When Do I Actually Need To Do Something?
Your 65th birth month is when you will first be eligible to start Medicare if you have not already been enrolled previously due to disability. You can apply for Medicare up to 3 months before your 65th birthday month.
There are two parts to the process: signing up for Medicare and signing up for secondary Medicare plans. If you have already started taking Social Security, you will automatically be enrolled in Medicare. If not, you'll have to sign up for Medicare directly through Social Security. Once you get your Medicare card, it is time to consider your options for Secondary Supplemental or Medicare Advantage coverage.
Do I Need To Take Medicare?
If you or your spouse are covered under a union or employer health plan, you may be able to delay your Part B enrollment until the time you lose that coverage. If you are claiming Social Security and still covered by one of these plans, you may need to proactively decline Part B. Regardless, every situation is unique and requires an experienced professional’s guidance to avoid costly mistakes. If you are not covered by another credible policy and you do not enroll in Part B when first eligible, you may need to wait up to a year to enroll, and you may be charged a penalty for the rest of your life.
What Does Original Medicare Cover And How Much Does It Cost?
Original Medicare comes in a few parts, Part A (your inpatient / hospital coverage) and Part B (your outpatient / primary care / specialist coverage). Most people have worked enough in their lifetime to get Part A for free, and Part B comes at a premium of $164.90 per month for 2023. Part D is your prescription drug coverage, which we will address further down the page. If you have a high income or haven’t worked enough in the USA over your lifetime, these amounts may be adjusted higher.
What Doesn’t Medicare Cover?
As you may already know, Original Medicare has relatively large deductibles, copayments, and coinsurances. There is no out-of-pocket maximum under Original Medicare, so the potential risk of health costs is infinite. For this reason, those on Medicare most often choose one of two options in conjunction with their Medicare coverage: 1) enroll in a Medicare Supplement and a Prescription Drug Plan or, 2) enroll in an MAPD. To do nothing is a major financial risk.
Original Medicare also doesn't cover Dental, Vision, Prescriptions, and Long Term Care. These all require separate insurance policies on top of Original Medicare and your supplement. Medicare Advantage plans may help cover some of these expenses.
What Is A Medicare Supplement?
A Medicare Supplement is a supplementary insurance plan that can pay for what Original Medicare doesn’t. For example, the standard Plan G covers all Medicare copays, the full 20% of remaining services, and the Part A deductible ($1,600 for 2023). Medicare with a Supplement allows you to see any Medicare provider in the country with no referrals needed. There is no cap to how much a Medicare Supplement will pay out to cover your health costs. This approach would be paired with a stand-alone Prescription Drug Plan is in our opinion, the best option.
Does It Matter Which Insurance
Company I Choose?
Medicare Supplements are standardized benefit plans mandated by the government. These plan benefits cannot differ between insurance companies. However, you will find a wide range of prices for the same plans. This is why it is important to work with a broker like us, so that you don’t get tricked into paying more than you should for a given plan. On the MAPD side, plan benefits do differ between carriers, so it is important to choose the plan with the carrier that best meets your health needs in your area.
What Is An MAPD, Advantage Plan,
or Part C?
Medicare Part C is known as Medicare Advantage. In its most basic form, Medicare Advantage is an equivalent to Parts A & B from Medicare-approved private insurance companies. A Medicare Advantage plan may also cover things Original Medicare does not.
What Is Part D?
Part D of Medicare is your prescription drug coverage. This can be obtained by purchasing a stand-alone Prescription Drug Plan (PDP) alongside a Medicare Supplement Plan or by enrolling in an MAPD. When purchased alongside a Medicare Supplement, this combination is the most comprehensive way to cover your Medicare costs. Please note that if you do not enroll in Part D when first eligible, you may need to wait up to a year to enroll, and you may be charged a premium penalty for the rest of your life.
What If I’m On Medicare Disability?
People under 65 who have been on Social Security Disability for 24 months or have ESRD or ALS are eligible for Medicare. When on Medicare due to disability, you can choose any Medicare Advantage plan or Stand Alone Prescription Drug Plan available to Medicare recipients in your area. There may also be plans available in your area specific to your condition like D-SNP plans, C-SNP plans, and more. You are also able to choose from a few different Medicare supplements if you are under 65. Your choices of Plan and carrier vary greatly depending on your state, age, and Medicare Enrollment date.
What If I’m On Medicaid or NJ Family Care?
Most often, Medicaid recipients become eligible for Medicare at 65 like everyone else. Medicaid income limits go down at 65 which means those on Medicaid under 65 may not be eligible for Medicaid over 65. If you continue to be eligible for Medicaid over 65, there are Dual Special Needs Plans (DSNP’s) available to you which combine the benefits of Medicare and Medicaid into a single plan with a private insurance carrier. These plans oftentimes offer more benefits than either Medicaid or Medicare offers on their own.
I Already Figured All This Out, I Don’t
Think I Need Help
You may have already done the research, perhaps even found the lowest price plan, but do you know about each carrier’s rate increase trends and the plans that are leaving the market? Do you know how often you should change your prescription plan?
When you turn 65 or become eligible for Medicare due to disabiliy, you are given a multitude of options depending on your situation. Be sure to use this time wisely, and talk to brokers you can trust.
Can’t I Just Do This Myself? Why Do I
Need A Broker?
Yes, you can feel free to try and handle this yourself, but the reality is that a broker can offer you specialized Medicare guidance. By working with nearly every carrier offering insurance in NJ, we can show you all the prices across almost every plan and almost every company. Working with a broker gives you piece of mind, as we will work on your behalf to ensure your policy works as intended. We help you directly and by providing great resources for you to help. Our clients are lifelong, and we keep in contact consistently to ensure they are receiving everything they need.
What Do You Mean This Doesn’t Cost Anything? How Can You Offer Your Services To Me For Free?
Our services are completely no cost to you, and there is absolutely no difference in premium cost to work with an independent broker. We are compensated by the insurance carriers, which allows us to provide advice at no cost to you.