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Medicare: Top Things You Should Know


Medicare is often overwhelming for people who are new to it and trying to learn the basics. It has rules apply differently to individuals depending on what type of circumstance they have.

However, there are a few things about Medicare that every beneficiary should know, and we've included them here.

1. Your Initial Enrollment Period Begins 3 Months Before Your 65th Birthday Month

You'll need to know when your initial enrollment period begins and ends to ensure you enroll on time. Your initial enrollment period is a 7-month period that begins lasts during the three months before your birthday month all the way until the third month after your birthday.

For example, if your birthday is in April, your initial enrollment period will begin in January and end in July. We recommend that you enroll during the first three months of your initial enrollment period though unless you are still working and have other creditable coverage. If you enroll in the latter part of your initial enrollment window, you will have delayed coverage for your Medicare.

2. If You Have Creditable Coverage, You Can Delay Enrolling in Medicare

The most common form of creditable coverage is large employer group coverage. If you work for a company that has more than 20 employees, you can delay enrolling in Medicare without penalty. This will save you the premiums that would spend on Parts B and D.

Most people still enroll in Part A, however, since they usually get premium-free Part A. It doesn't cost you anything and could reduce your expenses in the event of a hospital stay. Also, keep in mind, that you will have to prove to the Social Security office that you have creditable coverage during the time you went without Medicare. Be sure to keep your creditable coverage letter from the insurance company as proof of your coverage.

3. If Your Doctor Accepts Medicare, They Accept Your Medigap Plan

Medigap plans do not have networks. Therefore, you do not need to ask if your doctor accepts your particular carrier. You simply need to ask if they accept Medicare. If they do, then you can use your Medigap plan as well.

Your doctor will bill Medicare and then Medicare will bill your Medigap plan. The only time you need to ask your doctor if they accept your particular plan is if you have a Medicare Advantage plan.

4. Medigap Plan F Will Be Discontinued in 2020

As many people have learned, Medigap Plan F will be discontinued as of 2020. Plan F will still be available to beneficiaries who had Medicare prior to the year 2020. Medigap Plan F will only not be available to new Medicare enrollees in 2020.

It has been assumed that Plan F's premium will increase at a faster rate than other Medigap plans after 2020. Only time will tell If you are interested in changing Medigap plans before that happens, you can certainly apply to change your Medigap plan. Changing carriers usually involves health questions though. Your Medicare insurance broker can walk you through these to see if you are likely to pass underwriting.

5. You Still Have to Pay Your Part B Premium Even If You Have a Medicare Plan

Yes, Medicare Advantage plans do take over your Part A and Part B care. However, you must continue to pay your Original Medicare premiums. Many people assume that if they enroll in a Medicare Advantage plan they will be exempt from Part B, and this is just not the case.

In order to have a Medicare Advantage plan or a Medigap plan, you must be actively enrolled in Medicare Part A and Part B and paying your Part B premiums.

6. The Annual Election Period is for Medicare Advantage and Part D

Many people think that the Annual Election Period (AEP) is for every part of Medicare. The AEP is only meant to change your Medicare Advantage or your Part D drug plan.

The AEP is not a time when you can enroll in a Medigap plan without answering health questions. Unlike Medicare Advantage and Part D plans, you can switch Medigap plans any time of the year as long as you can pass the underwriting to do so.

7. You Still Qualify for Medicare at 65 If You Didn't Work

Just because you didn't meet the minimum work quarters for premium-free Part A, doesn't mean that you can't have Medicare at all. Any American who is either 65 an older or is under 65 and disabled, qualifies for Medicare. You can contact Social Security to find out how much it would cost to purchase Part A based on the number of work quarters you do have.

In order to qualify for premium-free Part A, you must have worked at least 40 quarters in the U.S. However, you can qualify through your spouse if they meet the requirement and you don't.

In Conclusion

If you didn't know these important facts, you could end up having a rather difficult time with Medicare. You also need to remember that not everyone's Medicare situation is the same.

In addition to learning these key points about Medicare, you should research your particular circumstance. Talking to an expert who specializes in Medicare insurance can be helpful.