The Five Biggest Things to Know About Medicare

Q. I am turning 65 this year and will qualify for Medicare. I want to make sure I do things properly when it comes to applying. For instance, do I have to wait until I’m actually 65 to start the process, or can I start ahead of time? Also, long-term care is so expensive. Is it true it’s NOT covered by Medicare, or has that changed?

While I am asking about Medicare, my older sister is already enrolled and is confused about Medicare Advantage and the new enrollment period that is going on now. She is unhappy with her plan and considering making changes or disenrolling from Medicare Advantage altogether. Is this something she can do right now or does she have to wait until the fall?

A. Happy upcoming 65th Birthday! This year, you will join millions of senior citizens who depend on Medicare to pay for their healthcare services during retirement.

You are wise to ensure that you and your sister are taking all the right steps and avoiding any missteps when it comes to Medicare enrollment. Those who are not as careful could make wrong moves that cause them to miss out on important benefits or leave them paying more for them.

Here are five important things you should know before you sign up for Medicare (or make changes to your Medicare Advantage plan, in the case of your sister), and some mistakes to steer clear of in the coming year:

1. Be sure to enroll at the right time: You asked if you should wait until your actual 65th birthday to enroll in Medicare. I’m glad you asked, because enrolling at the right time is of utmost importance. Medicare eligibility begins at age 65, but what many people don’t realize is that you get a seven-month window to enroll initially. That window begins three months prior to the month of your 65th birthday and ends three months after it.

Don’t make the mistake of waiting to enroll in Medicare. Here’s why: If you don’t sign up for Medicare on time, you not only risk going without coverage, but you also risk paying more for Part B coverage throughout retirement.

Avoid Paying More for Medicare Part B

Medicare Part A covers hospital care and is free for most enrollees. Medicare Part B covers “medically-necessary services” such as doctors’ visits, tests, and outpatient care.

• If you are late signing up for Part A, you must pay a monthly premium for Part B. For every full 12-month period that you’re eligible for coverage but don’t take it, your monthly premiums when you do enroll will rise by 10%, and you’ll pay those higher premiums for life. As such, the financially wise course of action is to sign up for Medicare Part B during your initial enrollment period.
• If you decide to skip Part B for a while to save some money, you could wind up costing yourself a lot more!
• The rules are slightly different if you’re covered by a group health plan through a job (yours or your spouse’s) when you reach 65. Click here for more details. Be sure to check with your benefits manager at work and/or contact Medicare to be sure.

2. Sign up for Medicare Advantage during the open enrollment period: You inquired about Medicare Advantage on behalf of your sister. Many seniors who enroll in Medicare choose a Medicare Advantage plan to gain coverage for more services than original Medicare and for lower out-of-pocket costs. In addition, since last year, many helpful changes including additional offerings, have been made to Medicare Advantage plans. Click here for more details.
Here are some things you and your sister should know about Medicare Advantage plans:

• Not all Advantage plans are created equal, so if you find yourself unhappy with the one you’ve chosen — say, because it limits you to too narrow a network of providers — it might be wise to switch.

• Make changes during the designated open enrollment period, going on now: If you sign up for a Medicare Advantage plan during Medicare Open Enrollment and your needs later change, you no longer have to wait until the fall to switch plans. In 2019, the Medicare program established the Medicare Advantage Open Enrollment Period (MAOEP). This period runs from January 1 through March 31 and, during that time, you can change Medicare Advantage plans or switch back to Original Medicare. The additional Medicare Advantage Open Enrollment Period replaces the old Medicare Disenrollment period, which only allowed beneficiaries to switch back to Original Medicare.

3. Medicare offers FREE preventative care services. Take advantage of them: Many people who are new to Medicare, and others who have been on Medicare for a while are unaware or forget about the free preventive health services Medicare offers for enrollees. Here is a list of the no cost Medicare services you should know about:

Annual wellness visits: Your wellness visit is a good opportunity to see how you’re faring health-wise and get ahead of any issues that may be brewing.
• Alcohol counseling: Medicare will cover the cost of alcohol counseling so alcoholics can kick their addiction.
• Smoking cessation programs: Smoking is an unhealthy and expensive habit. If you’re looking to quit, Medicare will allow you to enroll in an approved program at no cost.
• Depression screenings: Retirees are 40% more likely to be diagnosed with clinical depression due to physical health issues that affect seniors and loneliness. Thankfully, Medicare offers an annual depression screening for free so those who need it can get help.
• Annual mammograms: Diagnostic tests can be expensive, and many people skip them to avoid hefty bills. In doing so, however, they put their well-being at risk. Medicare offers free mammography services once a year so that women can stay on top of their health.
• Obesity counseling: Being overweight can contribute to a wide range of health issues. Medicare will cover the cost of obesity counseling for enrollees whose weight puts them in that at-risk category.
• Colorectal cancer screenings: Medicare offers certain screening tests for free, the frequency of which will depend on the risk group you fall into.
• Flu shots: Medicare offers free flu shots to enrollees to help them avoid falling ill during flu season.
• Bone mass measurements: The risk of osteoporosis increases with age. Medicare will cover the cost of bone mass measurements once every two years for those at risk of osteoporosis.
• Diabetes screenings: Treating diabetes early on can help patients avoid complications. Medicare will pay for up to two diabetes screenings per year, depending on your level of risk. Medicare also offers training on how to manage diabetes, but for that, you’ll share in the cost. Medicare also has a diabetes prevention program you can enroll in if you haven’t been diagnosed with the condition but are at risk for it. That program is totally free.

It pays to take advantage of the free services Medicare offers to keep yourself as healthy as possible.

4. Medicare offers medical advice without leaving your house
If it’s hard for you to get from your home to a doctor’s office, you can rest assured that there’s still access to healthcare professionals under Medicare. Thanks to the program’s telehealth services, you can connect with a doctor online and get medical advice that often costs less than a visit to an actual office or facility.

5. Be aware that Medicare still does not pay for long-term care–which involves help with activities of daily living such bathing, dressing, and using the bathroom. What causes many people confusion is that Medicare will pay for some of your costs for up to 100 days (i.e., short-term care) in a skilled nursing facility if you meet certain conditions. Read more about them here. It’s important to be aware of this and to plan for the catastrophic costs of long-term care in advance.

Avoid Medicare Mistakes to Save Money and to Make the Most of Medicare

If you’re a senior, you probably can’t afford to spend more money than necessary on healthcare. Take heed of the information above and avoid making mistakes such as delaying enrollment for Medicare, making changes to Medicare Advantage at the appropriate time, not taking advantage of free preventative services and telehealth services (if they suit you), and not planning in advance for long-term care. Hope the information above was helpful as you embark on your Medicare journey and as your sister finds the plan that is right for her.

Planning in Advance for Long-Term Care

The significant costs of long-term care can impact retirement plans, savings, and assets, and the level of care one receives. That’s why it’s so important that people speak with an experienced elder law attorney, such as the attorneys at the Farr Law Firm, about long-term care preferences and to put a plan in place.

Medicaid Planning for Long-Term Care

Medicaid planning can be started while you are still able to make legal and financial decisions or can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if you are already in a nursing home or receiving other long-term care. In general, the earlier someone plans for long-term care needs, the better. But it is never too late to begin your planning.

To begin long-term care planning (and incapacity and estate planning) right away, please call us now to make an appointment for a no-cost initial consultation:

Elder Law Fairfax: 703-691-1888
Elder Law Fredericksburg: 540-479-1435
Elder Law Rockville: 301-519-8041
Elder Law DC: 202-587-2797

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