy commercially available Medicare supplement insurance, or “Medigap” coverage. The federal government regulates Medigap policies, but they are sold and administered by private insurance companies. Medigap policies are identified by letters and are standardized to help you shop for providers and premiums. (note that Medigap policies are standardized differently in Massachusetts, Minnesota, and Wisconsin.)
- An ideal time to buy a Medigap policy is during your initial enrollment in Plan B because Medigap plans cannot decline your application or charge a higher premium because of pre-existing conditions. After the Initial Enrollment Period, Medigap plans in most states may decline your application or charge higher premiums.
- If you find that you need to apply for or change the Medigap plan that you are in after that initial enrollment period, consider contacting your local State Health Insurance Program to get counseling on your options.
What are the Medicare enrollment periods?
Medigap Plans
Medigap plans do not have guaranteed issue rights during the annual open enrollment window like other Medicare plans do. You can still change plans, but you may have to fill out a medical questionnaire and go through underwriting. You may be declined coverage and the costs may go up.
If you need to change your Medigap plan after the initial open enrollment, you may have to fill out a medical questionnaire or go through underwriting and you may be declined coverage or have to pay more for coverage.
What is Medicare Advantage?
This alternative Medicare coverage plan is provided by a private insurance company approved by Medicare. It collects your Medicare payments from the federal government. Coverage includes items covered under Part A, B and D along with additional healthcare insurance benefits like dental, vision and $0 cost copays.
How to apply for Medicare
• Visit local Social Security office.
• Call the Social Security Office at (800) 772.1213.
• Mail a signed letter to the Social Security office (include your name, SSN and the date you wish to be enrolled).
• Apply online at www.ssa.gov.
Download our Medicare guide
Choosing your retirement health coverage is an important decision that can be complicated. This guide will help you to understand Medicare and the choices available to you.
Download NowHow an Ameriprise financial advisor can help
Given the costs and milestones for Medicare enrollment, meeting with a financial advisor prior to retirement is an important component of planning for the future. An Ameriprise financial advisor will help you to understand the basics of Medicare, as well as discuss other options to help you cover health costs in retirement so you can feel more prepared for the future.
Or, request an appointment online to speak with an advisor.
At Ameriprise, the financial advice we give each of our clients is personalized, based on your goals and no one else's.
If you know someone who could benefit from a conversation, please refer me.
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1Source: https://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html
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