Understanding Medicare … it's compllicated

Toni: I am turning 65 in September and need to make my Medicare decision. I do not know where to start or what to do. I am being bombarded by telemarketers and mail telling me that if I do not sign up for Medicare when I turn 65, I will make a major Medicare mistake. Can you please simplify the Medicare process for me? Thanks! — Paula from Atlanta

Paula:

The Medicare community is exploding, with an American turning 65 every 8 seconds daily, which means 10,000 baby boomers are entering Medicare every day for the next 10-plus years. Simplifying enrolling and understanding Medicare is what the Toni Says Medicare team specializes in. No one wants to make the wrong Medicare or medical decision, which can add stress to retiring.

Below are the Medicare basics every baby boomer should know:

Learn the different Medicare Parts (A, B, C and D): Original Medicare is Medicare Parts A and B which covers hospital, medical and provider expenses. Medicare Part C, known as Medicare Advantage, is another way of receiving your Medicare benefits. Part D is a Medicare Prescription Drug plan that can be a stand-alone plan with Original Medicare and a Medicare Supplement, or a Medicare Part D plan can be included with a Medicare Advantage plan.

Medicare is NOT free: Medicare covers a lot and there is a cost associated with Medicare Parts A and B. The premium for Part A is at no cost if you worked 10 years, or 40 quarters, and paid Medicare taxes. Medicare Part B (medical and provider expenses) has a premium, which is means-tested depending on how much you have earned for that year. In 2023, most Medicare beneficiaries pay $164.90 each month for their Part B premium. The Medicare Part A (hospital) deductible for 2023 is $1,600 — not once a year, but every 60 days or 6 times a year. The 2023 Medicare Part B deductible is $226 once a year with Medicare paying 80% of the Medicare-approved amount. You pay the remaining 20%.

Understand "Original" Medicare: Medicare Part A covers in-patient hospital, skilled nursing/rehab facility, home health and hospice care. Medicare Part B covers doctor services whether at the office or surgical care, outpatient surgery/services, lab work, X-rays, MRIs, durable medical equipment, and preventative services with no network.

Understand the Medicare Advantage Plan (MAPD): You can select from Medicare Advantage plans (Medicare Part C), which can be an HMO or PPO plan, offered by private insurance companies. A MAPD plan has an insurance provider network with healthcare professionals or facilities that provide lower in-network rates. You do not use your Medicare red, white and blue card because Medicare will pay the MAPD plan for your care. You will be responsible for co-pays, deductibles and maximum out-of-pocket for your medical care.

Remember to enroll at the right time: The only way Medicare enrollment is automatic for those turning 65 who are already receiving their Social Security check. If you are not receiving your Social Security check and not working full-time with true employer group health insurance from either your or your spouse's employment, then you will want to enroll in Medicare Parts A and B online, via www.socialsecurity.gov. Those turning 65 with "true" employer group health insurance, whether it is theirs or their spouse's, may want to delay enrolling in Medicare until they retire or are laid off.

Toni King is an author and columnist on Medicare and health insurance issues. She spent more than 27 years as a top sales leader in the field. For a Medicare or long-term care checkup, email: info@tonisays.com or call 832-519-8664. You can now visit www.seniorresource.com/medicare-moments to listen to her Medicare Moments podcasts and get other information for boomers/seniors.