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Explore Medicare before you turn 65

Friday, May 23rd, 2014
Issue 21, Volume 18.
Jason Aldermans
Special to the Valley News

Each day, approximately 10,000 Baby Boomers turn 65 ‚Äď and thereby become eligible for Medicare.

But becoming eligible for and actually enrolling in Medicare are two very different things. In fact, if you miss the initial window to sign up for certain parts of Medicare and later decide to enroll, you could wind up paying significantly higher premiums for the rest of your life.

If youíre approaching 65, get familiar with these Medicare basics now.

Medicare provides benefits to people age 65 and older (and those under 65 with certain disabilities or end-stage renal disease). For most people, the initial enrollment period is the seven-month period that begins three months before the month they turn 65. If you miss that window, you may enroll between January 1 and March 31 each year, although your coverage wonít begin until July 1.

Medicare offers several plans and coverage options, including:

* Medicare Part A helps cover inpatient hospital, skilled nursing facility and hospice services, as well as home health care. Most people pay no monthly premium for Part A, provided they or their spouse have paid FICA taxes for at least 40 calendar quarters.

* Medicare Part B helps cover medically necessary doctorís services, outpatient care, durable medical equipment and many preventive services. Itís optional and has a monthly premium. For most people thereís a $147 yearly deductible; after thatís met, youíll be responsible for 20 percent of the Medicare-approved amount of the service, provided the doctor or other provider accepts Medicare.

* Medicare Part C (Advantage) plans are offered by Medicare-approved private insurers as alternatives to Original Medicare Parts A and B. Most cover prescription drugs and some include additional benefits such as dental and vision coverage for an extra cost. Youíre usually required to use the planís doctor, Advertisement
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hospital and pharmacy provider network, which may be more restrictive than providers you can access through Parts A and B.

* Medicare Part D helps cover the cost of prescription drugs. Itís optional and carries a monthly premium. These privately run plans vary widely in terms of cost, copayments and deductibles and medications covered. If youíre enrolled in a Part C plan that includes drug coverage, you donít need Part D.

* Many people purchase additional Medigap (or Medicare Supplemental) insurance, which is offered by private insurers and helps pay for many items not covered by Medicare. Medigap plans can vary widely in terms of cost, covered benefits and states participating so compare your options carefully.

Keep in mind that for all Medicare plans, deductibles, co-payments and co-insurance may apply, depending on the service provided.

With Parts B and D, youíll often face sizeable penalties if you donít enroll when first becoming eligible ‚Äď Part B premiums could increase 10 percent for each 12-month period you were eligible but didnít sign up (the Part D penalty is more complicated); however, if youíre currently covered by an employerís plan you can enroll later without penalty.

Terms of Advantage and Part D plans such as premiums, co-payments and covered medications can change from year to year, so carefully review enrollment materials from your current plans to make sure they still match your needs.

Understanding and choosing the right Medicare options for your individual situation can be a complicated and time-consuming process. For assistance, call (800) 633-4227 or visit, where youíll find "Medicare & You 2014," a detailed guide that explains Medicare in easy-to-understand language and tools to compare prescription plans, hospitals, nursing homes, home health agencies and Medigap plans in your area.

Jason Alderman directs Visaís financial education programs.



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