Turning 65? 7 Things You Need To Know About Medicare

It’s difficult to navigate through Medicare on your own, especially when there are no easy, one-size-fits-all coverage options. So, to help minimize stress while maximizing your Medicare coverage, we listed things you should know about Medicare before you turn 65!

1. After you turn 65, Medicare is your primary insurer

Even if you haven’t applied for Medicare yet, once your turn 65, it is considered your primary insurer. This stands regardless if you have individual health insurance, retiree health insurance or COBRA. It is important to be aware of this change because it means you can’t count on your other forms of insurance to pay for your hospital or physician bills, as they are considered your secondary insurer.

2. Apply before you turn 65

It is suggested that you apply during the initial enrollment period of three months before your 65th birthday.

You don’t need to sign up for Medicare each year. However, each year you’ll have a chance to review your coverage and change plans. This is because most people paid Medicare taxes while they worked so they don't pay a monthly premium for Part A. Certain people may choose to delay Part B. In most cases, it depends on the type of health coverage you may have. Everyone pays a monthly premium for Part B. The premium varies depending on your income and when you enroll in Part B.

3. If you miss enrollment, you’ll have to pay penalties

Depending on the part of Medicare that you apply for, late enrollment penalties can vary from 10% for every 12 months you delay enrollment or 1% per month.

If you miss the initial Medicare enrollment period, you can still sign up! The general enrollment period runs from January 1-March 31. Those that enroll during this period will be eligible for coverage the following July.

4. Choose your plan wisely

You can choose either the original Medicare (Part A) or a Medicare Advantage Plan (Part C). You can also add other parts, such as prescription drug insurance (Part D).

There’s no “right” Medicare plan, but there are some things to consider when choosing between Original Medicare and a Medicare Advantage Plan.

With Original Medicare:

  • Though most doctors accept the original Medicare program, if remaining with your family doctor is important to you, then you should check to ensure your doctor will be accessible under this plan
  • You may have more out-of-pocket costs
  • You will have a choice of the drug plans available in your area

With a Medicare Advantage Plan:

  • There are limits to the doctors you can choose to see — If remaining with your family doctor is important to you, then you should check to ensure your doctor will be accessible under this plan
  • You may have fewer out-of-pocket expenses
  • You may have access to extra hearing and vision benefits
  • Drug coverage is included in some, but not all types of Medicare Advantage Plans

5. Four main parts of Medicare coverage

  • Medicare Part A refers to hospital insurance and covers most medically necessary hospital, skilled nursing facility, home health, and hospice care.
  • Medicare Part B refers to medical insurance and covers most medically necessary doctors’ services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. You pay a monthly premium for this coverage.
  • Medicare Part C refers to Medicare Advantage Plans. With these plans, private health insurance companies have contracts with the government. Medicare Advantage Plans are not provided directly by the government like Medicare is. Many resources about Medicare often skip Part C when talking about Medicare benefits because it is not a separate benefit like Parts A, B and D.
  • Part D refers to Medicare’s prescription drug insurance. Part D is never provided directly by the government and is a separate, optional plan to help cover cost of medication.

6. On Social Security?

If you’re on social security (which you can begin at age 62), then you should be automatically enrolled in Medicare Part A and/or Part B when you turn 65. Of course, it doesn’t hurt to double check!

7. You can supplement Medicare with a “Medigap Policy”

If you can afford it, it is possible to supplement Medicare with a Medicare Supplement Plan, or “Medigap” Policy. These plans will help cover expenses like:

  • Coinsurance (the portion of the money you pay after your insurance has paid your benefit)
  • Co-payments (the money you pay each time you seek care)
  • Deductibles (money you pay before your insurance benefits kick in)

Where to find additional information:

  • Medicare at 1-800-MEDICARE (1-800-633-4227) or access their website.
  • The “Medicare & You” handbook.
  • The Medicare Plan Finder.
  • The Medigap Plan Finder.
  • The Medicare Rights Center hotline 1-800-333-4114.
  • United Medicare Advisors to help you enroll and compare Medigap plan rates
  • Your local State Health Insurance Assistance Program (SHIP).
New Medicare Laws

Reimbursement for Daily Maintenance, Day Programs, and More

New Medicare Laws Allow Reimbursement for Daily Maintenance, Day Programs, Respite Care and More

The Centers for Medicare and Medicaid Services (CMS) recently announced non-skilled home care services, such as coverage for home safety devices, housekeeping, respite care for caregivers and adult day care services, will be covered in 2019.

The announcement marks the first time CMS has allowed supplemental benefits that include daily maintenance in Medicare Advantage insurance plans. The agency reports, “CMS is expanding the definition of ‘primarily health related.’ Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”

Coverage under Medicare Advantage will only apply if there is a health-related issue, such as a medical diagnosis. In its initial stages, the new Medicare Advantage plans will be available in over 20 states, but the Medicare Advantage coverage is expected to expand over time.

Some benefits will have no extra cost, while others will vary in cost and limits will apply in the reimbursement amount. For example, caregivers may be reimbursed for adult day programs, but only for two visits per week. Home care support services that will be covered include:

  • Adult day care services
  • Approved personnel to help with activities of daily living (ADLs)
  • Coverage for safety devices to prevent injuries in the home
  • In-home assistance for bathing, medication management etc.
  • Respite care for caregivers
  • Supportive services by personal care attendants

In a recent speech, CMS Administrator Seema Verma, states, “For the first time ever, Medicare Advantage beneficiaries can access significant new flexibility for additional benefits that can help them live healthier, more independent lives.” Long Island Alzheimer's and Dementia Center takes considerable pride in its pioneering role in the development of cutting-edge services that foster the independence, dignity, well-being and safety of individuals with Alzheimer's and other forms of dementia, thus aiding in the prevention of premature nursing home placement on Long Island. Long Island Alzheimer's and Dementia Center is here, every step of the way, to help caregivers and diagnosed individuals receive the guidance and comfort they deserve. Call today to learn more about our services, which may be covered by your insurance plans.

Featured in Newsday

Long Island Alzheimer’s and Dementia Center Featured in Newsday

"Many others with dementia remain at home. The Westbury-based Long Island Alzheimer's and Dementia Center has programs aimed at allowing people who want to live independently to do so, but for safety and health reasons, an assisted-care residence or nursing home may be more appropriate, and a memory-care wing is better than living in a non-specialized area, said Tori Cohen, the group’s executive director."

“They need specialized care in every part of their everyday living,” she said. “They need to be monitored more. And there needs to be a lot of [staff] training with this disease.”

Executive director of Westbury-based Long Island Alzheimer's and Dementia Center, Tori Cohen was featured in Newsday. Click button below to read the entire article.

Melissa Katz

Long Island Alzheimer’s and Dementia Center Social Worker Honored by Long Island Business News

Melissa Katz, LMSW Director of Early Stage and In-Home Respite Programs, was honored at the Long Island Business News 40 Under 40 annual event! A very well-deserved honor, Melissa was supported and cheered on by staff and family at the award ceremony. Melissa’s interview was featured in numerous newspapers throughout Long Island.