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Understanding the Nuances of Medicare Can Save you Money and Heartache
Understanding the Nuances of Medicare Can Save you Money and Heartache image
Understanding the Nuances of Medicare Can Save you Money and Heartache
Posted May 11, 2022

Medicare is a complicated program that many do not understand or know how to navigate. It is important to learn how it works or you could face long lasting consequences. An understanding of timing, eligibility, available plans and coverage is essential for choosing the best plan for you at the right time.

Medicare Eligibility

You become eligible for Social Security when you reach age 65. However, if you are disaabled prior to that age, you must sign up for at least part A (generally automatic)  and possibly part B. If you have insurance coverage elsewhere such as through an employer, check with them to see if you are required to sign up for Part B.

Medicare supplement or Advantage plans are also available, but to use these you must have signed up for Part A and Part B.  If you miss your enrollment period because you have other insurance (or if you wait to get social security) you will incur life penalties for not enrolling during your initial enrollment period, which is when you first become eligible. 

Medicare Plans/Coverage

The majority of Medicare beneficiaries also sign up for a Medicare Advantage plan which may or may not have a Prescription Plan attached (Part D). Part D is valuable for aging seniors as they generally present with more health issues. Remember, Medicare does not have limits on out-of-pocket cost for prescription drugs. Very important to consider when you have an expensive illness that requires a very expensive drug regimen for your treatment. 

Medicare supplement plans can cover gaps in your traditional plan that can provide you better coverage. However, if you don't sign up for this at your initial enrollment, you may not be able to qualify for it at a later date. When you are first eligible, you are guaranteed an issue no matter your health status. If you wait and you have a pre-existing medical issue you may not be allowed enrollment at all or may have to wait a period for the Medicare Supplemental Plan to cover your illness.

With all of these complexities, it’s imperative that you contact a Medicare specialist to determine the best program for you, And, please do not wait until your birthday, as you may find you have a lapse in coverage because of the start day of the medicare coverage. The Medicare specialist can help you navigate the associated cost of your options as well as your need for coverage for your medical treatments. (You may need a broader coverage if you see specialists.) 

Also, If you have a lower income it is all the more important to speak to someone to make sure you have the right coverage for you. Medicaid programs are not administered the same in all states. Choosing a Medicaid program instead of traditional Medicare Part A and B can be beneficial to those with lower income. Also, in some states you may be eligible for both Medicare and Medicaid.

When comparing Medicare vs. Medicaid remember :

  • Medicare part A and B does not have a cap on your out of pocket cost
  • You will need to add a prescription plan - Part D, and/or Medicare Adavantage or supplement plan to bridge the gap in coverage provided with traditional Medicare

Because your decision are so important, speak to a specialist to make sure you're getting the best coverage for you. Making these decisions on your own will put you on the wrong path for inferior and possibly costlier insurance. Assistance is available at medicare.gov , medicaid.gov. State Health Insurance Assistance programs can also provide assistance.

Most individuals over age 65 also have need for vision and dental coverage. Traditional Medicare does not provide these. Therefore, it’s important to make sure you have the complete coverage you need. Some Medicare Advantage plans do offer this coverage, and also offer additional programs as well such as fitness programs. 

Insurance coverage is the foundation of your health care. Getting to know your options and understanding the associated cost and time requirements is essential. It can be the difference in getting the treatment you need versus not getting it at all.  What was mentioned here is just the tip of the iceberg. Do your due diligence and see what plan and coverage level is right for you.


 

The author Diahanna Vallentine

about the author
Diahanna Vallentine

Diahanna is the Financial Program Manager for the HealthTree Foundation,  specializing in financial help for multiple myeloma  and AML patients. As a professional financial consultant and former caregiver of her husband who was diagnosed with multiple myeloma, Diahanna perfectly understands the financial issues facing myeloma patients.

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