Above: Prepare for your 65th birthday by learning what you can about Medicare now. Photo by Christopher Martyn on UnSplash

This is general information to help older adults begin learning about Medicare. For specific and personal information, contact Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you’re looking at your 65thbirthday this year, you’re definitely not alone. About 10,000 baby boomers will turn 65 every day this year.

According to the PEW Research Center, the oldest member of the baby boom generation celebrated his or her 65thbirthday on Jan. 1, 2011. On that day, and every day since, PEW estimates approximately 10,000 ‘boomers’ a day will continue to celebrate turning 65 until the year 2030.

For some, it’s a landmark birthday, which leads to Medicare and Social Security planning (although, today boomers wait beyond 65 for Social Security). They hope they have the right amount in their 401Ks for their disposable income and, at best, a comfortable retirement.

Like most things in life, early planning helps. Simply signing up for Medicare without a good understanding what’s covered and what’s not can cost plenty. And, more importantly, Medicare should be contacted about three months ahead of that big birthday.

Marietta resident and fellow journalist Mark Woolsey says he’s been aware of the three-month notice for a while.

Mark Woolsey

“My wife paved the way for me. She’s a year and a half older than me — and yes, she robbed the cradle,” he said with a smile.

Mark turns 65 in September. Mrs. Woolsey turned 65 a year ago in April and had already cut through some of the concerns confronting her husband.

Fortunately, Woolsey has a good attitude about the entire ordeal. However, turning 65 can be a bit overwhelming especially when it comes to learning about Medicare’s healthcare options.

“I had also talked to some other folks my age who let me know that the clock would be running,” he said. “And that was very helpful.”

In addition, Woolsey’s started reading books on the topic as he began to grasp some of the choices and complexities. “Get What’s Yours for Medicare” and “Get What’s Yours, The Secrets for Maxing Out Your Social Security” are two of them. Both books required many hours of reading and working out what’s best for his personal set of circumstances, Woolsey said.

“Although, the books have been quite helpful, they tend to mention some specialized-circumstances — such as cases that don’t apply to my personal situation,” he added. “Based on what I’m reading, I think I’ll apply for Medicare Part A and get into the system. I’m going to avoid Medicare Part B for now, as I’m under my wife’s health insurance plan at her work.

“She hasn’t set a date to end her employment,” said Woolsey. “It sounds like I can go back and pick it up later.” And in his case, he probably can.

For example, if his wife’s employer has 20 or more employees, her group plan will pay first on a medical claim, and then Medicare will be billed. Medicare (in his case) would be the second payer while Woolsey’s healthcare is part of his spouse’s insurance plan.

Woolsey said, “I’ve also read the official “Medicare and You 2018” publication from the federal government,” he said. “It’s been quite helpful. The biggest takeaway for me has been that during my working life, my employers had to navigate this complex territory. Now that I’m going on Medicare, it’s all on me to do the heavy lifting.”

A note of caution: Woolsey said that he’s been deluged with mail from medical organizations and people who say they are Medicare analysts. “Many have offered to help me navigate my options at no charge,” he said.

Of course, nearly all of them want to sell a Medigap insurance program, too, “but that’s to be expected,” he said.

What if your initial Medicare choice seems to be the wrong choice for you?

According to Medicare, “…if a person enrolled in Medicare isn’t satisfied with the initial plan or coverage he or she selected, they may only choose a new plan that fits their coverage during Medicare’s Open Enrollment period.”

“Traditionally, open enrollment has been Oct. 15 through Dec. 7,” said April M. Washington, Public Affairs Officer with Centers for Medicare & Medicaid Services.

Certain Medicare and Medigap selections can be costly if you wait to join. In the book “Get What’s Yours for Medicare,” author Philip Moellerstates: “The good reason for the [Medicare] penalties is [that] without them, healthy people wouldn’t get Medicare when [turning] 65.”

Moeller said that healthy people likely would wait until they need care to enroll.

“If only sick people had Medicare,” Moeller continues, “the rates for them would be much, much higher — [this] program needs everyone to enroll to be affordable.”

Where to Find Help

Many questions about billing can be answered by “Your Guide to Who Pays First,” an online publication by Centers for Medicare & Medicaid Services.

The right place to get credible answers to all your questions is through a licensed insurance broker who specializes in Medicare plans. They’re trained to review options available to you that fit the individual circumstances you and your family face.

For example, original Medicare pays 80 percent of covered medical expenses, the remaining 20 percent is yours. That’s why so many brokers suggest a “Medigap,” or supplemental, insurance policy to help cover the difference.

There are also a myriad of publications available to you through the internet at medicare.gov and by calling 1-800-Medicare or 1-800-633-4227. TTY users should call 1-877-486-2048.

New Medicare Cards for 2018

According to Forbes.com, one major change for 2018 will be noticeable when new Medicare cards are mailed. Social Security numbers will be missing. The new cards will have unique numbers assigned to each Medicare beneficiary.

The Centers for Medicare & Medicaid Services reminds all Medicare beneficiaries to watch out for scammers who hope you are not familiar with the new card change.

These tips are important if you already have a Medicare card:

  • Do NOT pay for a Medicare card (ever!).
  • Do NOT give your Medicare number to people you don’t know or you haven’t contacted first.
  • Do NOT give your bank account information to anyone you don’t know.
  • Do NOT let anyone trick you into believing your Medicare benefits will be canceled unless you give them your Medicare number.
  • Do NOT toss your old card in the trash.

It may take a full year for the new cards to arrive. See the Medicare website, medicare.gov, for info on the best way to destroy your old card.

A Quick Review: Medicare Parts A & B

Medicare is a federal health insurance program for those 65 and older. It was signed into law in 1965 as a way to help older adults pay their medical expenses. Medicaid, on the other hand, is the federally (and state managed) health insurance program for low-income people.

Created simultaneously, these two somewhat similar names can still cause confusion.

Medicare can be used as your sole health insurance coverage or as a “companion” or backup coverage, to insurance you may have through your employer, spouse, former employer (after retirement) or union, according to the Department of Health and Human Services.

However, not everyone is eligible.

Generally speaking, Medicare is available for people age 65 or older, younger people with disabilities and people with end-stage renal disease (a permanent kidney failure requiring dialysis or transplant).

However, you only become eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years.

According to HHS.gov, you can get Part A at age 65 without having to pay premiums if:

  1. You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
  2. You are eligible to receive Social Security or railroad benefits, but you have not yet filed for them.
  3. You or your spouse had Medicare-covered government employment.

In general, Medicare Part A covers:

  • Hospital Care
  • Skilled nursing facility care
  • Nursing home care, as long as custodial care isn’t the only care needed
  • Hospice
  • Home health services

In general, Medicare Part B covers two types of services:

  • Medically necessary services, or the supplies needed to diagnose or treat your medical condition and also meet accepted standards of medical practice, and
  • Preventive services, such as healthcare to prevent illness (like the flu) or even diagnose the problem at an early state when treatment is most likely to work best.

Some options may be state dependent. Thus, the following may or may not be covered:

  • Clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health (inpatient, outpatient and partial hospitalization)
  • Second opinions before surgery
  • Limited outpatient prescription drugs

Watch for information on Medicare Parts C & D in the September Atlanta Senior Life.

Judi Kanne

Judi Kanne is a public health communications consultant and contributing writer to Atlanta Senior Life.