By Robyn A. Friedman
City & Shore PRIME Magazine
If you’re a baby boomer in South Florida, you’ve no doubt heard people discussing Medicare — even if you’re not quite 65. Listening to them speak their mysterious language — Part A, Part B, open enrollment, donut hole — you’re just thankful you don’t have to deal with any of that. Yet.
But 65 will be here before you know it — so start boning up now.
“Older Americans rely very heavily on Medicare to ensure they have access to high-quality, affordable health care,” says Jeff Johnson, AARP’s Florida state director. “It’s a wonderful program. And like anything else that is important in life, you’ll need to understand how it works.”
Here are six things you should know about Medicare:
Medicare is a federal health insurance program that covers people 65 or older, certain younger people with disabilities and people with end-stage renal disease.
Medicare has different parts. Part A covers 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. (Parts A and B are often referred to as “Original Medicare.”) Part C, also known as Medicare Advantage Plans, are private plans that are an alternative to Original Medicare. They often include prescription drug coverage. Part D plans are private plans that add prescription drug coverage to Original Medicare.
Medicare is not free. Part A is usually free if you or your spouse paid Medicare taxes while working. You’ll need to pay a premium each month for Part B, but the amount varies based on your income and whether you receive Social Security benefits. You must pay for Parts C and D, which are private plans.
You must sign up — you are not automatically covered when you turn 65. The initial enrollment period starts three months before your 65th birthday and ends three months after the month you turn 65. You must pay a penalty if you don’t sign up in this time period, unless you have another form of health coverage.
The donut hole is a gap in the coverage for prescription drugs. After your Part D drug plan has paid a certain amount for covered drugs, you’ll have to pay all costs out-of-pocket up to an annual limit. For 2017, once your plan has spent $3,700 on covered drugs, you’re in the donut hole. Drug costs are on you at that point until you hit $4,950.
The Medicare website (Medicare.gov) can be confusing. While it contains a wealth of information, it’s not easy to navigate. And, although it contains a glossary, it uses jargon that is difficult to understand for those new to Medicare. Give yourself plenty of time to read — and re-read — the site and other resources before you’re eligible.
For more information, check out AARP’s step-by-step guide to Medicare, at aarp.org/health/medicare-insurance/info-04-2011/medicare-starter-guide.html.