As people of Medicare age prepare to leave their careers, to start a new life’s chapter and to enroll in Medicare, most are faced with a health-care system that is unfamiliar, offers dozens of choices and often delivers confusion.
Oregon’s scores of volunteer Medicare counselors with the Senior Health Insurance Benefits Assistance (SHIBA) program receive all kinds of questions, of which these are the most frequent.
How do I enroll in Medicare?
Most people enroll either online or by phone. If enrolling online, go to the Social Security website (ssa.gov), look for Medicare at the top of the homepage, and follow the prompts. If enrolling by phone, call the Salem Social Security office at 866-593-1559; you will be given a date and time when you will get a callback to do the enrollment.
What if I want to continue working?
If you have employer health-care insurance, you don’t need to do anything. But these two actions are recommended: First, ask your employer’s human resources (personnel) department if its insurance is creditable as Medicare defines it (if it isn’t, you risk a sizable lifetime penalty later on). Second, enroll in Medicare Part A to make later Part B enrollment a bit easier (to enroll later in Part B you would submit completed CMS forms 40B and L564, which your employer may provide).
Will I have to pay a Medicare fee?
Unless they have a seriously limited income, most Medicare beneficiaries pay Medicare’s monthly Part B premium, which this year is $174.70. To avoid paying the premium, your monthly gross income would have to be no more than $1,715 for a single person or $2,320 for a couple.
Must I enroll in a Medicare insurance plan?
You are not required to have additional insurance. You could limit your coverage to Medicare only, known as Original Medicare. Most people do enroll in insurance to put a ceiling on how much they could have to pay in out-of-pocket medical expenses during the year.
What are my Medicare insurance options?
For most people the options are a Medicare Advantage plan that has both medical and prescription drug coverage, OR a medical-only Medicare supplement (Medigap) policy complemented by separate prescription drug insurance. Most Oregon public employees also have access to Medicare insurance through the Public Employees Retirement system; to request a copy of the PERS insurance booklet and to speak with a PERS representative, call the program at 503-224-7377.
Which type should I choose?
Between Medicare Advantage and Medigap, that depends on a variety of factors including how much you are willing or able to pay in monthly premiums, what insurance types your doctor(s) will accept and which insurance will do the best job of covering your prescription drugs.
Tip: Before reviewing Medicare insurance plans, ask your doctor office(s) with which Medicare Advantage insurance plans the doctor is in network and, for Medigap insurance, whether the doctor will bill Medicare.
What are the likely costs for insurance?
For Marion and Polk county residents, the monthly premiums for Medicare Advantage plans range from the 12 plans that charge nothing to one that costs $155 a month. For a Medigap policy, a 65-year-old Medicare beneficiary in Marion or Polk county can expect to spend about $140 a month plus the premium for prescription drug insurance.
You said insurance puts a ceiling on out-of-pocket medical costs?
Yes. With Medicare Advantage insurance, the limit on annual medical cost ranges from $3,450 to $8,850 depending on the plan; most of the no-premium plans have a limit of less than $6,000.
With most Medigap policies, all Medicare-approved medical costs are paid except for the Medicare Part B annual deductible, which is $240 this year.
Where can I see the premiums?
The Medicare.gov website has a tool that delivers premiums for both Medicare Advantage and Medigap insurance. Or a SHIBA counselor can assist with either or both insurance types. To make a SHIBA appointment, please see the end of this column.
What if I later want to change Medicare insurance?
You can. Medicare beneficiaries with Medicare Advantage or prescription drug insurance may review plans during annual open enrollment, Oct. 15 through Dec. 7. They also can revert to Original Medicare or seek to enroll in Medigap insurance. Switching from Medicare Advantage insurance to Medigap may be challenging for some (but not all) beneficiaries, a subject for another day.
A beneficiary with Medigap insurance could enroll in Medicare Advantage insurance during annual open enrollment. Likewise, the beneficiary could change Medigap companies or Medigap plan types using Oregon’s birthday rule.
If I don’t take any drugs, can I forgo drug insurance?
That would be unwise. That’s because if you enroll in drug insurance later you would be faced with a lifetime monthly penalty. The monthly premiums for prescription-drug insurance start at zero and go up from there. Note: If the Veterans Administration provides your prescription drugs, you could forgo other drug insurance without risking a penalty; that said, you might still want insurance as a backup.
Should I carry my Medicare card at all times?
No. Medicare recommends that the Medicare card be kept in a safe place at home, carried only if it’s needed. If a Medicare card is lost, the Medicare number could be used to defraud Medicare or the Medicare beneficiary. Medicare fraud accounts for an estimated $60 billion annually.
Although this leaves many Medicare questions unanswered, it’s an excellent start for getting enrolled and insured.
If you would like to make an appointment with a SHIBA volunteer counselor, or to ask a question to be answered here, please see below.
Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, e-mail [email protected]. To schedule a free SHIBA phone, Zoom or in-person appointment with a volunteer Medicare counselor, call 800-722-4134.
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