Judd Matsunaga
If you’re nearing your 65th birthday, it’s time to start thinking about enrolling in Medicare. Medicare is designed to give you access to affordable, credible health insurance from 65 and on. It’s the federal health insurance program that helps older adults and younger people with disabilities pay for their health care.
However, understanding how to enroll in Medicare if you are turning 65 is the tricky part. If you’re not receiving Social Security benefits, you’ll need to take steps to enroll. Keep in mind, you can enroll only at certain times. If you sign up late, you could end up with gaps in coverage and costly penalties for the rest of your life.
I just turned 64 and thought it was time to start thinking about Medicare. But, after reading several articles on “How to Enroll in Medicare,” I ended up totally confused. So, this article is to help you get familiar with Medicare’s four different service types so that you’re prepared and ready to receive coverage as soon as you become eligible (source: AARP, Understanding Medicare’s Options: Parts A, B, C and D, Nov. 15, 2021).
Part A: Hospital Coverage
When you apply for Medicare, you will automatically be enrolled in Part A. It covers hospital stays, hospice care and some skilled nursing care that you may need after being hospitalized for a stroke or other episodes that require rehabilitation in a nursing home or other facility.
Most people don’t have to pay a premium for Part A. You’ve already paid into the system in the form of the Medicare tax deductions on your paycheck. However, Part A isn’t totally free. Medicare charges a hefty deductible each time you are admitted to the hospital. It changes every year, but for 2022, the deductible is $1,556.
You can buy a supplemental or Medigap policy to cover that deductible and some out-of-pocket costs for the other parts of Medicare.
Medicare pays for virtually all hospital services for the first 60 days you’re in the hospital. There are some exceptions — it won’t pay for a private room, for example. If you are a U.S. citizen or permanent resident and have not worked long enough to qualify for Medicare, you may be able to buy into the program by paying a Part A premium.
Part B: Doctor and Outpatient Services
This part of Medicare covers doctor visits, lab tests, diagnostic screenings, medical equipment, ambulance transportation and other outpatient services. Unlike Part A, Part B involves more costs, and you may want to defer signing up for it if you are still working and have insurance through your job or are covered by your spouse’s health plan. But, if you don’t have other insurance and don’t sign up for Part B when you first enroll in Medicare, you’ll likely have to pay a higher monthly premium for as long as you’re in the program.
The federal government sets the Part B monthly premium, which is $170.10 for 2022. It may be higher if your income is more than $91,000. You’ll also be subject to an annual deductible, set at $233 for 2022. You’ll also have to pay 20 percent of the bills for doctor visits and other outpatient services. If you are collecting Social Security, the monthly premium will be deducted from your monthly benefit.
Part C: Medicare Advantage
Medicare Advantage is the private health insurance alternative to the federally run original Medicare. Think of Advantage as a kind of one-stop shopping choice that combines various parts of Medicare into one plan. If you decide on a Medicare Advantage (“MA”) plan, you’ll still have to enroll in parts A and B and pay the Part B premium. Then, in addition, you will have to choose a Medicare Advantage plan and sign up with a private insurer.
The federal government requires these plans to cover everything that original Medicare covers, and some plans pay for services that original Medicare does not, including dental and vision care. In addition, the Medicare Advantage plan may cover such extras as wheelchair ramps and shower grips for your home, meal delivery and transportation to and from doctors’ offices.
Medicare Advantage plans generally are either health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In HMOs, you typically choose a primary care doctor who will then direct your care and usually will have to give you a referral to see a specialist. PPOs have networks of doctors that you can see and facilities you can use, often without the need of a referral. If you go to a provider who is not in the plan’s network, you likely will pay more.
Part D — Prescription Drugs
This is the part of Medicare that pays for some of your prescription drugs. You buy a Part D plan through a private insurer. Each generally has premiums and other out-of-pocket costs, either flat co-pays for each medication or a percentage of the prescription costs. It also may have an annual deductible.
If your total drug costs — the amount you and your Part D insurance plan have paid — reach $4,430 in 2022, you will be responsible for 25 percent of the price of the rest of the prescription drugs you buy during the year. If your drug costs continue to mount, you may reach the point of qualifying for catastrophic coverage.
Be sure to check at medicare.gov whether the plan you’re considering has the medicines you take on its covered list, called a formulary. Those lists change from year to year, so it’s important to recheck your plan every year at open enrollment time.
In conclusion, if you’re not receiving Social Security benefits yet, you’ll need to enroll in Medicare. You can enroll as early as three months before your 65th birthday. When it comes to how to enroll in Medicare when you turn 65, you have three options: (1) simply visit the Social Security website (ssa.gov) to apply online; (2) call Social Security Administration at (800) 772-1213; or (3) visit a local administration office.
One important tip is to make sure you keep proof of your attempt at enrollment in order to protect yourself from any late enrollment penalties should your application be lost. Print any confirmation information, note dates, times and representatives you spoke with, and request any receipts possible in person.
Judd Matsunaga is the founding attorney of Elder Law Services of California, a law firm that specializes in Medi-Cal Planning, Estate Planning and Probate. He can be contacted at (310) 348-2995 or judd@elderlawcalifornia.com. The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Pacific Citizen or constitute legal or tax advice and should not be treated as such.
