The Lake Today

Editor’s Note: The following column will appear in each of the “Your Active Life” special sections ran quarterly throughout the year. Its intentions are to educate the public about Medicare, and make sure to look for the next installment of this column in the June “Your Active Life” special section within the pages of The Lake Today.

The best way to make any decision is education first. Whether it's buying a new car, deciding what breed of dog you want as a pet, or what kinds of flowers to plant, understanding those choices can make each decision easier. Options for health care coverage are no different. When it comes to Medicare and all of it's parts, educating oneself is a top priority.

Here are some questions that people ask me regularly. Hopefully, this will help give you a clearer picture of Medicare and what you can expect.

Q: What is the difference between Medicare and Medicaid?

A: While both help cover healthcare costs, here is the difference. Medicare is a federally-governed program for people 65 and over; people of any age who have kidney failure or long term kidney disease; or people who are permanently disabled and cannot work. To apply for Medicare, contact the Social Security office. Medicaid is a state-governed program and is for people with a low income who are pregnant; under the age of 19, or 65 and older; blind, disabled, or need nursing home care. To apply for Medicaid, contact your local Medicaid office.

Q: When should I apply for Medicare?

A: Typically, when a person is turning 65, they are enrolled automatically in Medicare A and B. Generally, it will start the first day of the month in which you turn 65. If your birthday is July 14, you would likely have an effective date of July 1. The exception would be if your birthday is July 1, your effective date would be June 1. Note: If you are not going to draw Social Security at 65, you should contact the Social Security office about your Medicare.

If you are disabled, and under 65, you automatically get Medicare A and B after you have received disability benefits from Social Security for 24 months.

If you believe you fall into either of these categories and are not sure if you are receiving Medicare, you can contact Medicare at 1-800-MEDICARE or Social Security at 1-800-772-1213.

Q: When will I get my Medicare card?

A: About three months before you turn 65 (or the 25th month after disability benefits begin), you will receive your card. It is white with a red and blue stripe across the top. It comes attached to a larger piece of mail and is perforated. Sometimes, my clients receive these and don't realize they have it.

Hint: This may seem obvious to some, but when it is getting close to your 65th birthday, and you receive anything from Social Security or CMS (Center for Medicare and Medicaid Services), you should open it and read it thoroughly. I have gone to many appointments for people new to Medicare who don't know if they have their card. I have sat down at kitchen tables and helped clients sort through mountains of mail to discover they have already received their card and didn't know it.

Q: Why do I get so much mail from all of these insurance companies?

A: If I had a nickel for every time someone asked me this question, I'd definitely have a pocket full of nickels!! CMS regulates how companies can communicate with Medicare beneficiaries. For example, once you are on Medicare, an agent cannot "cold" call you and solicit your business, even if you are NOT on the do-not-call list, nor should any agent EVER knock on your door to discuss your federal benefits. CMS also regulates how companies explain benefits. This is an effort to protect beneficiaries from being inundated with telemarketing calls and more confusing information. So, in order to let potential clients know what is available, direct mail seems to be one of the most effective ways to get the information to you accurately, while complying with CMS regulations.

Q: Why do I need anything besides Medicare and a drug plan?

A: Medicare has deductibles and co-pays. There is no maximum out-of-pocket protection. Your deductibles and coinsurance can add up quickly. I suggest you have an open conversation with someone who is knowledgeable about Medicare. Discuss your needs and concerns. Find out what your potential financial exposure might be. A few hospital stays, and a couple of trips to the emergency room, can be thousands of dollars. You will want to prepare for those costs.

Q: My friend has a supplement that is free. How does that work?

A: Often times people use the word "supplement" and what they really mean is a Medicare Advantage plan. A Medicare Advantage Plan (also called Part C) works different than a supplement. These plans typically have a lower monthly premium than a supplement, in addition to co-pays. These plans often have networks and restrictions. Once you understand how the plan would work for you, it may be a very cost effective option for you. Medicare Advantage plans are county specific. So what is available in Camden County, may not be what is available in Miller County. No plan is free. Some plans offer a $0 premium plan. Meaning, the Medicare beneficiary pays nothing to the advantage plan, but they are still paying for their Part B, and Medicare is paying the advantage plan.

• This article is for education purposes only. No plan specific details will be shared. I am an agent contracted with multiple companies. I am compensated based on enrollment.