En español | Welcome to Medicare. More than 60 million Americans get their health care coverage through this federal insurance program for older Americans.
At 65, you become eligible for the program — which means you will need to set aside time around that milestone birthday to sift through many options so you can sign up for the coverage that meets your health needs and budget.
It’s up to you to get ready. No letter will arrive in the mail announcing it’s time to start making these decisions. What’s more, the timetable is specific — and important. You can start signing up three months before you turn 65, and you’ll have until three months after your birthday month to enroll. If you miss that deadline, you may end up paying higher premiums. If you are still working and have employer-sponsored health coverage, you can probably wait to sign up — but more about that later.
You’ll need to do some homework before you start assessing options and picking plans. Make a list of your doctors and decide how important it is to you that you can continue seeing them once you are on Medicare. Also make a list of any medications you take so you can make sure any prescription drug plan you select will meet your needs.
Think about your lifestyle. Are you a homebody and never travel outside the U.S.? Or are you an adventurer who goes abroad frequently? Do you split your time between residences and need medical care in different states? All these factors are likely to figure into the decisions you make.
Your financial situation also is important. You’ll learn through this guide that Medicare helps pay for medical care for older Americans and people with disabilities. But it’s not free. You’ll want to choose an option you can afford and build the array of out-of-pocket costs into your annual budget. And take time to review the ways the federal government can help you pay Medicare’s costs if you can’t afford them.
You need to pay attention to all of Medicare’s parts: Part A covers hospital and hospice care and some skilled nursing services after you’ve been in the hospital. Part B includes doctor visits and other outpatient services. Part C is Medicare Advantage, which is a combination of parts A and B and usually Part D, which helps pay for prescription drugs.
Medicare experts say the most important thing is not to ignore the open enrollment period.
“People tend not to review their options each year because it’s a lot of work,” says Tricia Neuman, a senior vice president and director of Medicare policy at the nonpartisan Kaiser Family Foundation. But making the effort will be worth it.
Neuman has some advice about how to proceed: Don’t just look at a plan’s premiums. That’s the easy part. And they aren’t the best gauge of what your total out-of-pocket costs will be during the year.
Check out whether the doctors you see are in the plan’s network you are considering because going out of network can cost you more. Make sure all the drugs you take are covered either in your MA plan or a Part D plan. Taking a drug that isn’t covered or isn’t considered a “preferred” medication could mean you’ll pay more out of pocket. Copays differ among the plans, so be careful to look at what the 2020 costs will be.
For the first time in a decade, the Centers for Medicare and Medicare Services (CMS) has given its plan-finder website a makeover. There’s a new medicare.gov home page, which will guide you to your enrollment journey. You’ll have fewer clicks to find what you need, easier comparisons between original Medicare and MA plans, and more complete information about the differences among Part D choices. The site also includes a cost calculator.
Also new for 2020 is the ability of MA plans to pay for telehealth benefits nationwide. Virtual check-ins with doctors and other health care providers will now be available to all Medicare beneficiaries.
And CMS is continuing to expand the availability of Medicare Advantage extra services, particularly for the 73 percent of beneficiaries who have chronic health conditions. These benefits range from meals at home to transportation to health appointments to nutrition counseling to safety improvements to your home. Not all MA plans are offering these benefits, so look carefully at their coverage descriptions on the plan-finder site.
You can also get personalized help as you ponder your open enrollment decisions. Medicare.gov has an online chat feature available during open enrollment, and the Medicare hotline, 800-MEDICARE (800-633-4227), is open 24 hours a day, seven days a week.
Monthly premiums for Medicare Advantage plans are expected to drop in 2020 to an average of $23, and Part D prescription drug premiums are also slated to decrease to an average of $30 a month. Premiums and out-of-pocket costs vary for MA and Part D plans based on what the plans cover and where you live. The standard monthly premium for Part B will be $144.60 in 2020 and the annual Part B deductible will be $198. The inpatient deducible that patients will pay for each hospital admission will be $1,408. Almost all Medicare beneficiaries (99 percent) do not pay a Part A premium.