Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Medicare three sixty, where the world of medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with hosts licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three.
Speaker 2 (00:40):
Sixty Welcome back to Medicare three sixty Radio, the show
where we simplify the complex waldom medicare so you can
make confident, informed decisions. I'm your host, Jennifer Alfonso, l,
certified long Term care Specialist, investment Advisor, representative and founder
(01:02):
of Premiere three sixty Insurance and Financial Solutions. Today we're
diving into one of the biggest milestones, turning sixty five,
and what that means when it comes to your medicare journey.
If you're approaching sixty five or helping a loved.
Speaker 3 (01:21):
One who is.
Speaker 2 (01:23):
Grab your notebook, and we'll walk through everything from when
to enerroll and how to avoid penalties and what coverage
options make sense for you.
Speaker 3 (01:39):
Let's start with the basics.
Speaker 2 (01:40):
What exactly happens when you turn sixty five. For most Americans,
turning sixty five is the first time you're eligible to
enroll in Medicare, our federal health insurance program primarily for
people aged sixty five and older. Medicare has four parts.
Part A covers hospital stays and in patient care. Part
(02:05):
B covers doctor visits, outpatient care, and preventive services. Part
C our Medicare Advantage combines Part A and B and
often adds extra benefits. Could also include Part D and
Part D covers prescription drugs. Now. While that might sound simple,
(02:28):
the timing of when you enroll matters a lot. Here's
what people mostly get tripped up. The initial enrollment period.
So your initial enrollment period begins three months before the
month you turn sixty five, includes your birthday month, and
(02:49):
then extends months after. That's a seven month window to apply.
If your birthday is in June, your wind runs from
March first through September thirtieth, so meaning three months before June,
which is March April, May, and then three months after June.
Speaker 3 (03:14):
Which would be July, August, September.
Speaker 2 (03:20):
I highly suggest enrolling early, ideally during those three months
before your birthday to avoid coverage delays. Typically I have
my clients enroll the first of the first month eligible,
which is that three month window. So if it's June
(03:41):
is your birthday, then enroll March first for an effective
day of June. Now, if you already receive Social Security benefits,
you'll automatically.
Speaker 3 (03:56):
Be enrolled in parts A and B.
Speaker 2 (03:59):
Your Medicare will arrive in the mail in about three
months before your sixty fifth birthday, which is awesome because
sometimes it just takes so long, and there's so many
things that sometimes pens from Social Security that they sometimes
(04:19):
need your birth certificate and it has to be the original,
or sometimes they need your naturalization certificate, so things like
that that could delay the process and they want the original,
and I know most people are leary on sending their
original copy, but that is a requirement. They do promise
(04:42):
to mail it back to so cross your fingers. But
I haven't really had anyone complain and say I never.
Speaker 3 (04:50):
Got my documents back.
Speaker 2 (04:53):
But Okay, if you're not drawing Social Security yet and
many also are are waiting till they hit their full
retirement age, you'll need to apply manually through the Social
Security Administration at SSA dot gov.
Speaker 3 (05:13):
So let me talk about that. First.
Speaker 2 (05:17):
You do have to create a user ID and password
with login dot gov or id dot me, and you
will go through rigorously in putting your information, then having
them text you with codes to verify everything, and then
(05:43):
it's long. I feel like it's a long drawn process
and I'm pretty quick with it. Then they will ask
you to take a picture of your driver's license front
and back and a picture of yourself like on your phone.
So keep in mind if you're wearing glasses and you're
(06:04):
not wearing glasses on your on your ID. Your driver's
license removed the glasses a couple months ago. The process
was just not very great for some reason. The systems
weren't capturing your driver's license compared to your picture, and
(06:30):
I even had clients that had to actually go to
the post office because you only had five tries to
do this. But fortunately the last month, I would say
it's gotten better and people are actually getting into the website.
Remember to keep your user IDA and passwords, and then
(06:51):
they also give you like this like active number where
they tell you to have a keep in a safe
place if you need to actually input it to get
into the Social Security website.
Speaker 3 (07:06):
Okay.
Speaker 2 (07:06):
And then in regards to that, you could definitely apply
just for Part A, or if you want to apply
for Part A and B, and if you want to
actually apply for your Social Security benefits, but I do
not recommend completing it at that same time because your
(07:30):
Social Security benefits may require more additional information, so it
will definitely be more of a hold up for your Medicare.
Speaker 3 (07:40):
Okay, that was a lot. Okay. So one of the
most important.
Speaker 2 (07:49):
Questions I get is what if I'm still working at
sixty five, do I still need to sign up for Medicare.
The answer to pads on the size of your employer
and the type of coverage you have.
Speaker 3 (08:05):
So if your employer.
Speaker 2 (08:06):
Has twenty or more employees and offers credible group coverage,
you could delay Part B without penalty.
Speaker 3 (08:15):
But people do this.
Speaker 2 (08:18):
To avoid paying for both Medicare and their work plan.
Speaker 3 (08:22):
So this is the biggest thing.
Speaker 2 (08:24):
You don't have to get Part B, which costs currently
and twenty twenty five one hundred eighty five dollars. Word
is that it probably will go up to two hundred
and five, but we do not have the final results
on that just quite yet, maybe mid November, I'm guessing.
(08:47):
And remember, if you have an income related monthly adjustment,
you will actually might even pay more for it depending
on your income which was two years before. So for
twenty twenty five social Security, we'll look at your income
(09:09):
in twenty twenty three to see if you made more
money than the threshold, and if you did, then you
will get surcharged, meaning you'll pay more than the standard
one hundred and eighty five dollars for twenty twenty five.
(09:31):
I don't recommend getting Part B if you are going
to be on your group plan with more than twenty employees,
if it makes sense. So what I mean about that
is you could compare Medicare versus your group plan. You
(09:51):
will need to look at your premium amount for your share,
right if you have a spouse or if you're on
your spouse's look at your share. You're going to look
at your maximum out of pockets, your co pays, your
co insurance, the network, just the overall quality of the
plan to see which would benefit you more, either going
(10:13):
on a Medicare going on Medicare and the different options
there versus staying on your group plan and what they're
offering you there. If you keep both, you're basically paying
double for your healthcare. However, if your employer has fewer
(10:35):
than twenty employees, Medicare typically becomes primary and you should
enroll in both Part A and B when you turn
sixty five, So that's the rule of thumb. If it's
your company has twenty or more, I mean twenty or
less employees, Medicare becomes primary and you definitely need to
(10:56):
get Medicare when you turn sixty five. The key is
always verifying with your HR department if your plan is
deemed credible. So that's the biggest thing, and most plans
are credible. And just remember, twenty employees or less you
(11:17):
need to apply for Medicare to become primary. So let's
just say you decide to stay on your group a
plan that's credible that's more than twenty employees. Once you
stop working or lose employer coverage, or you're just like,
I do not want my plan anymore even though you're
still working, you get a special enrollment period, an eighth
(11:42):
month window to sign up for Medicare Part B without
any penalty. But I really don't recommend this. I've seen
people get penalized and it's just really hard to prove
that you were in this window. So I would say,
do not leave any gaps in coverage. When you know
you want to get on Medicare or are going to
(12:04):
retire or quit or lose your coverage, apply apply three
months before, just so you get it out of the
way that you're not stressing that month to figure out.
Speaker 1 (12:16):
How to.
Speaker 2 (12:21):
Get on Medicare right and have no gaps in coverage.
So definitely keep that in mind. So now let's unpack
Parts A and B a bit more because there this
is where mistakes can be very costly. Part A is
usually premium free if you or your spouse worked and
(12:43):
paid Medicare taxes for at least ten years. If you
don't qualify for Part A, you could still buy it.
It's kind of costly, and if you could get it
at zero costs, why don't you maybe work to get
those credits or use your spousal credits. So Part B
(13:05):
has a monthly premium currently one hundred eighty five dollars
for most people in twenty twenty five. Higher income individuals
may pay more due to something called IRMA, which you
know I mentioned earlier, which is the income related Monthly
Adjustment Amount. If you delay and rolling in Part B
(13:27):
when you should have, you can have a ten penalty
for each full twelve month period you were eligible but
didn't sign up, and this penalty lasts a lifetime. It's
one of the biggest avoidable mistakes you could make.
Speaker 3 (13:50):
So the thing is make sure that.
Speaker 2 (13:57):
You don't delay it if you don't have credible coverage.
And let's just say, even though the ten percent penalty
off one year may not sound so bad if you
do the calculations, but you're attacking on that additional.
Speaker 3 (14:15):
Fee for the rest of your life. So who wants
to do that, right?
Speaker 2 (14:20):
And also there are penalties for your drugs as well.
So now once you have Parts A and B, you'll
need to decide how you want your medicare delivered. So
there are two paths. Original medicare that's your red, white
(14:43):
and blue card that you receive and it shows a
Part A effective and a Part B effective. You could
add a Medicare supplement also called a metagap, to cover
what original Medicare doesn't, and then you'll also add a
separate Part D prescription plan. Then you have the other choice,
(15:06):
which is called your Medicare Advantage plan, which is Part C.
Speaker 3 (15:11):
It combines the A.
Speaker 2 (15:12):
And B and most of the time D, But there
are Medicare advantage plans that don't have the D, the
all in one alternatives. These plans offer prescription drugs, dental vision, hearing,
gym memberships, and more. You'll typically have a local provider
network and codepays instead of deductibles.
Speaker 3 (15:35):
The right choice depends on your health needs, travel, habits,
and budget.
Speaker 2 (15:45):
Not going to delve too much on the exact services
in these, but these are definitely your options.
Speaker 3 (15:55):
You don't want to be.
Speaker 2 (15:56):
Without coverage because there are gaps in original Medicare that
you would want to avoid, and their costs could be
unlimited if something catastrophic were to happen to you. So
now let's talk about Part D because this one catches
(16:18):
people off guard. Even if you don't take prescription medications
right now, you'll want to enroll in Part D plan
when you're first eligible. Why because if you go sixty
three days or longer without credible coverage. Medicare adds a
permanent penalty to your premium, so plans vary by medication
(16:41):
they cover. So it is important to compare formula lists
and preferred pharmacies every year during the annual enrollment period.
So when you do receive your red, white, and Blue card,
it does have Part A, it does have Part B
on there, but it has the vision Bullpart D, which
(17:02):
you know if you don't know, sometimes you don't take
any drugs and you're like, I don't need that, right, Okay,
So I actually wanted to go back and touch on
Medicare original versus Medicare advantage and getting a medic gap plan.
(17:27):
So to simplify it, let's just say your Medicare supplement plan,
which is a medagap plan, is a la carte, meaning
it's piecemeal together. You do have to purchase a separate
supplemental medigap plan, a separate drug plan, and if you
(17:48):
want other benefits such as say dental vision hearing, you
will need to get a separate plan. Of course, once
in a while there are plans that give you those
additional benefits for an additional cost, but that's just really
based on regional versus a Medicare advantage plan, which is
part C. You could have an HMO a PPO and
(18:13):
then also one without drug plan. So these plans are
your like let's just say your five course meal comes
with the A, comes with the B most of the
time the D and then all the extras like the
dental vision hearing.
Speaker 3 (18:28):
However, these plans.
Speaker 2 (18:31):
Could change every single year. That's why a plan review
is very important, so you know the benefits you're receiving
and are not caught off guard with cost or savings
or just the benefits that you are receiving. Do you
want to go over special cases and spouses, that's a
(18:55):
big one. So the quick note for spouses is that
Medicare is an individual coverage. You can't combine these together.
Everyone gets their own right. Sometimes there's these household discounts,
but that's just you have to get Medicare. So you
could be on one plan, your wife could be on
(19:17):
another plan, or your husband. So even if you've been
covered on your spouse's employer plan, you'll need to enroll
separately for Medicare. So if your spouse is younger than
sixty five and you retire, they'll need other coverage until
they become eligible. If you're caring for an aging parent
(19:37):
or loved one turning sixty five, help them understand these
timelines so it can prevent stress, penalties, and unnecessary costs later.
Speaker 3 (19:47):
So keep in mind.
Speaker 2 (19:48):
Another question people do ask is why I'm on my
spouse's group plan.
Speaker 3 (19:54):
Do I have to get Medicare?
Speaker 2 (19:55):
Right? So now it's just a comparison of what yours
else's group plan cost, the benefits, the maximum out of pockets,
code paste, co insurance and networks compare it to Medicare.
Speaker 3 (20:10):
If it's worth it makes sense.
Speaker 2 (20:13):
For you to get on Medicare, and that's what we're
here to help you with.
Speaker 3 (20:17):
So how do you actually apply?
Speaker 2 (20:19):
I did go over some this a little bit earlier,
but you can enroll in three ways. Visit the SSA
dot gov slash Medicare website. It's the fastest and easiest.
By phone, you could call eight one hundred seven seven
two one two one three and in person schedule an
appointment at your local Social Security office. Make sure you
(20:43):
do have your social Security number, your proof of residents,
and if you're still working, your employee insurance information. So
once you're enrolled, you'll get your red, white and Blue
Medicare card and from there it's time to explore coverage options.
So with this sometimes it's snail mail. Sometimes my clients
never get it, but we are able to look in
(21:04):
the system to see if it's active and we could
help you out with that. So this is where working
with an independent agent my team at Premiere thirty sixty
can really help. We compare all the top carriers for you,
look at your doctors and prescriptions and make sure you're
not overpaying. One of the biggest thing on this Yes,
you could definitely go to Medicare dot gov, compare your choices,
(21:27):
look at your Medicare and you handbook. But the nitty gritty,
the little things the vendors that these insurance company use,
the stability, just the overall feeling of the company and
how they will serve you. We provide better insight if
you are going to get on an HMO plan, then
(21:49):
sometimes you cannot just independently go on Medicare dot gov
and know if all your doctors are in one medical group.
So that's the biggest thing with HMOs is that you
do want to have one primary care doctor that refers
you out to the specialists in the same medical group,
and that's something definitely on Medicare dot gov you cannot
(22:10):
really look at or confirm.
Speaker 3 (22:13):
You would have to.
Speaker 2 (22:14):
Go to each each insurance carrier's website to do that.
In it's just tough to navigate, especially how if you
have a lot of doctors. So okay, let's wrap up
with some des and dotes for turning sixty five. Do
you mark your calendar three months before your sixty fifth birthday.
(22:36):
Do you review your current coverage and confirm it's credible.
Do talk to a licensed Medicare advisor, a licensed independent
insurance agent before you apply, and don't assume Social Security
will automatically enroll for you. Don't delay Part B or
D unless you have credible coverage. Don't pick a plant
(22:57):
just because your friend has it. Everyone's a situation is different,
so definitely that is a big thing. You can't go
off your friends or your relatives plan just because your
situation and your needs may be different. So keep that
(23:18):
in mind. In regards to having a licensed independent insurance
agent help you think that is very important. Do not
let a call center give you a call and you
change it. You're never going to talk to these people again.
They might even be overseas, which is not good. Right,
You're never going to talk to these people again. So
(23:41):
turning sixty five should be an exciting milestone, not a
stressful one. But the right information and guidance you can
make Medicare work for you, protecting your health, your wallet,
and your peace of mind. If you'd like to personalize
Medicare three sixty consultation, or if you're unsure where to start,
reach out to my team at Premiere three sixty Insurance
(24:02):
and Financial Solutions. You could find us online at Premiere
three sixty solutions dot com or call our office. We'd
be happy to walk you through your options step by step.
I'm Jennifer Alfonso Lee and this has been another episode
of Medicare three sixty show where clarity meets confidence in
(24:23):
your Medicare journey. Until next time, stay informed, stay healthy,
and take care of yourself and your loved ones.
Speaker 1 (24:33):
Thank you for joining the program Medicare at three sixty.
Hope you found today's episode insightful and empowering. Remember, understanding
your Medicare options is key to making the right choices
for your health and financial well being. If you have
questions or topics you would like cover it in future
episodes of Medicare three sixty. Don't hesitate to reach out
(24:56):
and speak with our licensed insurance agents until next time.
Stay informed and take charge of your health care journey.
This has been Medicare three point sixty, your trusted source
for all things Medicare Take care,
Welcome to Medicare three sixty, where the world of medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with hosts licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three.
Speaker 2 (00:40):
Sixty Welcome back to Medicare three sixty Radio, the show
where we simplify the complex waldom medicare so you can
make confident, informed decisions. I'm your host, Jennifer Alfonso, l,
certified long Term care Specialist, investment Advisor, representative and founder
(01:02):
of Premiere three sixty Insurance and Financial Solutions. Today we're
diving into one of the biggest milestones, turning sixty five,
and what that means when it comes to your medicare journey.
If you're approaching sixty five or helping a loved.
Speaker 3 (01:21):
One who is.
Speaker 2 (01:23):
Grab your notebook, and we'll walk through everything from when
to enerroll and how to avoid penalties and what coverage
options make sense for you.
Speaker 3 (01:39):
Let's start with the basics.
Speaker 2 (01:40):
What exactly happens when you turn sixty five. For most Americans,
turning sixty five is the first time you're eligible to
enroll in Medicare, our federal health insurance program primarily for
people aged sixty five and older. Medicare has four parts.
Part A covers hospital stays and in patient care. Part
(02:05):
B covers doctor visits, outpatient care, and preventive services. Part
C our Medicare Advantage combines Part A and B and
often adds extra benefits. Could also include Part D and
Part D covers prescription drugs. Now. While that might sound simple,
(02:28):
the timing of when you enroll matters a lot. Here's
what people mostly get tripped up. The initial enrollment period.
So your initial enrollment period begins three months before the
month you turn sixty five, includes your birthday month, and
(02:49):
then extends months after. That's a seven month window to apply.
If your birthday is in June, your wind runs from
March first through September thirtieth, so meaning three months before June,
which is March April, May, and then three months after June.
Speaker 3 (03:14):
Which would be July, August, September.
Speaker 2 (03:20):
I highly suggest enrolling early, ideally during those three months
before your birthday to avoid coverage delays. Typically I have
my clients enroll the first of the first month eligible,
which is that three month window. So if it's June
(03:41):
is your birthday, then enroll March first for an effective
day of June. Now, if you already receive Social Security benefits,
you'll automatically.
Speaker 3 (03:56):
Be enrolled in parts A and B.
Speaker 2 (03:59):
Your Medicare will arrive in the mail in about three
months before your sixty fifth birthday, which is awesome because
sometimes it just takes so long, and there's so many
things that sometimes pens from Social Security that they sometimes
(04:19):
need your birth certificate and it has to be the original,
or sometimes they need your naturalization certificate, so things like
that that could delay the process and they want the original,
and I know most people are leary on sending their
original copy, but that is a requirement. They do promise
(04:42):
to mail it back to so cross your fingers. But
I haven't really had anyone complain and say I never.
Speaker 3 (04:50):
Got my documents back.
Speaker 2 (04:53):
But Okay, if you're not drawing Social Security yet and
many also are are waiting till they hit their full
retirement age, you'll need to apply manually through the Social
Security Administration at SSA dot gov.
Speaker 3 (05:13):
So let me talk about that. First.
Speaker 2 (05:17):
You do have to create a user ID and password
with login dot gov or id dot me, and you
will go through rigorously in putting your information, then having
them text you with codes to verify everything, and then
(05:43):
it's long. I feel like it's a long drawn process
and I'm pretty quick with it. Then they will ask
you to take a picture of your driver's license front
and back and a picture of yourself like on your phone.
So keep in mind if you're wearing glasses and you're
(06:04):
not wearing glasses on your on your ID. Your driver's
license removed the glasses a couple months ago. The process
was just not very great for some reason. The systems
weren't capturing your driver's license compared to your picture, and
(06:30):
I even had clients that had to actually go to
the post office because you only had five tries to
do this. But fortunately the last month, I would say
it's gotten better and people are actually getting into the website.
Remember to keep your user IDA and passwords, and then
(06:51):
they also give you like this like active number where
they tell you to have a keep in a safe
place if you need to actually input it to get
into the Social Security website.
Speaker 3 (07:06):
Okay.
Speaker 2 (07:06):
And then in regards to that, you could definitely apply
just for Part A, or if you want to apply
for Part A and B, and if you want to
actually apply for your Social Security benefits, but I do
not recommend completing it at that same time because your
(07:30):
Social Security benefits may require more additional information, so it
will definitely be more of a hold up for your Medicare.
Speaker 3 (07:40):
Okay, that was a lot. Okay. So one of the
most important.
Speaker 2 (07:49):
Questions I get is what if I'm still working at
sixty five, do I still need to sign up for Medicare.
The answer to pads on the size of your employer
and the type of coverage you have.
Speaker 3 (08:05):
So if your employer.
Speaker 2 (08:06):
Has twenty or more employees and offers credible group coverage,
you could delay Part B without penalty.
Speaker 3 (08:15):
But people do this.
Speaker 2 (08:18):
To avoid paying for both Medicare and their work plan.
Speaker 3 (08:22):
So this is the biggest thing.
Speaker 2 (08:24):
You don't have to get Part B, which costs currently
and twenty twenty five one hundred eighty five dollars. Word
is that it probably will go up to two hundred
and five, but we do not have the final results
on that just quite yet, maybe mid November, I'm guessing.
(08:47):
And remember, if you have an income related monthly adjustment,
you will actually might even pay more for it depending
on your income which was two years before. So for
twenty twenty five social Security, we'll look at your income
(09:09):
in twenty twenty three to see if you made more
money than the threshold, and if you did, then you
will get surcharged, meaning you'll pay more than the standard
one hundred and eighty five dollars for twenty twenty five.
(09:31):
I don't recommend getting Part B if you are going
to be on your group plan with more than twenty employees,
if it makes sense. So what I mean about that
is you could compare Medicare versus your group plan. You
(09:51):
will need to look at your premium amount for your share,
right if you have a spouse or if you're on
your spouse's look at your share. You're going to look
at your maximum out of pockets, your co pays, your
co insurance, the network, just the overall quality of the
plan to see which would benefit you more, either going
(10:13):
on a Medicare going on Medicare and the different options
there versus staying on your group plan and what they're
offering you there. If you keep both, you're basically paying
double for your healthcare. However, if your employer has fewer
(10:35):
than twenty employees, Medicare typically becomes primary and you should
enroll in both Part A and B when you turn
sixty five, So that's the rule of thumb. If it's
your company has twenty or more, I mean twenty or
less employees, Medicare becomes primary and you definitely need to
(10:56):
get Medicare when you turn sixty five. The key is
always verifying with your HR department if your plan is
deemed credible. So that's the biggest thing, and most plans
are credible. And just remember, twenty employees or less you
(11:17):
need to apply for Medicare to become primary. So let's
just say you decide to stay on your group a
plan that's credible that's more than twenty employees. Once you
stop working or lose employer coverage, or you're just like,
I do not want my plan anymore even though you're
still working, you get a special enrollment period, an eighth
(11:42):
month window to sign up for Medicare Part B without
any penalty. But I really don't recommend this. I've seen
people get penalized and it's just really hard to prove
that you were in this window. So I would say,
do not leave any gaps in coverage. When you know
you want to get on Medicare or are going to
(12:04):
retire or quit or lose your coverage, apply apply three
months before, just so you get it out of the
way that you're not stressing that month to figure out.
Speaker 1 (12:16):
How to.
Speaker 2 (12:21):
Get on Medicare right and have no gaps in coverage.
So definitely keep that in mind. So now let's unpack
Parts A and B a bit more because there this
is where mistakes can be very costly. Part A is
usually premium free if you or your spouse worked and
(12:43):
paid Medicare taxes for at least ten years. If you
don't qualify for Part A, you could still buy it.
It's kind of costly, and if you could get it
at zero costs, why don't you maybe work to get
those credits or use your spousal credits. So Part B
(13:05):
has a monthly premium currently one hundred eighty five dollars
for most people in twenty twenty five. Higher income individuals
may pay more due to something called IRMA, which you
know I mentioned earlier, which is the income related Monthly
Adjustment Amount. If you delay and rolling in Part B
(13:27):
when you should have, you can have a ten penalty
for each full twelve month period you were eligible but
didn't sign up, and this penalty lasts a lifetime. It's
one of the biggest avoidable mistakes you could make.
Speaker 3 (13:50):
So the thing is make sure that.
Speaker 2 (13:57):
You don't delay it if you don't have credible coverage.
And let's just say, even though the ten percent penalty
off one year may not sound so bad if you
do the calculations, but you're attacking on that additional.
Speaker 3 (14:15):
Fee for the rest of your life. So who wants
to do that, right?
Speaker 2 (14:20):
And also there are penalties for your drugs as well.
So now once you have Parts A and B, you'll
need to decide how you want your medicare delivered. So
there are two paths. Original medicare that's your red, white
(14:43):
and blue card that you receive and it shows a
Part A effective and a Part B effective. You could
add a Medicare supplement also called a metagap, to cover
what original Medicare doesn't, and then you'll also add a
separate Part D prescription plan. Then you have the other choice,
(15:06):
which is called your Medicare Advantage plan, which is Part C.
Speaker 3 (15:11):
It combines the A.
Speaker 2 (15:12):
And B and most of the time D, But there
are Medicare advantage plans that don't have the D, the
all in one alternatives. These plans offer prescription drugs, dental vision, hearing,
gym memberships, and more. You'll typically have a local provider
network and codepays instead of deductibles.
Speaker 3 (15:35):
The right choice depends on your health needs, travel, habits,
and budget.
Speaker 2 (15:45):
Not going to delve too much on the exact services
in these, but these are definitely your options.
Speaker 3 (15:55):
You don't want to be.
Speaker 2 (15:56):
Without coverage because there are gaps in original Medicare that
you would want to avoid, and their costs could be
unlimited if something catastrophic were to happen to you. So
now let's talk about Part D because this one catches
(16:18):
people off guard. Even if you don't take prescription medications
right now, you'll want to enroll in Part D plan
when you're first eligible. Why because if you go sixty
three days or longer without credible coverage. Medicare adds a
permanent penalty to your premium, so plans vary by medication
(16:41):
they cover. So it is important to compare formula lists
and preferred pharmacies every year during the annual enrollment period.
So when you do receive your red, white, and Blue card,
it does have Part A, it does have Part B
on there, but it has the vision Bullpart D, which
(17:02):
you know if you don't know, sometimes you don't take
any drugs and you're like, I don't need that, right, Okay,
So I actually wanted to go back and touch on
Medicare original versus Medicare advantage and getting a medic gap plan.
(17:27):
So to simplify it, let's just say your Medicare supplement plan,
which is a medagap plan, is a la carte, meaning
it's piecemeal together. You do have to purchase a separate
supplemental medigap plan, a separate drug plan, and if you
(17:48):
want other benefits such as say dental vision hearing, you
will need to get a separate plan. Of course, once
in a while there are plans that give you those
additional benefits for an additional cost, but that's just really
based on regional versus a Medicare advantage plan, which is
part C. You could have an HMO a PPO and
(18:13):
then also one without drug plan. So these plans are
your like let's just say your five course meal comes
with the A, comes with the B most of the
time the D and then all the extras like the
dental vision hearing.
Speaker 3 (18:28):
However, these plans.
Speaker 2 (18:31):
Could change every single year. That's why a plan review
is very important, so you know the benefits you're receiving
and are not caught off guard with cost or savings
or just the benefits that you are receiving. Do you
want to go over special cases and spouses, that's a
(18:55):
big one. So the quick note for spouses is that
Medicare is an individual coverage. You can't combine these together.
Everyone gets their own right. Sometimes there's these household discounts,
but that's just you have to get Medicare. So you
could be on one plan, your wife could be on
(19:17):
another plan, or your husband. So even if you've been
covered on your spouse's employer plan, you'll need to enroll
separately for Medicare. So if your spouse is younger than
sixty five and you retire, they'll need other coverage until
they become eligible. If you're caring for an aging parent
(19:37):
or loved one turning sixty five, help them understand these
timelines so it can prevent stress, penalties, and unnecessary costs later.
Speaker 3 (19:47):
So keep in mind.
Speaker 2 (19:48):
Another question people do ask is why I'm on my
spouse's group plan.
Speaker 3 (19:54):
Do I have to get Medicare?
Speaker 2 (19:55):
Right? So now it's just a comparison of what yours
else's group plan cost, the benefits, the maximum out of pockets,
code paste, co insurance and networks compare it to Medicare.
Speaker 3 (20:10):
If it's worth it makes sense.
Speaker 2 (20:13):
For you to get on Medicare, and that's what we're
here to help you with.
Speaker 3 (20:17):
So how do you actually apply?
Speaker 2 (20:19):
I did go over some this a little bit earlier,
but you can enroll in three ways. Visit the SSA
dot gov slash Medicare website. It's the fastest and easiest.
By phone, you could call eight one hundred seven seven
two one two one three and in person schedule an
appointment at your local Social Security office. Make sure you
(20:43):
do have your social Security number, your proof of residents,
and if you're still working, your employee insurance information. So
once you're enrolled, you'll get your red, white and Blue
Medicare card and from there it's time to explore coverage options.
So with this sometimes it's snail mail. Sometimes my clients
never get it, but we are able to look in
(21:04):
the system to see if it's active and we could
help you out with that. So this is where working
with an independent agent my team at Premiere thirty sixty
can really help. We compare all the top carriers for you,
look at your doctors and prescriptions and make sure you're
not overpaying. One of the biggest thing on this Yes,
you could definitely go to Medicare dot gov, compare your choices,
(21:27):
look at your Medicare and you handbook. But the nitty gritty,
the little things the vendors that these insurance company use,
the stability, just the overall feeling of the company and
how they will serve you. We provide better insight if
you are going to get on an HMO plan, then
(21:49):
sometimes you cannot just independently go on Medicare dot gov
and know if all your doctors are in one medical group.
So that's the biggest thing with HMOs is that you
do want to have one primary care doctor that refers
you out to the specialists in the same medical group,
and that's something definitely on Medicare dot gov you cannot
(22:10):
really look at or confirm.
Speaker 3 (22:13):
You would have to.
Speaker 2 (22:14):
Go to each each insurance carrier's website to do that.
In it's just tough to navigate, especially how if you
have a lot of doctors. So okay, let's wrap up
with some des and dotes for turning sixty five. Do
you mark your calendar three months before your sixty fifth birthday.
(22:36):
Do you review your current coverage and confirm it's credible.
Do talk to a licensed Medicare advisor, a licensed independent
insurance agent before you apply, and don't assume Social Security
will automatically enroll for you. Don't delay Part B or
D unless you have credible coverage. Don't pick a plant
(22:57):
just because your friend has it. Everyone's a situation is different,
so definitely that is a big thing. You can't go
off your friends or your relatives plan just because your
situation and your needs may be different. So keep that
(23:18):
in mind. In regards to having a licensed independent insurance
agent help you think that is very important. Do not
let a call center give you a call and you
change it. You're never going to talk to these people again.
They might even be overseas, which is not good. Right,
You're never going to talk to these people again. So
(23:41):
turning sixty five should be an exciting milestone, not a
stressful one. But the right information and guidance you can
make Medicare work for you, protecting your health, your wallet,
and your peace of mind. If you'd like to personalize
Medicare three sixty consultation, or if you're unsure where to start,
reach out to my team at Premiere three sixty Insurance
(24:02):
and Financial Solutions. You could find us online at Premiere
three sixty solutions dot com or call our office. We'd
be happy to walk you through your options step by step.
I'm Jennifer Alfonso Lee and this has been another episode
of Medicare three sixty show where clarity meets confidence in
(24:23):
your Medicare journey. Until next time, stay informed, stay healthy,
and take care of yourself and your loved ones.
Speaker 1 (24:33):
Thank you for joining the program Medicare at three sixty.
Hope you found today's episode insightful and empowering. Remember, understanding
your Medicare options is key to making the right choices
for your health and financial well being. If you have
questions or topics you would like cover it in future
episodes of Medicare three sixty. Don't hesitate to reach out
(24:56):
and speak with our licensed insurance agents until next time.
Stay informed and take charge of your health care journey.
This has been Medicare three point sixty, your trusted source
for all things Medicare Take care,
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