Critter Corner: Happy Birthday Medicare! 

Dear Kiwi and Mango, 

I understand that July 30 marks the 59th birthday of Medicare. I will be 65 early next year. What should I do and what resources can I count on for more information before I sign up? 

Thanks for your help! 

Cella Brate 

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Dear Cella, 

You are correct! Next month marks the 59th anniversary of Medicare, a vital source of health care and economic security for Americans over age 65 and adults of any age who are permanently disabled. Medicare provides access to comprehensive health care for millions of older adults. Many Americans with private insurance often wait until they turn 65 and become eligible for Medicare to receive needed care that was previously out of reach. There are a few important things that you should know before you turn 65. 

Be Sure to Sign Up on Time 

Knowing when to apply for Medicare is very important. You have a limited initial enrollment period to apply. If you miss the initial enrollment period, you may have to pay a higher monthly premium for the rest of your life. Most people become eligible for Medicare at age 65, your initial enrollment period begins three months before your 65th birthday and ends three months after that birthday. Note that if you apply for Social Security benefits at age 65, you’ll be automatically enrolled in Part A, but many people wait longer to claim Social Security benefits in order to hopefully get more from the benefit over the course of their lifetime. 

If you fail to enroll for Medicare during the initial enrollment period, you’ll get another chance during the fall open enrollment period, which runs from October 15 to December 7 each year. The problem is that there’s a financial penalty for missing the initial 6-month window, and this penalty increases the longer you wait. So be sure to pay attention to any mailings you receive from the Centers for Medicare and Medicaid Services and any existing health insurance plan as you approach your 65th birthday. You can apply for Medicare or learn more here.  

Educate Yourself Early on Original Medicare vs. Medicare Advantage Plans 

Not all Medicare plans are the same. Although Original Medicare is a government health insurance program for people over the age of 65, Medicare Advantage plans are private health insurance plans offered by private health insurance companies. If you don’t understand the difference between Original Medicare and Medicare Advantage, you could end up spending too much money on a plan that doesn’t fit your needs, especially as you age and need more and more medical care and/or long-term care. 

Be wary of flashy commercials, often featuring famous personalities, selling Medicare Advantage plans, and carefully compare your options. Working with an expert who’s not affiliated with a specific company or plan can also help. Read more about Medicare Advantage in Mr. Farr’s many articles on the subject.  

Research Which Hospitals and Providers Are Covered by Your Plan 

Original Medicare covers medical care everywhere in the US – at any hospital, any nursing home, and almost all private physicians (except for some “concierge medicine” physicians who don’t take any insurance). People generally purchase Medicare Advantage plans because they are less expensive than Original Medicare and often make exagerated promises as to what they cover. But the truism of “you get what you pay for” of course applies to Medicare Advantage plans being less expensive than Original Medicare. The biggest problem with Medicare Advantage plans is that each Medicare Advantage plan limits (often severely limits) the physicians, hospitals, and nursing homes that are “in-network” with that Medicare Advantage plan. We have a client in Maryland right now who has a Medicare Advantage plan so restrictive that it only covers care in the county where he lived when he enrolled, and was further limited to which providers in that county would accept the plan. Not all Medicare Advantage plans are that limited, but be sure to check that all of the doctors or facilities you anticipate you’ll use are included. And if you think there is any possibility that you may move in the future, perhaps to be closer to children or other family members or to a Continuing Care Retirement community or an assisted living facility, which is very common, don’t fall for getting trapped into a limited-service-are Medicare Advantage plan. Ask a lot of questions and be sure you understand which providers and facilities accept your insurance in advance. 

The official Medicare website offers many online services where you can find help with the following:  

• Create your secure Medicare account 
• What Medicare covers 
• Medicare health and prescription drug plans (costs and services) 
• Giving Medicare permission to talk to someone you trust 
• Get Extra Help (prescription assistance program) 
• Find care providers 
• Live chat with Medicare.gov 

Hope this is helpful! 

Kiwi and Mango