Time For Medicare Enrollment?? Here's Some Helpful Tips!


Time to Enroll for Medicare??  In this Video, Michelle T. Robinson of Stolz & Associates and Laci Moyer of Pilkey Hopping & Ekberg disucss the items you need to know when it's time to enroll in Medicare.

Items discussed are the enrollment time frame and the different components of medicare including Part A, Part B, Part C, and Part D. They also discuss the benefits of an Advantage Plan and additional considerations for when it is time for you to enroll.

As always, feel free to reach out if you have questions!



Video Transcript...

Hello, I'm Michelle Robinson, Vice President and CCO of Stolz and Associates. And with me today is Laci Moyer, Vice President of Pilkey Hopping & Ekberg. Laci knows everything there's to know about Medicare. So I asked her here today to kind of go over some basic information, but with a little bit of a twist, we're going to do "True or False?" with Medicare.


True or false?  You must be age 65 in order to file for Medicare.


Ultimately that is false. Most people are going to fall into the age 65 and over category. However, if you have a disability, you can potentially secure Medicare coverage prior to age 65. So that typically falls onto people that have social security disability income. If you've been receiving that for at least 24 months, you could be eligible for Medicare before age 65.


So, if you are eligible, whether it's through disability or turning 65, there's the 7 month window or the 7 window. You want to explain that a little bit?


Yeah. So, when you turn 65, you have a 7 month window, 3 months prior to your birth month, the month of your birth month, and then 3 months after your birth month to enroll. Disability would be the same way.


Number two, true or false? If you are still working at 65, you can defer filing for Medicare.


True. You can defer if you are still working. The main thing to know on that is that you need to be on a creditable employer plan. So, every October your employer sends out a notification – it’s called a Medicare creditable coverage notice. And they're required to send it out by October 15th. You might get it in August or September, a little bit early. But you want to hang onto that notice because that tells you if your plan is creditable.


So you can defer it at that point and continue on your employer plan until you retire from that plan. And then you have a special enrollment period to be able to go onto Medicare when you come off your employer plan. But there are some significant penalties if you don't have that creditable coverage notice. So we always say make sure you have that notice or you talk to a broker like me so that we can help confirm whether you can defer. Otherwise, those penalties can add up.


Number three. There are 4 major sections of Medicare, A, B, C, and D. True or false?


That is true. There are. We call it the alphabet soup.

  • Part A, we refer to it as "Hospital", it's going to cover basically hospital insurance. So if you end up in the hospital, it's going to cover the majority of the components of the hospital. It can cover skilled nursing. However, it's important to know that Medicare does not cover long-term care. So if you fall and you break your hip and you end up in a skilled nursing facility and you're improving, it will cover that. However, if you have dementia or some other degenerative disease, then Medicare’s not going to cover your long-term care needs.
  • So pretty much everything else falls into Medicare part B. It’s all the other components of Medicare that you would need. Like lab work, doctor's visits, pretty much everything else we just say falls into B outside of being in a hospital essentially. So we consider those original Medicare, you have to obtain those from the federal government via Social Security. So you go to the Social Security office to get that coverage, and they basically cover everything. Part B does have a cost associated with it, Whereas part A, most people received part A for no cost because they've been paying into it during their working years. So, you need to work at least 40 quarters, or that's the equivalent of about 10 years. So you work 40 quarters and then you're eligible for it when you turn 65. Part B’s cost is income-based. It's actually based on income from your tax return from 2 years prior. So that's key. If you're getting ready to retire, you want to be planning for that. It's around $200 for the average person, but as your income goes up, then the cost of part B goes up from there. And it can go down. So the thing to remember that it is based on your tax return, it's also reviewed. So if one year you have, for some reason you have big income, like a huge capital gain or something that's going to affect you, eventually it will go down because maybe next year you won't.
  • So Part C is "Advantage", right? Yes. So that is a combination of A and B, but it's through a Managed Care Plan. It's a supplement to A and B. But the insurance company is managing it on behalf of the government. So you still have to go enroll in A and B in order to get C. But, it then takes care of everything for you. We really like those plans because they have a lot of added benefits, like dental, vision, typically prescription, which we're going to talk about in a second. The biggest disadvantage is that you have to stick within a network of doctors. So, if you're traveling, if you're a snowbird and you're going to spend 6 months in Arizona or another warmer location, then it doesn't typically work great for people that are going to do that. So there's some pros and cons to it overall, but cost ranges we've seen anywhere from $0, because the federal government subsidizes the plan, all the way up to $200. So, if you don't sign up for it right away, like a year later if you're like, "Oh, hey, I really, you know, I saw all those commercials on October 15th, I really want to switch my plan." Is that something you can do? Yeah, you can switch, you can come onto it later, but there are certain time periods of the year that you can enroll on it. So, if you choose not to go with it now, and then you have a health event, wind up in the hospital, That could be a disadvantage to you.
  • You always remember D is for drugs. So prescription drugs, this, you have to get through private insurance. You have to come to someone like me or go directly to an insurance company or call the ads on the TV in order to get the prescription coverage. There's a number of components to the prescription. So first of all, typically, they have a deductible. They have a copay once you've met the deductible, and then there's a whole bunch of other components to it that you want to be aware of If you have high drug costs. The thing I tell people when searching for prescriptions is to look at the formulary. The formulary is a list of prescriptions, And every insurance company is different in what they cover. So one person might have a list of drugs that is covered by one company and another person might have a list that doesn't get covered by that company. They need to go elsewhere. And the cost on these plans we see range from about $5 to a $100 dollars per month. And on average, we probably see most clients in about the $30 range. There is an income component to this as well. It's not as much as the part B, so most people don't think about it, but just be aware, you might see a little bit of an add-on to that cost if you're in one of those higher income brackets. And is there a penalty associated if you don't get D? Yes. This is really important. A lot of people might go into Medicare and not be on any prescriptions so they may say, "I don't need to enroll in this." However, if you defer it and you don't enroll until you need it, it's 1% per month forever. So, two years, you're looking at 24%, and it's of the national average, which is around $35. So that can really add up if 5 years later is the first time you need prescriptions, right?


Number 4. Medicare supplement coverage is mandatory.


That is False. It's not, just like we were talking about, people can choose just to go with A and B. You don't have to buy a supplement. Why do people want to buy a supplement? If you only get A and B, there's a lot of holes in that. So, the federal government is going to cover a portion of what you need, but there's some things they're not going to cover. So we suggest purchasing a supplement. The medical supplement is federally regulated. So all the plans across every insurance company are going to be the same. The difference is the cost and some of the value-added benefits that they might add. So they're very easy to compare. The most popular plan that we see is Plan G. And that has a cost about $200, $250, give or take. It covers everything except for the Part B deductible, which is right around $200. So, I had someone that had a stroke, they were in the hospital and it covered everything except for $200. So that's why it's so popular. The other reason it's popular is because you can see any doctor that takes Medicare, so you're not stuck with that network. If you're traveling a lot, you can take this anywhere with you in the United States. Even if you move, if you decide to permanently move to a new location, you can take this with you. And you don't have to worry about changing plans again.


Well, that was my last card. So thank you so much for all of this information. We hit on a lot of things, but a lot of things we didn't. So a good resource is medicare.gov. That's the official website. Again, you can always reach out to an independent insurance broker, someone like Laci, or check with your financial advisor, someone like me.


Thanks for watching!