“Too often when seniors reach the age of 65 and become eligible to enroll in Medicare they don’t take the time to fully understand the program and the benefits it offers,” says Mr. John E. Kasarda, Administrator of Little Brook Nursing Home in Califon, NJ. Unfortunately, many don’t ask enough questions before enrolling in Medicare. Then they are suddenly faced with enrollment time and don’t know what to do. Here are the five most important things a new Medicare Beneficiary should know:

1. Learn Basic Medicare Terminology

One of the most important things that any new Medicare Beneficiary should do is to learn Medicare terminology. Understanding the difference between words like “premium” and “co-payment” will go a long way in helping one to navigate their Medicare coverage. Go to www.medicare.gov or simply travel to your local library and ask the reference librarian for help and supplemental information.

2. Know When You Are Eligible to Sign Up

Why is this so important? If you don’t sign up during your initial enrollment period for a Medicare program—like Medicare Part B (Medical Coverage) and Medicare Part D (Prescription Drug Coverage)—you might pay a higher monthly fee when you sign up later. The exceptions would be if you turn 65 and still have coverage through your or your spouse’s employer and/or you have better prescription coverage at the time of eligibility. You have seven months within which to initially enroll in Medicare. The enrollment period begins three months before the month of your 65th birthday and ends three months after. During these seven months you can sign up for whatever Medicare coverage you choose.

3. Find Out How to Enroll in Medicare

To sign up for Medicare Parts A and B, call the Social Security Office (1-800-772-1213) to make an appointment for an interview between 7am-7pm, M-F. The interview can be done by phone or in person. You can also apply for retirement benefits along with Medicare Parts A and B by going online to the Medicare website at www.medicare.gov

4. Understand Medicare Parts A, B, C and D

There are four parts to Medicare: Parts A, B, C and D. They each provide different coverage and you can choose what you need accordingly. Medicare Part A is hospital insurance and will help cover you for inpatient stays at hospitals, rehab at skilled nursing facilities and hospice as well as home health care and medicines administered to inpatients. There are no fees for Medicare Part A if you paid enough in Medicare taxes while working. Medicare Part B is your medical insurance. This portion covers your doctor visits, outpatient services like lab tests, preventive services, doctor services in the hospital and medicines administered in the doctor’s office. Most will pay a monthly fee for Medicare Part B of $109, on average, in 2017.

When you sign up for Medicare you have the option of choosing original Medicare (Medicare Parts A and B) or a Medicare Advantage Plan (Medicare Part C). Very often those who choose original Medicare also select a Medicare supplement or Medigap plan. Original Medicare coverage is provided through the government whereas a Medicare Advantage Plan is provided through a government-approved private insurer. A Medicare supplement or Medigap plan fills in the gaps not covered by original Medicare. You can choose to buy a Medigap policy from a private insurance company. If you choose a Medicare Advantage Plan you do not need to have a Medigap plan. Medicare Part C is also known as Medicare Advantage. Medicare Advantage Plans combine Medicare Parts A and B and very often includes Medicare Part D into a single plan. Medicare Part D is for prescription drug coverage at home.

5. Medicare D Doesn’t Have to be Confusing

As of January 1, 2006, the federal government expanded Medicare coverage with the launch of the Medicare Part D program. This program enables seniors to get prescriptions with the benefit of an insurance program that can help lessen annual drug costs. To take advantage of the program, however, Medicare recipients have to navigate a system that may seem confusing. To understand how the Medicare program works, it is important to understand a few basic facts. Part D is available to everyone on Medicare. There are no other eligibility requirements. A Medicare recipient cannot be denied Part D coverage for medical reasons or income level. If you are enrolled in Medicare, the prescription coverage is available. The choice to participate, however, is up to the individual. That is, the coverage is voluntary and you have to enroll. “For those who already have solid prescription coverage from other sources, it is important to carefully weigh the benefits of both,” says Mr. Kasarda.

A private policy might, in fact, cover more for less cost. Look to see which plan works better for your particular situation. When enrolling in Medicare Part D prescription coverage, the first thing recipients will notice is that there are several options from which to choose. There is no single drug plan and what is even better is that Medicare does not administer them—private drug plan companies manage the plans. For those on very limited incomes, the Medicare Part D plan will cover most drug costs. For those with very high drug expenses, there is even a Medicare Part D plan that will cover about 95 percent of the costs beyond a deductible each year. To review the different plans available, it is a good idea to speak directly to a Medicare representative or look at the agency’s web site shown below. The plans are diverse and are meant to assist as many people and their different situations as possible. Ideally, the best way to approach studying the different plans is to look at each of the options while keeping your personal circumstances in mind. For those who decide to use the Part D coverage, it is important to note that the discount cards issued in the past are not the same thing. Those cards only provided discounts, not insurance. The Part D coverage replaces those on a permanent basis. Since Part D is new and may be confusing for Medicare clients to understand, it is important for interested seniors to get informed advice on choosing plans, benefits and so on. Medicare has promised to provide information to its clients each year prior to the annual open enrollment period, which will include a list of plans available and their benefits. For other help, Medicare Part D recipients or those who want to enroll in coverage should visit the Medicare web site or call 1-800-MEDICARE. State agencies and the Social Security Administration may also be able to provide informed advice. Visit the Medicare web site at www.medicare.gov

“Medicare coverage is an important government benefit that you have earned over the years and you should take advantage of the excellent coverage it offers as soon as you are eligible!,” says Mr. Kasarda.

Editor: Dr. JP Hampilos of Senior Care Focus, LBHI; Excerpts from an interview with John E. Kasarda, Administrator, Little Brook Nursing and Convalescent Home on William Richards’ article on Medicare published in articlesbase.com

Senior Care Focus, Issue No. 17.2