8 Tips for Navigating Medicare

Medicare is an insurance program that covers millions of Americans aged 65 and older. Despite its widespread prevalence, many find that navigating the ins and outs of Medicare is complex. With its various coverage plans, enrollment periods, and exclusions, you want to learn as much as you can about your healthcare options.

Whether you’re approaching eligibility or already enrolled, the following eight tips give you the Medicare help needed to make the most out of the insurance coverage.

Knowing the Enrollment Periods

The enrollment periods for Medicare significantly impact your coverage selections and costs. The three options you need to know include:

• Initial Enrollment Period (IEP): The IEP refers to the seven months surrounding your 65th birthday when you’re first eligible to sign up for Medicare.
• Special Enrollment Period (SEP): You can sign up for Medicare during the SEP if you or your spouse were still working during the initial signup period.
• General Enrollment Period (GEP): The GEP occurs annually between January 1 and March 31. If you didn’t apply during the initial and special enrollment periods, you’re permitted to sign up for Medicare each year only during that timeframe.

Choosing the Right Plan

Most seniors have the choice between two plans when enrolling in Medicare: Medicare (Part A and B) or Medicare Advantage (Part C). Medicare Advantage was created to combine Part A and B into a single plan. Medicare Part A and B will cover the insurer’s hospital stays, doctor’s visits, and outpatient care appointments.

Medicare Advantage is a bundled plan that includes coverage for hospital visits, doctor’s appointments, and prescription medications. It is sold through private insurers and works similarly to traditional insurance plans. Depending on your plan details, you may need to choose in-network doctors and receive referrals to visit specialists.  

Checking Eligibility for Savings Programs

Medicare is associated with several discount and assistance programs, allowing subscribers to save on healthcare costs. If you qualify for one or more of the following plans, you could pay less for coinsurance, premiums, and deductibles.

• Medicare Savings Plan (MSP)
• Pharmaceutical Assistance Program (PAP)
• Extra Help
• State Pharmaceutical Assistance Program (SPAP)

Considering Medigap Coverage

If you have a Medicare plan, Medigap coverage should be a consideration. Medigap, also called Medicare Supplemental Insurance, will help pay for costs not covered by Medicare, such as deductibles and copays. You must have Medicare Part A and B to be eligible to purchase Medigap coverage. Medigap plans differ by state, and you may enroll during the six months surrounding your 65th birthday.

Coordinating Benefits

If you have other insurance plans in addition to Medicare, you’ll need to consider how to coordinate benefits. Additional plan options may include Medicaid and private employer insurance. Coordination of benefits allows Medicare subscribers with additional insurance options to determine which insurance plan has the primary responsibility to pay claims. The process also decides how much each plan will contribute if multiple insurance carriers cover the subscriber.

Prioritizing Preventative Care

Some patients don’t realize that Medicare covers multiple preventative services. Wellness visits, vaccinations, and routine lab work are typically free to Medicare subscribers. Each year, they can visit their family doctor to review their health and get basic checks, such as blood pressure and weight. Taking advantage of preventative services helps identify health issues early.   

Reviewing Changes to Medicare

Medicare policies will change over time. For instance, deductibles tend to increase by approximately six percent each year. Rules also change annually about the income requirements needed to avoid a surcharge on Medicare coverage. Surcharge amounts typically range between $70 and $420, depending on how much money you make.

Getting Medicare Help When Needed

If you ever encounter problems with Medicare and need assistance, resources are open to you. Organizations like the Medicare Rights Center advocate on behalf of Medicare beneficiaries. For assistance, you may also contact Medicare directly at 1-800-MEDICARE.