Transitioning to the Medicare System – It’s All About Process, Not Product
In the US, we have a system where every person that becomes 65 years old must make some decision related to Medicare, the health insurance system for people over 65. It’s a system where every person has to do something or NOT do something, and it’s a system riddled with complexities.
The Role of the SSA
From the get-go, you must understand that to enroll in the Medicare system, you must interact with the Social Security Administration (SSA). That automatically makes you think that the SSA must know how to answer some questions related to Medicare, right?
Not at all! The Social Security Administration does the official enrolling and processing for Medicare beneficiaries. They also collect the premiums that are assessed for Medicare’s coverage. And, essentially, that’s the scope of their involvement.
There are a few ways to enroll in the Medicare system. One method is to be proactive, go online when you are soon to be 65 years old, and enroll using your computer.
If you are collecting Social Security benefits prior to age 65, you will become enrolled automatically and receive your Medicare Red, White, and Blue card in the mail. Make sure, however, that you want to keep the Medicare coverage.
A third way is to visit your local Social Security office with the proper forms and enroll for the coverage that you need.
It’s Not Such an Obvious Matter
So, right here is where the first layer of confusion sets in. I recently spoke with a gentleman who turned 65 in Fall, 2019. He said that “everybody” told him that his Medicare ID card would arrive in his mailbox. He waited and waited.
I asked him if he was currently receiving Social Security benefits. He replied “No.” Well, his card isn’t going to show up! Ever. And, he never enrolled into Medicare during his initial election period because he listened to others regarding being automatically enrolled.
Hence, he now needs to head into the Social Security office to officially apply. And, he needs the correct forms so that his Medicare does indeed start at the proper time.
Is Medicare Right for You?
Before you do anything, however, make sure you ask, “Is Medicare right for me?” IF it’s a choice. Some people find themselves at age 65 having Medicare become the next logical step to their health insurance choices. It’s rather “mandatory.”
Others will need to make comparisons with group insurance, retiree coverage, and more. They may have the option of looking into Medicare as their coverage or another alternative that they can retain.
Medicare Requires Early Study
Those approaching age 65 should regard their healthcare insurance transition as they would an exam. We always suggest starting to learn around the time you are 64.5 years old.
Bite off small pieces at a time. If you try and cram for the final, you’ll possibly fail. Take the time to read, study, and make a long list of questions. Then find proper counsel and get a second or third opinion as well.
Use the Internet wisely, as a source of information to learn from.
Very important note: Many websites promise help and quotes if you enter your phone number or email address and will call to make sure you enroll through their services. Other than earning them a bonus, you will likely gain nothing, so consider yourself warned.
Next, think about all of the material you read, the comments your friends and family make, the commercials that you see on TV, and more. Take all of those sources of “information” and write down your questions.
Write down everything that is unclear to you, including, “I don’t understand how dental can be free like the TV commercial says.” No question is a dumb question.
Find an Agent Willing to Help You
Take that list to an agent of your liking.
Tip: If you decide to call an insurance carrier instead, realize that the person that you speak with will be discussing one carrier’s products only. We always suggest either making multiple calls or working with an independent insurance agency that represents a number of insurance carriers.
After you’ve gone through the assessment that “Yes, I need Medicare,” find someone that can help you follow the enrollment process. Realize that agents are not compensated for this part of their work unless they have charged you a consulting fee.
Agents are paid from insurance carriers once a product is purchased by you. So, if an agent isn’t interested in helping you through the process of enrollment, that’s a clue that you may want to steer clear.
There are several excellent Medicare agencies in the US. They will guide you through your decision tree and help you to enroll into Medicare with the proper forms and at the proper time. Half the battle is finding those agencies.
What to Choose?
Having found an agent, you’re on the doorstep of product selection. Take a deep breath and use this time as almost a halftime to catch your breath and wait for the rest of your Medicare pieces to fall into place!
Next, you’ll need to work with your Medicare Sherpa to help you decide which of the two available products are proper for you, your life, and your budget. This is a really important decision to get right. And, you must get it right the very first time you enter the Medicare arena.
There are two paths to Medicare. One is to remain in Original Medicare (Parts A and B) and add a Medigap contract and a Part D (drug) plan to your world.
With this option you pay a monthly fee to an insurance carrier and this carrier will be the secondary carrier to Medicare, your primary insurance “company.” You may see any physician that accepts Medicare. Co-pays are either minor or non-existent depending on the Medigap letter plan you select.
The second path to Medicare coverage is opting to enroll into a Medicare Advantage plan. When you do this, you are enrolling into a private insurance carrier’s plan that takes over delivering what Parts A and B of Medicare do.
With Medicare Advantage plans you enroll with the carrier plan and you agree to the carrier rules. The carrier will often offer extra benefits that are not available with a Medigap contract, such as dental cleanings, x-rays, and a gym membership.
You must remember that these plans have networks, co-pays, and a final maximum out of pocket you will pay in terms of costs. Always check ahead to be sure that your physician or hospital will accept the plan.
Don’t be fooled into thinking that you won’t be paying your Medicare premiums any longer, however. Whichever path you choose, you will always pay your Medicare premiums to the US government.
Once you’ve spent considerable time finding out whether or not you should enroll into Medicare, and investigated what product best fits your world, you are ready to enroll into the plan with your agent’s help.
An agent’s assistance is important and can help you avoid mistakes while acting as liaison between you and your new insurance carrier.
Finally, you are enrolled. Go forth in confidence with your new health insurance called Medicare. Remember, it’s more about “process” than “product,” though, each word surely has great importance in the Medicare system.
What questions do you have about Medicare? Did you find the answers you were seeking? Which resource helped you the most? Please share with our community.