There comes a time in everyone’s life when our 65th birthday approaches.Traditionally, this is the birthday where we turn off our office computers, gather our belongings into a cardboard box, and head out the door for the last time. Before we settle into our new lives, waking to fresh squeezed orange juice, taking our vitamins, then going for a run or out to yoga class, we need to get our health coverage squared away. As more and more of us continue to work at least part time, past the traditional retirement age, Medicare benefits have taken on greater meaning. There are many fractured truths and common knowledge surrounding this government subsidy primarily made available to older American citizens. In this article we cover what Medicare is, how it works, and how to determine what supplemental insurance you’ll need.
Medicare was legislated in 1966 and originally was part of the Social Security Administration. Today it falls under the aegis of the newly created Centers for Medicare and Medicaid Services. To qualify for Medicare, one has to be eligible to receive Social Security, and to qualify for Social Security, one has to have worked for a specified number of contiguous pay periods. (Yes, you have been paying into the Medicare system with every paycheck.)
It is a mistake to think, however, that over the age of 65 one receives free medical care in the U.S. Nope. Not a bit of it. The good news is that Medicare covers roughly half the healthcare expenses of those enrolled in the program. The not so good news is that what the program does not cover must be picked up by the patient and a third-party insurance provider. That’s why Medicare is divided into four parts, A-D. The biggest, Part A, covers hospital surgeries, stays, and related expenses such as chemotherapy and radiation therapy. While technically, it is free, the catch is, that it covers about 80% of the services offered. The overage must be paid by the patient.
This fact leads to great confusion. What do parts B-D do and who issues policies for same?
Here is a brief rundown:
Medicare Part B:
This covers outpatient services and some inpatient services depending on the provider. It also covers outpatient hospital charges, office visits, and most prescription drugs that are administered by a medical practitioner (i.e. inoculations).
Medicare Part C:
Known as Managed Medicare, this health insurance provider coverage combines Parts A and B, and some Part D benefits, but with an annual out-of-pocket spend limit which standard A and B do not have. And (eyes crossed yet?) beneficiaries must enroll in Parts A and B prior to signing up for Part C.
Okay. Your 65th rolled around and just before or after you paid a visit to the appropriate government office and were thoroughly confused by what the nice civil servant (about 30 years too young to qualify for Medicare) told you. What are your options to help you decide what will and will not work for you? And incidentally, how are you going to pay for all this?
Here are the five top sources I found to assist with making your all-important Medicare decisions:
YouTube Videos: there are a wealth of online videos flacked by persons who are way too young to have to know about these programs or have used them themselves. They range from snooze-inducing to highly informative. Just keep listening, and when you have found a series that you like, that also answers your questions, be sure to view it at least 3 times and take notes. The information can be very easy to misinterpret.
Social Security Office: Where you go to learn more varies by state. In mine, one reports to the Social Security Administration office nearest to their home. My well-intentioned, representative could only tell me what he knew, boilerplate, and could not field any of my questions. Happily, I was continuing to work and did not have to make a decision at that time. You might have more luck.
Government Agency Websites: As a writer myself, I personally found some of the site content contradictory and ambiguous. And there was no one to reach out to if I had a question. Give this one a pass unless a state of confusion is where you like to reside.
Friends/neighbors: If you are lucky, someone who has gone before you down this rabbit hole will remember their experience and share it with you. It might also cause even more confusion as no two citizens, it would appear, have the same health requirements. One great piece of advice: find a Debbie. My friend Debbie has assisted some of her older friends by calling the Social Security Administration on their behalf, enduring the extremely long wait period for a live response, and then running down her list of requests and questions. Bonus: many who cover the SSA phone lines are older workers themselves, and offer great advice from personal experience!
Online Benefits Organizations: On my long fact-finding journey I have located (via YouTube videos) organizations that are in fact, insurers or insurance brokers themselves. These organizations are dedicated to assisting Medicare enrollees to determine which options and providers are right for their individual needs. A bonus is that they additionally serve as Medicare advocates should a problem arise now or in the future. Some are fee-driven, others are subsidized by health insurance providers.
AND A BONUS:
Another place to find helpful, if not self-promotional information is from health insurance providers websites. Most offer useful questionnaires that can get you thinking about what your coverage requirements might be to make an educated decision regarding your supplemental Medicare coverage options.
While we’re at it, let’s not confuse Medicare with Medicaid. Medicaid is solely to assist those living at or below the poverty level to receive quality health care. It pays for doctor visits, surgeries and hospitalization, long-term and custodial care expenses, and more. It is funded by the federal government but administered at the state level. There are no out of pocket expenses for its enrollees or their family members. Providers are limited, but the program makes healthcare available to the disadvantaged.
The U.S. is a great country and wants to ensure the continued good health of its citizens over age 65. With a little research and an understanding of our current health needs, it should be fairly easy to determine the best insurance policy for now, knowing that within the year, updates or changes can be made. We hope this article has been informative and has provided the guidance you need. To your continued good health!