What you need to know:
1. Open enrollment ends Dec. 7. You can apply for Medicare at the socialsecurity.gov website or visit your local Social Security office.
2. Hospital care is covered by Medicare Part A. Medicare Part B is medical insurance that pays for doctor’s visits and outpatient services. Medicare Advantage plans, or Medicare Part C, are an alternative to traditional Medicare offered by private insurance companies, typically with different premiums and restrictions. Prescription drug coverage is provided through Medicare Part D.
2. You can first sign up for Medicare during a seven-month window around your 65th birthday. Coverage can start beginning the month you turn 65. If you fail to sign up during this initial enrollment period, you could be charged higher premiums for the rest of your life. If you delay Medicare enrollment due to group health insurance through your current job, sign up for Medicare within eight months of leaving the job or the coverage ending to avoid the penalty.
3. Most people don’t pay a premium for Medicare Part A. The standard Medicare Part B premium is $104.90 in 2015, but costs are higher for retirees with a modified adjusted gross income above $85,000 for individuals and $170,000 for couples. Medicare Part D premiums vary depending on your plan choice.
4. There’s no annual limit on out-of-pocket costs for Medicare Part B. Medicare Part A has a $1,260 deductible if you are hospitalized, and additional costs apply if your hospital stay exceeds 60 days.
5. Medicare provides many preventive care services, such as flu shots and mammograms, without any cost-sharing requirements. Beneficiaries are also eligible for a free wellness doctor’s visit once each year. However, tests and services performed during the wellness visit could result in additional charges.
6. Retirees must choose between an average of 30 different Medicare Part D prescription drug plans, which each have different covered medications, premiums and copays. The covered medications and their costs also change annually, so it’s a good idea to shop around for a new plan each year during the open enrollment period.
Source: The Centers for Medicare and Medicaid Services and The Associated Press
Users of Medicare Advantage, a private alternative to Medicare, will pay less for monthly premiums next year and costs for Medicare Part D will remain flat, according to the Centers for Medicare and Medicaid Services.
Open enrollment for traditional Medicare began last month, but it’s also the time of year when people who are eligible can enroll in Medicare Advantage.
Medicare is the government-sponsored program created in 1965 that offers health care coverage to people aged 65 and up, and younger people with certain disabilities — but it doesn’t cover everything.
It won’t pay for eyeglasses, dental care or for more than 100 days of long-term care in a nursing home or assisted living facility. Nor does it cover prescription drugs, one of the biggest health care expenses for seniors, unless enrollees sign up for Medicare Part D coverage, which requires a monthly premium payment.
Most Medicare Advantage issuers, who receive funds from the federal government to provide benefits, offer comprehensive coverage, including prescription drugs at monthly premium costs that are about the same as the cost of Part D alone.
Next year, average Medicare Advantage premiums are expected to decline slightly to $32.60 per month, while average monthly premium costs for Part D will remain flat at $32.50 per month, according to CMS.
And more than three-quarters of Medicare Advantage beneficiaries will have access to zero-premium plans, according to research from the Henry J. Kaiser Family Foundation.
“Assuming your Medicare Advantage options have good doctor networks, they can be a wonderful choice for people on fixed incomes because they have maximum out-of-pocket limits, which are not part of original Medicare, and about 97 percent of them roll in benefits that are not part of original Medicare,” said Kev Coleman, head of research and data for insurance comparison website, HealthPocket.com. “You’re getting coverage in areas that you don’t have in original Medicare, so you get additional cost savings.”
Medicare Advantage might look like even more of a deal this year for about 7 million Americans who supplement traditional Medicare with Medicare Part B, which covers services such as lab tests, surgeries and doctor visits. Part B premiums could increase more than 50 percent next year for individual enrollees because of a quirk in the law that ties Part B premiums to Social Security benefits.
Medicare Advantage plans have surged in popularity in recent years and are now offered by a growing number of insurers throughout Ohio.
Enrollment in Medicare Advantage increased in nearly every state this year, and the number of beneficiaries has more than tripled over the past decade to 16.8 million from 5.3 million in 2004, according to Kaiser. In Ohio, more than 811,000 residents are enrolled in advantage plans, or about 38 percent of all Medicare beneficiaries.
Enrollment continues to grow despite reductions in payments to Medicare Advantage plans included in the Affordable Care Act.
Reduced payments led some issuers to drop doctors from their Medicare Advantage networks in 2013 and 2014 after many seniors had already enrolled in plans.
But lawmakers, including U.S. Sen. Sherrod Brown, are preparing to introduce legislation — the Medicare Advantage Participant Bill of Rights — that would ensure that enrollees know what providers will be covered for the entire year under their plan, rather than just at enrollment time.
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