- What are the basics?For someone new to Medicare – it can be confusing. The Medicare program is complex and can be hard to navigate alone for someone just starting. First, familiarize yourself with the differences between Medicare and the health insurance coverage you have now, whether that is employer-sponsored coverage, a Marketplace (ACA) plan, or a Short-Term Medical plan. This can help you get a good idea of the coverage you will need for the future and what budget you would like to spend on your Medicare coverage.
Then, familiarize yourself with the different parts of Medicare and what they cover, such as
- Part A – Hospital Insurance
- Part B – Medical Insurance
- Part C – Medicare Advantage (MA) and Medicare Advantage and Prescription Drug Plans (MAPD)
- Part D – Prescription Drug Plans (PDP)
- Medicare Supplements (Medigap)
Learn what makes a person Medicare-eligible, the times to enroll in Medicare, and the penalties that can result from putting off enrollment. Familiarizing yourself using these steps will make your transition to Medicare much more comfortable in the long run.
- What are my coverage options?Everyone’s healthcare needs are different, as is their budget. The coverage that your friends think is wonderful may not be the best fit for you – everyone’s “best” option is different and based on their unique needs. Will you enroll in Original Medicare, or will you choose a Medicare Advantage plan that may limit your provider network or change the cost but offer additional coverage? If you are not yet retired – you can opt to stay in your employer-sponsored coverage until retirement if that works best for you. If you are currently retired, you could opt into Original Medicare plus retiree insurance or choose to enroll in a Medicare Supplement (Medigap) policy alongside original Medicare. It is all about what best suits your needs. Make sure you explore all your different coverage options.
- Should I enroll in Part D (Prescription Drug Plan)?Be sure to enroll in a Part D Prescription Drug Plan when you become Medicare Eligible unless you have other credible drug coverage. But, there are many different Part D options available to you. Sometimes, retiree coverage offers prescription drug coverage that could be equivalent to or even better than Medicare Part D. If so, you might not want to enroll in Medicare Part D because you already are covered. If you have difficulty affording your prescription drug costs, consider applying for programs that can help make these costs more affordable.
- Am I eligible for programs that will help lower Medicare costs?Yes. There are several programs for those with low incomes that will help cover costs, such as Medicare premiums and copays. Some programs are federally run, while others are state-specific. There is also eligibility for Dual Special Needs Plans (D-SNP) if you qualify for Medicaid and Medicare. Ensure you find out if you are eligible for any of these programs and take advantage of them.
- What resources can help me navigate Medicare?Medicare is complicated, and there are many trusted sources to help you navigate your rights and options. A few are listed here: