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Ten Ways to Take Advantage of Medicare

If you are approaching age 65, then you are probably very interested in how Medicare can assist you.  You have probably been paying into the federal health care assistance program for most of your life, and it is finally time for you to start receiving some of your promised benefits.  If you aren’t very knowledgeable about Medicare, here are ten important ways it can serve you:

  1. You can enroll before age 65—although most Americans don’t enroll in Medicare until age 65, if you are already qualified for Social Security Disability Insurance and have been receiving SSDI benefits for at least 24 months then you may also qualify for Medicare.  Following the two year waiting period, you will be enrolled in Medicare automatically.  If you are suffering from Amyotrophic Lateral Sclerosis, then your Medicare benefits begin at the same time as your SSDI.
  2. Enroll on time—about three months before you turn 65, you should get a card from Medicare notifying you that you will be automatically enrolled in the program. Automatic enrollment only occurs if you are getting Social Security benefits, and this is only enrollment in Medicare Parts A and B.  If you are not automatically enrolled, you will need to contact your local Social Security office.  If you fail to enroll on time during a seven month period around your 65th birthday, you may be penalized by up to 10 percent of your premium. In some cases, these penalties may persist for as long as you are enrolled in Medicare.
  3. Consider a Medicare Advantage plan—one of the most effective ways to maximize your Medicare benefits is to join a Medicare Advantage plan, also known as Medicare Part C.  In one of these plans, you obtain health coverage from a private insurer while Medicare pays the premiums.  You may still take advantage of Medicare Part D for drug benefits but your private insurer must include it in their MA plan. All MA plans must offer comparable coverage to Medicare Parts A and B, but some may offer additional perks like limit out-of-pocket maximums, cover some expenses Medicare doesn’t, or include dental/vision benefits.
  4. Get cheaper prescription drugs—if you are enrolled in Medicare Part D or select Medicare Advantage plans, you may be eligible for some big drug discounts.  If you reach the annual threshold of $3,310 spent on prescription medications by you and Medicare, then you may be required to start paying a larger portion of drug costs.  If you shop around, you may find pharmacies that are willing to provide big discounts for Medicare beneficiaries who are paying out of pocket. Some pharmacies are willing to provide generics for only a few dollars or, even free.

    vitamins, pills and tablets
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  5. Utilize free preventive care services—with the implementation of the Affordable Care Act, Medicare was required to provide free or low cost preventive care.  Each year, Medicare beneficiaries may be screened for a number of health issues including prostate cancer, depression, breast cancer, diabetes, or glaucoma.  Medicare enrollees may also receive flu shots, pneumonia vaccines and hepatitis B vaccines at minimal or no cost. To obtain these services just make an appointment for preventive care with your physician.
  6. Reevaluate your plan each year—whether you have a Medicare Advantage plan or merely parts of traditional Medicare, it is important to reevaluate it annually, preferably right before or during the annual open enrollment. Not only do these plan benefits change, but your health circumstances may have also.  You may find you need more or less coverage than you initially thought, and the open enrollment period allows you to make changes without a penalty.
  7. Obtain reliable advice from advocacy groups—most people tend to get Medicare advice from friends and family, but that may not be the most reliable way. If you have questions or issues with your private insurer or Medicare, there are some trusted advocacy groups that are available to help you.  The State Health Insurance Assistance Program and the Medicare Rights Center are well respected organizations available to assist you. For legal issues, you may find help at the Center for Medicare Advocacy.
  8. Get Medicare in addition to employer insurance—if you are still working at age 65 and are covered under your employer plan, you should still enroll in Medicare.  Even if you have employee, retiree or COBRA coverage, it is in your best interest to add Medicare because you may be penalized if you sign up for Medicare after age 65.  Some employers may also require senior employers to enroll in Medicare.
  9. Avoid a high income surcharge—if you make more than $85,000 a year individually or more than $170,000 with your spouse, you may be charged hundreds of dollars more in monthly premiums.  You may be able to avoid this if you contact the Social Security Administration and prove a significant life change like retirement, divorce or spousal death has occurred. You may need to provide documentation like a death certificate or pay stub as evidence.
  10. Medigap insurance can help with additional expenses—although Medicare may pay for the bulk of your medical expenses, it typically won’t pay for all of the out-of-pocket costs like co-pays, deductibles and co-insurance.  A supplemental health insurance policy commonly referred to as Medigap may be a smart option to cover these expenses, as well as expenses beyond Medicare’s coverage maximum.  Medigap may be ideal for chronically ill enrollees who expect frequent or extended hospital stays.

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Medicare is one of the government’s most important assistance programs for seniors, but it is a complex system with many features.  If you want to maximize your Medicare benefits, then it is in your best interest to do some research, understand your responsibilities, and carefully consider your options.  If necessary, ask questions; there are a number government and private organizations that can provide you with answers to help you make informed decisions.  After all, you may be using Medicare for many years to come.

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