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TEXAS DEPARTMENT OF INSURANCE – Most people need to enroll in Medicare through Social Security when they turn 65. It can be a confusing process, but knowing some key facts can help you decide on the best plan. You can also change Medicare plans during open enrollment each year. Medicare open enrollment is October 15 to December 7
- Know the deadlines
There are only certain times you can sign up for Medicare so make sure you know your window for enrollment without penalties. For most people, that begins three months before your 65th birthday and runs until three months after your birthday. You may be able to delay enrollment if you have job-based health insurance, but check with your benefits manager to see if your employer plan qualifies. If you don’t enroll when you’re first eligible, you may have to pay higher premiums once you do sign up.
If you’re already getting Social Security or disability benefits, you will be automatically enrolled in medical services and hospital care through Medicare.
- Learn the lingo
There are different parts of Medicare:
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Medicare Advantage Plans (Part C) provide all your Part A and Part B benefits through a plan offered by a private company. These plans must cover all Medicare services and may offer extra coverage. Compare costs of Advantage plans carefully. Each year, the plans set the amounts they charge for premiums, deductibles, and copayments.
Part D covers prescription drugs. Part D plans are offered by insurance companies and other private companies approved by Medicare. You may not need a separate Part D plan if you have a Medicare Advantage Plan because most advantage plans include drug coverage. Check the plan’s drug formulary to make sure it covers your prescriptions.
- Decide if you need a gap plan
You can also buy a private plan to supplement your Medicare coverage. These Medigap plans help pay out-of-pocket costs, such as copayments and deductibles, and may cover some things not covered by Medicare. You may not need a Medigap plan if you still have health coverage through an employer or get help from Medicaid.
If you do need a Medigap policy, it’s often best to shop for one when you sign up for traditional Medicare because you’re guaranteed coverage regardless of your medical history. It may be difficult to change Medigap policies later so think about medical needs in the future when deciding which policy is best.
- Calculate the costs
Most people don’t pay a premium for Part A (hospital) Medicare, but you will pay premiums for Part B and other types of Medicare coverage. Your Part B premium is based on your income. After you meet the Part B deductible, Medicare will pay 80 percent for covered services, and you’ll pay the remaining 20 percent unless you have a Medigap policy. Your costs will be different if you decide to go with a Medicare Advantage plan instead of traditional Medicare.
- Compare plans
Use the Medicare Plan Finder to compare plans, benefits, and costs. The cheapest premium doesn’t always result in the lowest total cost. Make sure to enter your prescriptions in the plan finder to see how your costs will vary by plan and look closely at copayments and deductibles. The Medicare Plan Finder also includes a helpful rating system based on several factors, including consumer complaints and satisfaction. You should also check with your doctors to see what plans they accept.
Need more help? Visit Medicare.gov or call your local Area Agencies on Aging at 800-252-9240 for individual benefits counseling.
More about the free Medicare Help Line: Texas Health and Human Service website | Poster (PDF)
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