Medicare is the federal government program that provides health insurance to those age 65 and older or those under 65 with certain disabilities or chronic conditions. Medicare programs and policies are regulated by the Centers for Medicare and Medicaid Services (CMS). When you are new to Medicare, there can be a lot to learn about your enrollment and coverage choices. At least for now, there are no Medicare Advantage programs available to Alaskan residents (also known as Part C of Medicare), so this article will focus on Original Medicare along with additional benefits such as prescription drug coverage and supplemental insurance options.
Know when to enroll in Medicare Parts A and B
Original Medicare is also known as Part A (inpatient care), and Part B (outpatient care). You may be automatically enrolled if you are already receiving retirement benefits from Social Security when you become Medicare-eligible (most often at age 65) or if you have been collecting Social Security Disability Insurance for two years.
As you may have surmised, the Social Security Administration determines your Medicare eligibility. Automatically enrolled people receive a package in the mail with their Medicare insurance card. Otherwise, there are three time periods to enroll in Parts A and B, by contacting the Social Security Administration:
First, during your Initial Enrollment Period (IEP), which is the three months before, the month of, and the three months after your 65th birthday.
Second, during a Special Enrollment Period (SEP), which allows you to delay Medicare enrollment without paying a penalty. For example, many people delay enrolling in Medicare because they or their spouse are still working and covered by their employer-sponsored healthcare insurance. An SEP allows them to enroll in Medicare without penalty.
Third, the General Enrollment Period (GEP), which is every year from Jan. 1 through March 31. Using the annual GEP is not ideal, because you may owe a late enrollment penalty and face gaps in coverage.
Note that if you qualify for premium-free Part A, which most people do, you can enroll in it at any time once you are eligible. You must use applicable enrollment periods to enroll in Part B, or in Part A when you must pay a premium.
Consider enrolling in Part D and Medicare Supplement Insurance
Medicare’s Part D provides Prescription Drug Plan options, provided through private insurance companies. Once you have either Part A or Part B of Original Medicare and wish to obtain Part D coverage, you must choose and enroll in a standalone Part D plan. This year, for example, there are 18 different plans offered by six different insurance companies. These companies establish contracted agreements with both prescription manufacturers (the drug companies) and prescription distributers (the pharmacy networks).
Our office recommends that you sign up for Part D when you first become eligible to enroll in Medicare unless you have other creditable drug coverage. In addition, you may review and select a new prescription drug plan every year during an open enrollment period, from Oct. 15 through Dec. 7, which will become effective for the following calendar year.
Medicare Supplement Insurance (also known as Medigap coverage) provides standardized benefits with Original Medicare (Parts A and B). As discussed in previous articles, your costs with Medicare include deductibles along with cost-share or copays. For an example when obtaining outpatient services (Part B), after your annual deductible ($240 this year), you will be charged 20 percent of the Medicare approved amount when you go to a medical provider who accepts what Medicare assigns as the amount.
When obtaining Medicare Supplement Insurance, you can “buy down” your risk with known premiums as opposed to an unknown future cost. In Alaska, you may obtain Medigap coverage throughout the year. Our office recommends that the best time to obtain a Medigap policy is during the first six months of your Part B coverage; during this period, you may enroll into any Medigap policy without any disqualifying health-related conditions.
My Health Care Tracker
Our office has a free booklet available, titled “My Health Care Tracker,” which includes space to take notes on your medical appointment, including the date, your provider’s name, the reason for your visit, length of appointment, and care received. Using My Health Care Tracker and comparing your notes with your Medicare statements is a great way to find potential billing errors, as well as Medicare fraud, abuse or a stolen medical identity. Ultimately, it can help you reduce your health care costs and protect yourself against potential Medicare fraud, errors and abuse.
To obtain a copy of My Health Care Tracker, or to ask any questions regarding your specific situation, contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers Act (MIPPA) program.
If you are part of an agency or organization that assists Seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our new Ambassador program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor for the Alaska Medicare Information Office.
