Cheat Sheet for Medicare

Here’s what you need to know about three key Medicare topics: a handy checklist of dos and don’ts to remember before starting the program; a fast rundown of the optimum times to enroll, based on your unique circumstances; and a mini-directory of organizations that can assist you with Medicare difficulties.

A few crucial Medicare dos and don’ts Medicare is a vital program for millions of elderly and disabled Americans, yet many are unaware of how it operates due to a lack of reliable information.

Medicare is a complicated program, but there are a few crucial features you should be aware of right away:

Give yourself plenty of time to learn everything there is to know about Medicare. It’s a system that has a lot of options and deadlines. Being well-informed is the greatest approach to prevent traps and costly blunders.

When it’s time to sign up, don’t expect to be notified. Unless you’re currently receiving Social Security retirement or disability payments, you’ll need to apply for Medicare — but you won’t be notified when or how to do so.

Don’t forget to enroll when the time comes. You must know your unique deadline for enrolling in order to avoid permanent late charges and maybe a delay in coverage. It’s either during your first enrollment period around age 65 or during a special enrollment period if you or your spouse continue to work for a company that offers health insurance after age 65.

If you haven’t yet been at that position long enough to qualify, don’t be discouraged. On your current or former spouse’s work, you may be eligible for Medicare Part A (hospital insurance) without having to pay any premiums. You may also be eligible to pay premiums to join Part A. However, regardless of how long you worked (or if you never did), you can get Part B (doctor’s services, medical equipment, and outpatient care coverage) and Part D (prescription drug coverage) by paying the required premiums — as long as you’re a citizen of the United States or a green-card holder who has lived here in America for at least five years before applying.

Keep in mind that Medicare is not a free service. If you don’t qualify for a low-income program or have supplementary insurance from another source, you may have to pay premiums for coverage and co-payments for most services.

Don’t assume that Medicare will cover all of your expenses. It covers many medical services, prescription medications, and medical equipment (including pricey procedures like organ transplants). However, there are several areas where coverage is lacking, such as routine vision, hearing, and dental treatment. Furthermore, Medicare does not pay the non-medical costs of long-term care in nursing homes or assisted living facilities.

Medicare will not cover your dependents. Except for individuals who qualify due to disability, no one under the age of 65 can get Medicare. There is no family coverage under Medicare.
If you require assistance, seek it. You may be eligible for low-income programs that pay your premiums or cover your prescription drugs at a reduced cost. Regardless of your income, you can obtain free personal assistance — in English or another language — in sorting through your Medicare alternatives and selecting the one that best meets your needs.

SEP (Special Enrollment Period): If you’re over 65, have group health insurance via the current employer of you or a spouse, and the employer has 20 or more employees, you’re eligible for a SEP. It’s possible that you may be able to postpone enrolling in Medicare until after you reach 65. The SEP lasts for the duration of your coverage and for an additional eight months after it ends or until your employment terminates, whichever happens first. If you stop working at the end of February, for example, you can enroll in Medicare without risking late penalties until your SEP ends on October 31 — but to prevent a coverage gap, you should enroll in February so that your Medicare benefits begin March 1. (However, if you work for a small business with fewer than 20 workers, your employer may force you to enroll in Medicare at the age of 65 in order to keep your health insurance.) To learn more about this, contact your employer.)

Automatic enrollment: If you begin receiving Social Security or Railroad Retirement Board retirement payments at age 65 or later, you will be automatically enrolled in Medicare Parts A and B without having to apply. If you want to postpone Part B enrollment because you qualify for a SEP, as mentioned in the preceding General enrollment period (GEP), you can decline: If you did not sign up for Medicare during your I EP or SEP, this GEP permits you to do so now. Each year, it lasts three months, from January 1 to March 31. If you enroll during a GEP, your Medicare coverage won’t start until July 1 of the following year. You could also face late fines, which will be added to your Part B premiums for the rest of your life.

What if you live in another country? Medical care in other nations is almost usually less expensive than in the United States, so paying out of pocket may not put you out of business. In some cases, the national health program of the country you’re visiting may be able to help you.

However, purchasing health insurance on the free market can be complex and costly. One alternative is to join the Association of Americans Resident Overseas, a non-profit group that has long battled Congress to make Medicare available to Americans living abroad. Members of AARO have access to a wide range of private health insurance plans that may be used in a number of countries. (However, you may be allowed to sign up for Medicare while residing abroad.)