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How Do I Prepare for Medicare?

By: Camila Cal, SeniorLivingGuide.com

Medicare is an important part of the aging process, but as we all have heard before, it can also be a stressful, confusing component of getting older. If you’re approaching your 65th birthday and are feeling overwhelmed with where to begin when it comes to Medicare coverage, we have good news! SeniorLivingGuide.com Podcast was joined by Lora Felger, Community Outreach and Medicare Advisor for FirstCarolinaCare, a homegrown insurance company in North Carolina. Her goal is to translate that complicated Medicare lingo into a language everyone can understand.

Don’t be alarmed if a year before your 65th birthday, you already begin receiving flyers and information in the mail about Medicare! Lora explained that because enrollment begins three months before you turn 65 years old, it is never too soon to begin preparing for this new phase of your life.

So, the key question is, just how do you prepare for Medicare?

First things first, it’s vital to know the basics. Medicare is a federally funded health insurance program for people aged 65 years or older, or for people under 65 years old that have specific illnesses or disabilities. During retirement, Medicare is the main way that most people have health insurance.

Medicare is made up of Part A, B, C, and D. Lora explained that Part A and B are called Original Medicare. Essentially, they are the part of Medicare that you paid into during your time spent working. The rule is that if you (or your spouse) worked 40 total quarters (an equivalent of about ten years) then you would qualify for Original Medicare. Part A is hospital coverage, and Part B is doctor coverage, and typically you would be automatically enrolled in this kind of Medicare. They both cover about 80% of expenses, but do not cover prescription drug costs. Part C, or Medicare Advantage, is an alternative that covers all services under Original Medicare plus prescription costs and several other extra perks. Part D is prescription drug coverage.

Lora said that considering the prescription costs is very important because all drugs are relatively costly. Perhaps at 65 years old, you may not need any prescriptions, but as you age, you may develop illnesses that require prescriptions. If you deny drug coverage when you are first eligible for Medicare, you will be penalized for every month without it and that cost will be added to your premium if you decide to take a drug plan later. There are some exceptions, such as if you have coverage with your employer and are delaying retirement. Lora advised thinking about it like car insurance. You can’t just sign up for car insurance a few minutes after experiencing a car crash! It’s all about planning for what might happen instead of making decisions based on your health in the present.

If you are 65 years old and don’t plan to retire any time soon, you can stay on your employer’s drug plan without SeniorLivingGuide.com Podcast Bannerbeing penalized (if it is creditable coverage) until after retirement. It’s important to keep in open communication with your employer about your targeted retirement date. Stay on top of the rules regarding your Health Savings Account (HSA) if you have one, what your company requires regarding enrolling into Medicare if you are 65 and will keep working, and how long your company group coverage will cover you and your family if you do retire, Lora said.

Veterans with veteran coverage and families with TRICARE qualify for Medicare without needing to add extra coverage as they can keep their coverage for life.

Now that you know the different components of Medicare, how do you choose which one is right for you?

One of the positive aspects of Medicare is that it truly can be individualized because every person has different health needs. Picking the right plans and policies is a very personal process, especially when it comes to private insurance. Everyone around you is going to have their own opinion of what they think is the best option but remember that this choice is about you and your personal health plan.

Think about how you like to shop, Felger said. Do you like to shop local so that you know where your food is coming from? Do you like to form relationships with salespeople, such as when you’re purchasing car or homeowners’ insurance? Then perhaps the best route for you is to find a local agent that can guide you through the process, represent more than one plan, and find the right choice based on your needs. If you’re more of an online shopper, Medicare.gov is an excellent resource because you can plug in your zip code, add what drugs you need, input other medical needs, and browse the different plans and costs.

Perhaps you’ve done business with a specific insurance company for many years; if so, you are more than welcome to be loyal to one company if you feel satisfied with the service they have provided for your needs. It’s all about how you like to shop!

When you find a company that you like, call their customer service line, talk to their agents, and test out how well they’ll treat you as a client. Get referrals from trusted friends or family members who had good communication experiences with agents. Or visit a local senior center for referrals and more information. Felger encouraged people based in North Carolina to reach out to her or FirstCarolinaCare.

And not to worry – you’re not completely locked in once you’ve decided; there is always an opportunity to make changes during the annual enrollment period (runs from October 15th through December 7th). Adjustments take effect on January 1st. Be on the lookout for any changes your insurance company may be making for the upcoming year, as they are required by law to state major changes such as reduced drug coverage or other adjustments that may impact your health plan. Review your plan ahead of time in case you need to make an adjustment.

If you’re content with your plan and are still enjoying fun activities, socializing, and are generally happy, don’t feel forced to make a change. Lora recommended tuning out the noise of insurance commercials and advertisements trying to hook you into a new plan. Listen to your needs, learn what you like and dislike, and consider switching the channel!

This phase of your life doesn’t have to be stressful and unpleasant. Lora emphasized that with a little bit of good planning, smart shopping, and helpful partners, the moment your magic 65th birthday arrives will be a wonderful, joyous experience.

For more senior and caregiver resource podcasts, visit SeniorLivingGuide.com Podcast or they can be found, listened and downloaded most anywhere you enjoy music or podcasts such as Spotify, Apple Podcasts, Podchaser, and more!