Have Medicare? Turning 65?


By Tina Fader

Did you know that there are 10,000 Baby Boomers turning 65 every day right now? You are probably one of them, or know someone who is. I would like to go over some basic facts about Medicare that you may already know about , but there still might be a few things you didn’t know.

Who is Covered
If you are turning 65 in the six months of your birth date, you may apply for Medicare Part A and Part B three months before or after your 65th birthday. You qualify for Medicare Part A and Part B even if you choose not to take your Full Retirement Benefits (i.e. Social Security).

What is Covered
Medicare Part A is hospital insurance that helps cover hospital, skilled nursing, home health and hospice care. Medicare Part B is medical insurance that helps cover doctor visits, outpatient care and preventative services. It also helps to pay for services Part A does not cover, like occupational and physical therapy. Medicare Part C is a Medicare Advantage Plan that covers everything that Parts A and B cover and often includes services at no additional cost and may include Prescription Drug coverage.

You must have both Medicare Part A and B to join a Medicare Advantage Plan. Medicare Advantage Plans usually include extra benefits and services like fitness programs and gym memberships, mail delivery pharmacy access, health education programs, and a 24 hour nurse advice line, and may lower your out-of-pocket costs. You may also be able to customize your plan to meet your needs with optional supplemental benefits such as dental and vision coverage, for an added cost.

Medicare Advantage Plan Types
Health Maintenance Organization (HMO). A primary care physician arranges your healthcare in the plan’s network. Preferred Provider Organization (PPO). You can choose any provider, although you may pay more for out-of-network providers.

Private Fee-For-Service (PFFS). More freedom to choose providers may be available, however, a network arrangement may still apply.

Medicare Supplement Insurance Plans. Medicare Supplement plans can be purchased to go with Original Medicare to help with some costs Part A and B don’t pay, like coinsurance and deductibles.

Special Needs Plans (SNPs). Medicare Special Needs Plans are available only to people with specific diseases or circumstances. These plans include tailored benefits, providers and Drug Lists to meet the needs of members.

How My Plan Choices Affect Costs
Whether you choose Original Medicare or Medicare Advantage, you must pay your Part A and B premiums, if you have one. Medicare Advantage, Medicare Part D prescription drug coverage and Medicare Supplemental Insurance may have additional premiums. Your cost depends on the coverage you choose. The cost for a Medicare Advantage plan depends on whether the plan charges a monthly premium and pays any of your monthly Part B premium.

Original Medicare and Medicare Advantage plans both cover routine services. Medicare Advantage Plans are required to cover everything that Original Medicare covers, including coverage for services that Medicare considers medically necessary.

If you choose a Medicare Advantage plan, you still have Medicare coverage. You simply choose to receive your Medicare benefits through a private insurance company. You may pay an additional premium for the extra services and benefits of a Medicare Advantage plan.

Annual Enrollment Period began Oct. 15. This is a special election period when Medicare Beneficiaries can change plans for the following calendar year between October 15th and December 7th to become effective January 1, 2022. There are exceptions that may allow you to enroll outside of this period.

Tina Fader is a Licensed Health and Life Insurance Professional offering Medicare Advantage Plans, Medicare Supplemental Plans, Vision and Dental Plans for all ages, and Life Insurance. Tina has been a local resident in the area for over 20 years years serving the community and looks forward to serving your needs. Call Tina Fader for a confidential assessment at 850-368-8007 or e-mail tinafader@yahoo.com.