It’s no secret: navigating Medicare can be difficult. Finding your way through the “Medicare Maze” to enroll in the program correctly can be difficult. Our licensed Medicare personnel can help educate you and understand your options so that you make the best decisions - all at no charge.
Have you ever tried to navigate through a maze? Either for fun with your kids, or as part of a work-related team-building exercise?
Everyone knows the goal of the maze: To find your way through the junctions, dead-ends, and confusing passages and reach freedom. But many times, the maze is so difficult that people just give up.
When it comes to something as important as your Medicare benefits, a maze is the last place you want to be.
Millions of Americans rely on Medicare for healthcare coverage. However, the program has grown extremely complicated and confusing. If Medicare confuses or frustrates you, remember that you are not alone.
If you, your parents, or any loved ones who are looking to enroll in Medicare answer YES to any of the following questions, The ROI Group can help:
- Do you have piles of Medicare papers put aside to deal with later?
- Are you struggling to understand Medicare and the program’s benefits?
- Do you want to ensure that you have everything you’re entitled to?
- Do you want to access Medicare but avoid penalties and coverage loss?
As with all of our other financial services, we are dedicated to education and guidance. Below is some information to help you understand the basics about Medicare. After you review, contact us if you have any questions – we offer free consultation services to help you enroll in Medicare the right way.
Important: If you are specifically looking for Medicare Supplement coverage, you can compare prices with our Medicare Supplement price comparison tool.
Medicare Overview & Eligibility
Medicare is the health insurance program run by the U.S. federal government.
Who is eligible for Medicare?
- Individuals who are age 65+ and have worked for 10+ years in the U.S. (or whose spouse has)
- Individuals under the age of 65 who have certain disabilities, and people with end-stage renal disease
- Individuals who are 65+ and have received Social Security disability benefits for 24 months
- NOTE: If you are receiving Social Security at the age of 65, you are likely already enrolled in Medicare Parts A & B
Medicare Enrollment
If you are taking Social Security benefits prior to turning 65, you will automatically be enrolled in Medicare Part A and Part B. You should be sent your card approximately three months before your 65th birthday. Coverage will begin the first day of the month that you turn 65. If you are born on the first day of the month, your coverage will begin on the first day of the previous month.
If you are not yet taking Social Security at the time you turn 65, you must enroll in Medicare yourself. If you continue working and have health insurance through your employer, you may opt out of Medicare Part B until you retire and need the benefits.
You may apply online for Medicare benefits by visiting https://www.ssa.gov/medicare/. Scroll down to the bottom of the page and click on “Apply for Medicare Only”. Before you do this, download and review the Social Security Administration Application Checklist to ensure that you have all the materials that you will be asked for when applying.
Note: If you are already signed up for Part A and have delayed Part B, you must either call 1-800-772-1213 (TTY 1-800-325-0778) or visit your local Social Security office to enroll. This process cannot be done online.
Medicare Coverage & Cost Structure
Medicare is comprised of five main components: Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), Medicare Part C (Medicare Advantage), Medicare Part D (Prescription Drugs), and Medicare Supplement (Private Insurance to fill the gaps where other Medicare parts don’t provide coverage).
If you hear the term “Original Medicare,” know that this refers to Part A and Part B.
Medicare Part A: Hospital Insurance
- Covers inpatient hospital services (lab tests, surgery, etc.)
- Covers supplies deemed medically necessary during inpatient stay to treat a disease or condition (wheelchairs, walkers, etc.)
- Covers inpatient room stay, skilled nursing care, hospice, and some home health costs
Medicare Part B: Medical Insurance
- Covers medically necessary doctor visits, outpatient surgery, durable medical equipment (oxygen, crutches, etc.), physical therapy, and ambulance services
- Covers preventative services, such as flu shots, cancer and diabetes screenings, etc.
Medicare Part C: Medicare Advantage
- Medicare health plan offered by a Private Insurance Company to provide Medicare Parts A & B (Original Medicare)
- Covers everything in Medicare A & B (except Hospice Care)
Medicare Part D: Prescription Drugs
- Covers outpatient prescription drugs
- Plans can be purchased individually or included in a Medicare Advantage plan
- Plans vary in price, cost of co-pays, and the drugs they cover
- Even if you do not take prescription drugs now, the chances that you will need to increase as you get older
Medicare Supplement (Medigap) Plans
- Also known as “Medigap”, this is Private Insurance
- Additional plans offering coverage not included in Medicare Parts A & B, such as copayments, co-insurance & deductibles
- Medicare pays your bills first, then the Supplement Plan is responsible for the rest
Compare Medicare Supplement Prices
What Medicare Does Not Cover
Medicare does not cover treatments and services that are not paid for by Parts A and B, including:
- Long-term care
- Dentures & Most Dental Care
- Hearing Aids & Hearing Exams
- Acupuncture & Cosmetic Care
- Routine Foot Care
When selecting your Medicare coverage, it is important to consider the following statistics:
- 92% of Older Adults have at least one chronic condition*
- 77% of Older Adults have at least two chronic conditions*
- Original Medicare (Parts A & B) only covers about 62% of the cost of health care services (not including long-term care)**
Medicare Cost Overview
Here are some basic elements of how Medicare costs are structured – and how your previous work experience might affect your plan.
- Costs for Medicare vary from year to year
- Most people do not pay a monthly premium for Part A because they have paid into the system during their working years
- You will generally need to pay a Part A Deductible, a Part B Deductible, and a monthly Part B premium
- If you enroll in Medicare Part D Prescription Drug Plan, you may also pay a monthly premium
2017 Medicare Costs at a Glance
Below is a breakdown of what Medicare coverage costs today. For more information, refer to the Medicare.gov website.
If you are looking for Medicare Supplement costs, use our Medicare Supplement Price Comparison tool.
Medicare Part A: Hospital Costs
Monthly Premium:
$0 (If you paid Medicare taxes through work for more than 39 quarters)
$227 (If you paid Medicare taxes for 30-39 quarters)
$413 (If you paid Medicare taxes for less than 30 quarters)
Hospital Inpatient Deductible and Co-Insurance:
$1,316 deductible for each benefit period
Days 1-60: $0 co-insurance for each benefit period
Days 61-90: $329 co-insurance per day of each benefit period
Days 91+: $658 co-insurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
Beyond lifetime reserve days: All costs
Skilled Nursing Facility Coinsurance: $164.50/day
Medicare Part B: Medical Costs
Monthly Premium:
$134 (or higher, depending on your income)
$109 (on average, for most people who get Social Security benefits)
Deductible and Co-Insurance:
$183/year (After deductible is met, you would typically pay 20% of the Medicare-approved amount for most doctor services, including most doctor services while you’re a hospital inpatient, outpatient therapy, and durable medical equipment.)
Medicare Part C: Medicare Advantage
Monthly Premium: Varies by plan, and most plans have low or $0 premiums.
Deductible and Co-Insurance: Deductibles, copayments, and co-insurance vary by plan.
Medicare Part D: Prescription Drug Plans
Monthly Premium: Vary by plan, but you may pay more if your income is higher.
Deductible and Co-Insurance: Deductibles, copayments, and co-insurance vary by plan.
Important Medicare Dates to Know
Below is a list of critical dates in the Medicare process.
October 15 – December 7: Open Enrollment Period for Medicare Advantage & Medicare Part D Prescription Drug Coverage: This is when all people with Medicare can change their Medicare health plan and prescription drug coverage for the next year.
January 1 – March 31: General Enrollment Period: If you do not enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during this time. However, you may have to pay a late enrollment penalty. Your monthly premium increases 10% for each 12-month period you were eligible for, but did not enroll in, Medicare Part B.
January 1 – February 14: Medicare Advantage Disenrollment Period: If you have a Medicare Advantage plan (Part C), you can leave your plan and switch to Original Medicare. (If you use this option, you also have until February 14 to join a Medicare Part D Prescription Drug plan.)
January 1 – December 31: Medicare Supplement Plans: Can be purchased year-round but may require health questions to be answered to determine eligibility.
When Do You Turn 65?
Locate your birth month to determine your INITIAL enrollment period.
January: October before your birthday to April after your birthday
February: November before your birthday to May after your birthday
March: December before your birthday to June after your birthday
April: January before your birthday to July after your birthday
May: February before your birthday to August after your birthday
June: March before your birthday to September after your birthday
July: April before your birthday to October after your birthday
August: May before your birthday to November after your birthday
September: June before your birthday to December after your birthday
October: July before your birthday to January after your birthday
November: August before your birthday to February after your birthday
December: September before your birthday to March after your birthday
Download Medicare Preparation Checklist
Medicare Frequently Asked Questions
Below are some questions we hear often related to Medicare. Please contact us if you have any specific questions for a free consultation.
Q: Can I qualify for additional financial help with paying for Medicare?
A: People with limited income and resources may qualify for “Extra Help” programs that pay the Part B Original Medicare premium and/or lower the costs of prescription drug coverage. Learn more by visiting a Social Security office, going to www.ssa.gov, or calling 1-800-772-1213.
Q: What if I still have employer coverage available?
A: If you are age 65+, eligible for Medicare, and have insurance through you or your spouse’s current job, in most cases you should at least take Medicare Part A (Hospital Insurance).
Regarding Medicare Part B (Medical Insurance), talk with the Benefits Manager about how the employer insurance works with Medicare. The goal is to determine whether paying for both types of coverage will be useful in offsetting your healthcare costs.
Q: When should I begin planning for Medicare Enrollment?
A: It is never too early! Download our Medicare Preparation Checklist to help you get started.