If you are Turning Age 65 and enrolling in Medicare for the first time, you may feel overwhelmed.
Additionally, if you already have Medicare and are preparing for the Medicare Annual Enrollment Period, the process can feel daunting.
Medicare has Parts A, B, C and D, Turning Age 65. Additionally, there are Medicare Advantage plans, Medicare Supplement plans, prescription drug plans, provider networks, co-pays, deductibles and premiums.
For many people, the problem is not finding Medicare information. However, it is understanding how Turning Age 65 and all the pieces fit together.
Fortunately, the good news is that Medicare planning does not have to be confusing.
Instead of beginning with, “Which Medicare plan is best?” start with a better question:
Which type of Medicare coverage fits my doctors, prescriptions, healthcare needs, budget and lifestyle?
That is where good Medicare planning begins.
Turning 65? Start Your Medicare Planning Before Choosing a Plan
If you are turning 65 in South Carolina, your Medicare decisions usually begin during your Initial Enrollment Period.
For most people, this period lasts seven months: the three months before the month you turn 65, your birthday month, and the three months after.
Turning Age 65 highlights when to enroll in Medicare. Additionally, knowing when to enroll can be as important as deciding which coverage to choose.
Before making any decisions, ask yourself:
- Are you retiring or continuing to work?
- Will you still have employer health insurance?
- Which doctors and hospitals do you use?
- What prescription medications do you take?
- How often do you travel?
- Are predictable healthcare expenses important to you?
Those answers can help determine which Medicare coverage path may fit you best.
Understanding Medicare Parts A, B, C and D
Before comparing Medicare Advantage vs. Medicare Supplement, it helps to understand Medicare’s basic building blocks.
Medicare Part A: Hospital Coverage
Medicare Part A is commonly known as hospital insurance.
It generally helps cover:
- Inpatient hospital care
- Skilled nursing facility care after a qualifying hospital stay
- Hospice care
- Certain home health services
For many people who worked and paid Medicare taxes long enough, Part A does not have a monthly premium.
However, Part A does not mean every hospital-related expense is paid in full. Deductibles, coinsurance and other out-of-pocket costs can still apply.
Medicare Part B: Medical Coverage
Medicare Part B generally covers the medical and outpatient side of Medicare, including:
- Doctor visits
- Outpatient services
- Preventive care and screenings
- Diagnostic testing
- Certain medical equipment
- Other medically necessary services
Most people pay a monthly premium for Part B.
Together, Medicare Parts A and B make up Original Medicare.
Original Medicare provides broad access to doctors and hospitals that accept Medicare, but it does not cover every healthcare expense. That is one reason many people consider additional Medicare coverage.
Medicare Part C: Medicare Advantage
Medicare Part C is also known as Medicare Advantage these are plans are offered by private insurance companies that are approved by Medicare.
Instead of receiving your Part A and Part B benefits directly through Original Medicare, you receive those benefits through the Medicare Advantage plan.
Many plans also include prescription drug coverage and may provide additional benefits such as:
- Dental
- Vision
- Hearing
- Fitness or wellness benefits
Plans can vary significantly when it comes to provider networks, co-pays, prescription coverage and annual out-of-pocket costs.
A Medicare Advantage plan that works well for one person may not fit another person at all.
Medicare Part D: Prescription Drug Coverage
Medicare Part D helps cover prescription medications.
If you remain with Original Medicare and choose a Medicare Supplement plan, you may also need a separate Part D prescription drug plan.
Part D plans can differ based on:
- Covered medications
- Drug tiers
- Preferred pharmacies
- Co-pays and coinsurance
- Monthly premiums
This is an important part of Medicare planning because two people living in the same town may need completely different Part D plans simply because they take different medications.
Important: Delaying Medicare Part B or Part D Can Cost You
This is one of the most important things someone turning 65 and enrolling in Medicare needs to understand.
If you do not enroll in Medicare Part B or Medicare Part D when you are first eligible, and you do not have qualifying coverage that allows you to delay enrollment, you could face late enrollment penalties.
For Medicare Part B, the penalty is generally added to your monthly premium based on how long you went without Part B when you could have enrolled. In many cases, that penalty continues for as long as you have Medicare Part B.
Medicare Part D also has a late enrollment penalty if you go too long without Medicare prescription drug coverage or other creditable prescription drug coverage.
This is especially important for people who are still working at age 65.
You may be able to delay certain parts of Medicare if you have qualifying employer coverage through current employment. Prescription drug coverage must also meet Medicare’s definition of creditable coverage if you are delaying Part D.
The key point is simple:
Do not assume that having some type of health insurance automatically means you can safely delay Medicare.
Before declining Part B or Part D, make sure you understand how your employer coverage works with Medicare and whether delaying enrollment could create a future penalty.
Medicare Advantage vs. Medicare Supplement: Which Is Better?
Once you understand Parts A, B, C and D, the next decision becomes easier.
There are generally two common Medicare coverage paths.
Option 1: Original Medicare + Medicare Supplement + Part D
or
Option 2: Medicare Advantage, which provides your Part A and Part B benefits through a private Medicare-approved insurance company and often includes prescription drug coverage.
Neither option is automatically better.
The better question is: Which approach gives you the right combination of doctors, hospitals, prescription coverage, costs and flexibility?
Medicare Advantage Plans in Upstate South Carolina
A Medicare Advantage plan or also known as the “All-In-One Plan” also known as Medicare Part C, can combine several pieces of Medicare coverage into one plan.
Many plans include prescription drug coverage and may include extra benefits such as dental, vision and hearing.
Some Medicare Advantage plans may have low monthly premiums, including plans with a $0 monthly plan premium.
But premium should never be the only thing you consider.
When comparing Medicare Advantage plans in Upstate South Carolina, ask:
- Are my doctors in the network?
- Is my preferred hospital included?
- Are my medications covered?
- What will I pay when I use healthcare?
- What is the plan’s maximum annual out-of-pocket cost?
Those questions may be far more important than the advertised monthly premium.
Medicare Supplement Insurance
A Medicare Supplement plan, also called a Medi-gap plan works alongside Original Medicare.
It helps pay certain healthcare expenses that Medicare Parts A and B do not fully cover.
Depending on the plan, this may include certain deductibles, coinsurance and co-payments.
Medicare Supplement coverage generally provides greater flexibility when choosing doctors and hospitals that accept Medicare nationwide.
However, Medicare Supplement plans usually have a monthly premium in addition to your Part B premium.
Prescription drug coverage is not included, so many people who choose this route also enroll in a separate Medicare Part D prescription drug plan.
For some people, paying more each month for greater predictability makes sense.
For others, Medicare Advantage may be the better fit.
That is why good Medicare planning should focus on the individual rather than simply trying to find the plan with the lowest premium.
Medicare Annual Enrollment: Do Not Automatically Keep the Same Plan
If you already have Medicare, your planning is not finished.
Medicare’s Annual Enrollment Period runs from October 15 through December 7 each year.
During this period, Medicare beneficiaries may be able to change Medicare Advantage or prescription drug coverage for the following year.
One common mistake many people make each year is assuming that last year’s Medicare advantage plan will automatically be the best choice next year.
Medicare advantage plans and their benefits can change each year. Your plan’s premiums, co-pays, prescription drug coverage, provider network, benefits and out-of-pocket costs may be different in the coming year.
Your own healthcare needs can change too.
You may have:
- New prescriptions
- A new doctor
- Different medical needs
- More frequent healthcare visits
- Different travel needs
That is why Medicare Annual Enrollment planning should include reviewing both your current plan and your current healthcare situation.
Sometimes the right answer is to change plans.
Sometimes the right answer is to keep exactly what you already have.
The important part is understanding why.
Local Medicare Planning in Pickens County and Upstate South Carolina
Medicare is a federal program, but many Medicare choices are very local.
The Medicare Advantage plans available in Pickens County, Easley, Clemson, Seneca, Anderson and Greenville, South Carolina can vary by county, insurance company and service area.
Doctor networks can differ.
Hospital networks can differ.
Prescription drug coverage can differ.
That is why working with a local Medicare insurance agent in Upstate South Carolina can be valuable.
At the Shanley Insurance Agency, we are an independent agency representing multiple Medicare insurance companies who deal specifically with Medicare planning.
That means we are not limited to showing you only one company’s Medicare plan.
Our goal is to help you compare your options, understand the differences and choose coverage based on your needs.
Whether you are turning 65, looking for Medicare enrollment help, comparing Medicare Advantage and Medicare Supplement plans, or reviewing your coverage during Medicare Annual Enrollment, the goal should be the same:
Choose Medicare coverage based on your healthcare needs, prescriptions, doctors, budget and lifestyle, not simply on an advertisement or monthly premium.
With more than 38 years of insurance experience and serving Upstate South Carolina families since 1999, Shanley Insurance Agency is here to help make Medicare easier to understand.
Have Medicare questions? Contact the Shanley Insurance Agency today and, let us help you review your Medicare options with confidence.