This month, we are in the midst of the open enrollment process for Medicare. This Medicare blog can clear up some myths, answer some basic questions and get you headed in the right direction.
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Enrolling in Medicare
Some people get Part A and Part B automatically and others need to sign up. Those who are already receiving benefits from Social Security or the Railroad Retirement Board, will get Part A and Part B automatically starting the first day of the month they turn 65. Those who are under 65 and disabled will get Part A automatically and Part B after they have received Social Security disability benefits for 24 months or when they reach 65, whichever occurs first.
But what if you are not automatically enrolled?
If you are almost 65, and you don’t get Social Security or Railroad Retirement Board benefits, you will have to sign up for Medicare. You should contact Social Security 3 months before you turn 65. They will allow you to schedule an appointment to enroll. You can also apply for Part A and Part B by going to https://www.ssa.gov/beneifts/medicare/.
How much does Medicare cost?
For most people, Medicare Part A is free if you paid Medicare dues while you were working. On the other hand, the standard monthly premium for Medicare Part B enrollees will be $174.80 for 2024. Most of the families we meet with think their Medicare coverage is completely free. Typically, the Medicare Part B premium is deducted from their Social Security before it is ever deposited into their account. Therefore, they might not be aware of the amount it costs. You can verify what you are paying for Medicare Part B by looking at your yearly Social Security award letter.
Determining Medicare Coverage
Often, our clients are not quite sure what type of health insurance coverage they have. An easy way to determine this is by seeing if they have a red, white and blue Medicare card. If they do, the face of the Medicare card will say Part A (Hospital) and/or Part B (Medical) and will also list an effective date of when the coverage started. However, an “advantage” plan delivers these benefits through an alternative channel: a PPO through private insurance companies. Therefore, the red, white and blue Medicare card is no longer effective for those who opt out of their Medicare coverage.
Medicare will not cover long-term care in a nursing home
Many people assume their Medicare will pay of long-term care in a nursing home. Unfortunately, this is not the case. After a three-day hospital stay, Medicare will pay for the first 20 days of skilled rehab days at no cost. Traditional Medicare can cover up to 100 days of skilled rehab with a copay or coinsurance due for days 21 through 100. After 100 days, Medicare will not pay for long-term nursing home care. Once again, it is recommended to closely review your Medicare supplement to make sure it will cover the co-pays for days 21 through 100. And of course, “advantage” will not typically cover rehab at all in Southwest Florida facilities (see our recent blog, “The Dis-advantage of Advantage.”)
What about paying for long-term care?
Those who need to stay in a nursing home for long-term care have two options: use their long-term care policy, or consider applying for Medicaid. For more information on planning for nursing home Medicaid, call our office at 239-434-8557.
As you see, there are many Medicare plan options and choices to consider. Our team at Burzynski Elder law can help explain the Medicare basics and can also share the names of insurance professionals who can assist you with figuring out the best plan for your needs. Don’t hesitate to call while you can still make the choices during open enrollment!