You’re 65 and Working: What about Medicare?

Repost: 
Medicare Tips & Resources | Tue, Jun 14, 2016 @ 09:00 AM

You’re 65 and Working: What about Medicare?

Posted by Medicare Made Clear: Retirement used to be closely linked to turning 65. No more. The full retirement age — when you can receive 100% of your social security retirement benefit — is 66 for anyone born in 1943. And, it’s 67 if you were born in 1960 or later.

However, Medicare eligibility still begins at age 65, even if retirement does not. People on disability could be eligible for Medicare before they turn 65.The question is: What do employed 65-year-olds do about Medicare

Medicare Before You Retire? Maybe

If you or your spouse is working, then you may have health insurance through an employer. It’s important to understand how Medicare may work with your existing insurance.

Before you do anything about Medicare, you need to talk with your employer health plan administrator. Questions you may want to ask include:

• What kind of health plan do I have? For example, many employer plans are HMOs (health maintenance organizations).
• Does my employer require that I enroll in Medicare?
• How would my health insurance change if I enrolled in Medicare?
• How much is deducted from each paycheck for health insurance? (Remember that you do not pay taxes on payroll deductions for health insurance. You need to consider the tax savings to determine the total value.)

This information may help you evaluate your Medicare choices and decide what’s best for you.

Enroll in Medicare Part A? Probably

Most people enroll in Medicare Part A (hospital coverage) when they turn 65, whether they are working or not. This is because Part A is premium-free for most people. You earn this benefit by paying into the Medicare program while you’re working. You qualify for premium-free Part A if you or your spouse contributed to Medicare for at least 10 years.

In general, hospital expenses are covered first by your employer health plan. Medicare Part A is the secondary payer. It’s a good idea to enroll in Part A as soon as you’re eligible, so you don’t have to worry about signing up later.

There may be reasons to delay Part A, such as if your employer health plan is a Health Savings Account (HSA)—employer contributions could stop if you have Medicare. It’s very important for you to learn how Medicare may change your employer health benefits.

Enroll in Medicare Part B? Depends

Medicare Part B (doctor and outpatient coverage) charges a premium. In 2016, the monthly premium starts at $121.80 per month for new enrollees. It may be more for people with higher incomes.

Many people who have employer coverage delay enrolling in Part B to postpone paying the premium. You can sign up later during a Special Enrollment Period without penalty.

Part B may be of limited value when you have other health insurance. Exceptions may be people who are self-employed or who work for an employer with less than 20 full-time employees, since Medicare would become the primary payer in these situations.

It’s very important to find out how Part B would work with your employer plan before making your decision.

Conclusion

You have a number of Medicare decisions to make when you become eligible for Medicare. This is especially true when you have other health insurance. You may want to start learning about your choices ahead of time. Preparation may help you avoid unnecessary costs.

Brought to you by UHC - Medicare Made Clear 

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2016 || Part D Donut Hole

Medicare Coverage & Costs | Tue, Apr 26, 2016 @ 09:00 AM

The Medicare Part D Donut Hole: Going…Going…Not Quite Gone

Posted by Medicare Made Clear

The prescription drug donut hole is a gap in Medicare Part D’s prescription drug coverage.

Once you and your Medicare Part D plan have spent a certain amount on covered prescription drugs during a calendar year ($3,310 in 2016), you reach the coverage gap. You are now in the Part D donut hole.

You pay a larger percentage of your prescription drug costs while you’re in the donut hole until another dollar limit ($7,062.50 in 2016) is reached. Then Medicare Part D coverage kicks in again.

Closing the Part D Donut Hole

The good news is the donut hole isn’t as big as it used to be. When Medicare Part D launched in 2006, Medicare beneficiaries had to pay 100% of their prescription drug costs during this gap in coverage. With the passage of the Affordable Care Act, that percentage started to drop.

In 2016, you pay 45% of the cost of brand-name prescription drugs and 58% for generics while in the donut hole. These percentages are scheduled to decrease every year, bottoming out at 25% for both brand-name and generic drugs in 2020.

This will effectively close the donut hole, putting costs on par with what you pay between the time you meet your deductible (if you have one) and when you hit your out-of-pocket spending limit.

Getting Into and Out Of the Donut Hole

It’s important to note that it’s not just your share of your prescription drug costs that get you into and out of the donut hole. The amount your plan pays also counts towards the first milestone that puts you into the donut hole.

Drug companies may help pay your way, too. They provide a 50% discount on brand-name drugs purchased while in the donut hole.

The drug company discount counts toward the second dollar limit, the one that marks the end of your passage through the coverage gap. For generic drugs, only the amount you pay out-of-pocket applies to your spending limit.

Conclusion

This will all get simpler in 2020 when the donut hole closes. Until then, following these tips may help you climb out of it more quickly – or keep you from falling into it in the first place:

• Stick with your plan’s formulary whenever possible. Only medications on the formulary, or for which you get an approved exception from the plan, count toward your spending limit.
• Make sure to get your drugs from a network pharmacy. Prescriptions you fill outside your network pharmacy don’t apply to your spending limit.
• Opt for generics if your doctor thinks they’re appropriate. The lower costs for generics may be enough to keep you from slipping into the donut hole.

Unexpected Costs of Medicare

The Unexpected Costs of Medicare

With a little planning, seniors on Medicare can minimize their out-of-pocket expenses.

Seniors can save hundreds – or even thousands – on Medicare costs through careful planning.

By Joseph P. WilliamsOct. 15, 2014, at 8:00 a.m.+ More

​Created in 1965, Medicare was intended to answer growing reports of impoverished seniors languishing or dying because they lacked health insurance. Since then, Medicare has acquired a reputation as the ultimate government entitlement, a system of low-cost, taxpayer subsidized health care provided at the stage in life when retirees need it most.

[Read: What You Need to Know About Medicare Open Enrollment.]

But the broad-reaching health care insurance system comes with costs that many seniors – including those already using the plan – don't see until the bills show up. Those out-of-pocket expenses, according to experts, can range from hundreds of dollars in monthly premiums and office visit copays to six-figure bills for surgery and hospitalization for things like joint-replacement operations, a procedure common among older Americans.

Those costs, which add up quickly, can stress or even break a household budget, particularly for retirees getting by on fixed incomes. Even declining to sign up for Medicare when you first become eligible, experts say, can cause a lot of pain in the wallet later on.

"A lot of people looked at Medicare as this Promised Land – 'Everything is covered, until the end of time,'" says Nicole Duritz​, vice president of health education and outreach for AARP, a nonprofit advocacy group. "I don't think people have a great understanding of how the system works. They're surprised at how much they'll have to contribute."

Compared to individual or group health insurance plans, "Medicare is unique in that it has no out-of-pocket spending limits," says Nancy Metcalfe​, a health policy analyst at Consumer Reports.

That's because Medicare plans are typically private health insurance policies that are government-subsidized. Nothing is completely covered, and no expense is 100 percent paid for. Though the subsidies paid to the insurance companies help keep costs low for seniors, the plans vary and usually require beneficiaries to pay some premiums.

There's good news, however: Metcalfe and others say a little planning, homework and realism can go a long way toward helping Medicare consumers keep more of their hard-earned money in their pockets.

That means seeing past the monthly premium payment to take a hard look at what may be some uncomfortable things – including a realistic assessment of your finances, anticipating how healthy you'll be during your sunset years and choosing what services you might need in a worst-case scenario.

Updated on Oct. 15, 2014: This article was originally published on Oct. 18, 2013 and has been updated to reflect new costs.

Visit Health News to Learn More: http://health.usnews.com/health-news/medicare/articles/2014/10/15/the-unexpected-costs-of-medicare

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Medicare 101: What is Medicare Part B?

TransAmerica Page: Medicare 101: What is Medicare Part B?

Now that you’ve learned about Medicare Part A, you may also be wondering what Part B can do for you. While Part A will help you with things like hospital stays and skilled nursing facility care, Medicare Part B helps with other areas in which you may need coverage. Find out what Medicare Part B covers and if it’s for you.

What does Medicare Part B cover?

You may remember that in Part A, we explained Original Medicare is the term used when a plan combines Part A with Part B. That’s because in addition to the benefits Part A will give you, Part Bcovers clinical research, ambulance services, durable medical equipment, mental health (inpatient, outpatient, and partial hospitalization), the ability to get a pre-surgery second opinion, and limited outpatient prescription drugs.

Who qualifies?

If you aren’t eligible for premium-free Medicare Part A, not to worry; you can buy Part B without having to buy Part A. Here are the qualifications you need to meet:
• 65 years or over
• A U.S. Citizen or permanent resident who has legally been in the country for five consecutive years

When should I enroll?

Much like with Medicare Part A, Part B’s has a seven-month Initial Enrollment Period. This means anywhere between the three months prior to month you turn 65, and the three months after that. For example, if your birthday is in April, you are eligible from January through July.

However, if you don’t sign up within that time, you may have to pay a late enrollment penalty for the entire time you have Part B. According to Medicare.gov, “Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B, and coverage will start July 1 of that year.”

How much does it cost?

If you signed up for Part B when you became eligible, then you’ll likely pay a $104.90 premium each month, according to Medicare.gov. Though, this premium can change based on your income, and recent reports indicate it will cost more for a few select groups in the future.

There are some people who automatically get Part B. If you receive Social Security benefits, Railroad Retirement Board (RBB) benefits, are under 65 years old with a disability, have ALS, or live in Puerto Rico and receive Social Security or RBB benefits, then you are eligible for automatic enrollment.

With these benefits, it’s possible that you still don’t feel like you’re getting the coverage that you need. In that case, you can get supplemental Medicare insurance plans.

For more information on Medicare, check out Transamerica Center for Health Studies^®‘s handy guide.

About Transamerica Center for Health Studies^®.
The Transamerica Center for Health Studies^® (TCHS) is a division of the Transamerica Institute^®, a nonprofit, private foundation. TI is funded by contributions from Transamerica Life Insurance Company and its affiliates and may receive funds from unaffiliated third parties. TCHS is dedicated to identifying, researching and analyzing the most relevant health care issues facing consumers and employers nationwide. For more information about TCHS, please visit www.TransamericaCenterforHealthStudies.org.

Medicare 101: What is Medicare Part A?

Medicare 101: What is Medicare Part A?

TransAmerica Page: Medicare 101: What is Medicare Part A?

Medicare can be confusing, but don’t worry. You aren’t the only one feeling that way. Although there are many benefits to Medicare, with its different components and enrollment periods, it can get a little confusing. In this three-part series, we’ll break down Parts A, B, C and D of Medicare down to their essentials. Here are simple answers to the most-asked questions about Part A:

What does Medicare Part A cover?

Medicare Part A combined with Part B, make up what is known as Original Medicare. Part A covers emergency care, hospital stays, some nursing home care, and other long-term visits such as home health services and hospice care.

Who qualifies?

• Seniors (age 65 and above) who are U.S. citizens and permanent residents.
• Individuals with qualified disabilities (age 64 and below).

When should I enroll?

You can enroll during your Initial Enrollment Period (IEP), which usually lasts 7 months:

• Three months before your 65th birthday or 25th disability check.
• Month of your 65th birthday or 25th disability check.
• Three months after your 65th birthday or 25th disability check.

If you miss your Initial Enrollment Period, you can sign up during the General Enrollment Period, which is from January 1 to March 31. If you sign up during this time, your coverage will start July 1. Please note that if you enroll during the General Enrollment Period you may have to pay a higher premium for late enrollment.

Fall Open Enrollment occurs every year between October 15th and December 7th and allows those who already have Medicare to change their coverage. We recommend you review your coverage every year, as this is the one time when all people with Medicare can make changes to their plans for the next year.

How much does it cost?

Part A plans are provided to you at no cost if you or your spouse have worked and paid taxes for at least 40 quarters (or 10 years).

If this isn’t the case, you will pay a monthly premium of up to $407. The exact amount you’ll pay is determined by different factors such as your income and assets.

If you’re concerned about the costs involved that aren’t covered by Medicare, Medicare Supplement Insurance can help cover expenses that you’ll have to pay out of pocket.

For more info, check out Medicare.gov and this chart published by the Transamerica Center for Health Studies®.

The Transamerica Center for Health Studies® (TCHS) is a division of the Transamerica Institute®, a nonprofit, private foundation. TI is funded by contributions from Transamerica Life Insurance Company and its affiliates and may receive funds from unaffiliated third parties. TCHS is dedicated to identifying, researching and analyzing the most relevant health care issues facing consumers and employers nationwide. For more information about TCHS, please visit www.TransamericaCenterforHealthStudies.org.

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