By Laurie E. Ohall, Board Certified Elder Law Attorney
If you are turning 65 soon, you will be eligible for Medicare. However, if you are still working, you may already have insurance through your employer or other private insurance.
What You Need To Know If You Are Still Working
If you are an individual who is still working – beware – seniors who do not sign up for Part B Medicare within three months before or after their 65th birthday will have to pay a penalty…..and it is permanent! What does Part B insurance cover? It covers your doctor visits and other outpatient services. Just because you have insurance through your employer or the marketplace does not exempt you from having to pay the penalty. The penalty is 10% of the monthly premium for each 12-month period you are late.
Also, if you are late enrolling in Part B, you can only sign up during the General Enrollment Period (between January 1 through March 31st) for coverage that will not begin until July 1st. So, you might be stuck continuing to pay for your employer or marketplace coverage.
What else do you need to know about Medicare?
Medicare Part A is free if you or your spouse have paid Medicare taxes for at least 10 years while working. Otherwise, you may be eligible to purchase Part A under certain circumstances.
Many people do not understand the difference between Original Medicare (Part A and B) and a Medicare Advantage Plan (Part C coverage). Medicare Advantage Plans are like a PPO or an HMO which provide the same coverages as Part A and B, but also may offer additional benefits (such as covering part of the Part B premium you must pay). Also, with Original Medicare, you can go to any doctor who accepts Medicare and you do not need a referral to go to a specialist. With an Advantage Plan, you have to go to the doctors on the particular plan you choose and you do need a referral to go to specialists. Finally, with Original Medicare, you pay 20% of the costs for common medical services like office visits and outpatient surgery (which a Medicare supplement can cover) versus Advantage Plans – you pay a co-pay for every visit and you cannot purchase a supplement plan to cover the co-pays.
The most important thing to know about the difference between Original Medicare and Medicare Advantage Plans is this – while an Advantage Plan can be good coverage for someone who is healthy (i.e., does not go to the doctor often and is not on a lot of different medications), for someone who is sick or needs a significant length of care, he or she is better off with Original Medicare. This is because Advantage Plans have a limited network of providers and enrollees will face higher costs for going out of network.
It is so important to educate yourself and be careful who you are listening to for information – those selling insurance may not always have your best interests at heart. If you really want unbiased information about which type of Medicare is best for you, SHINE (Serving Health Insurance Needs of Elders) is a free program offered by the Florida Department of Elder Affairs and your local Area Agency on Aging. Specially trained volunteers can counsel you regarding your Medicare, Medicaid, and health insurance questions. Our local SHINE office can be reached by calling 1-800-336-2226 or going to www.FloridaSHINE.org.