Phone: 715-379-3778
Learn More About Medicare to Navigate it Confidently
As you approach retirement age, it's essential to consider your healthcare needs and expenses. At Retirement Service Solutions in Eau Claire, WI, we understand that Medicare can be overwhelming. We are here to help you navigate the complexities of Medicare confidently. Our team of experienced professionals can guide you through the process, answer your questions, and help you choose the best plan that meets your unique needs and budget.
More importantly, we are here to SERVICE YOU.
What is Medicare and who is eligible?
Medicare is a federal health insurance program primarily for people aged 65 and older, as well as for certain younger individuals with disabilities and people with End-Stage Renal Disease (ESRD). Eligibility generally depends on age, citizenship or legal residency, and work history. Medicare is not to be confused with Medicaid, which has eligibility requirements for people with limited income and resources.
What are the different parts of Medicare and what do they cover?
Medicare consists of four parts:
Part A: Hospital Insurance
This covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Part B: Medical Insurance
This covers certain doctor services, outpatient care, medical supplies, and preventive services.
Part C: Medicare Advantage
These plans are offered by private companies approved by Medicare. They combine Parts A and B and may include additional benefits like prescription drug coverage (Part D), vision, hearing, and dental.
Part D: Prescription Drug Coverage
This helps cover the cost of prescription drugs. It can be obtained through stand-alone Prescription Drug Plans or through Medicare Advantage plans that include drug coverage.
How do I sign up for Medicare?
If you're receiving Social Security or Railroad Retirement Board benefits before you turn 65, you will automatically be enrolled in Medicare Parts A and B. You'll receive your Medicare card in the mail about three months before your 65th birthday. If you're not receiving Social Security or Railroad Retirement Board benefits, you'll need to sign up for Medicare through the Social Security Administration.
When can I sign up for Medicare?
There are 3 enrollment periods:
Initial Enrollment Period (IEP)
This is the 7-month period that starts 3 months before you turn 65, includes the month you turn 65, and ends 3 months after you turn 65.
If your birthday is on the first of the month, your IEP period starts 4 months before you turn 65 and ends 2 months after you turn 65.
To avoid any potential late enrollment penalty, it’s important to sign up promptly unless you have creditable insurance. It’s your responsibility to confirm with your HR and Social Security if you can delay Medicare without incurring a late enrollment penalty. If you miss your 7-month IEP, you may have to wait to sign up and pay a lifelong late enrollment penalty.
General Enrollment Period (GEP)
If you didn't enroll during your IEP, you can sign up during the GEP. This runs from January 1 to March 31 each year. Coverage starts the month after you sign up. You might pay a monthly late enrollment penalty if you don’t qualify for a Special Enrollment Period.
Special Enrollment Periods (SEP)
After your first chance to sign up during your IEP, there are certain situations when you can sign up for Part A and/or Part B without paying a late enrollment penalty. A SEP is only available for a limited time and for certain situations (such as loss of current creditable employer coverage.) If you don’t sign up during your SEP you’ll have to wait for the next GEP and you might have to pay a monthly late enrollment penalty.
What does Medicare cost?
The costs of Medicare vary depending on the specific parts you choose and your household income. Generally, beneficiaries may have to pay premiums, deductibles, coinsurance, and copayments for various services.
Also, if you take Part B, there is a monthly premium that is automatically deducted from your Social Security benefit payment (or Railroad Retirement Board benefit payment). If you don't get benefits from Social Security (or the Railroad Retirement Board), you'll get a premium bill from Medicare.
Do I need additional coverage if I have Medicare?
While Original Medicare (Parts A and B) provides coverage for many healthcare services, it doesn't cover everything. Many people choose to enroll in additional coverages such as Medicare Advantage plans (Part C) or Medigap (aka Medicare Supplement), and Part D to help cover costs related to prescription drugs, dental, vision, and other services not covered by Original Medicare.
Does WI have a drug assistance program?
Yes, WI has a State Pharmaceutical Assistance Program (SPAP) called “SeniorCare”. This program is for Wisconsin residents 65 or older to help cover the costs of prescription drugs and vaccines.
You can apply for SeniorCare the month you turn 65 or later. Your coverage begins the month after your application has been processed. The enrollment fee is $30 per person, per year. Your household annual income determines your SeniorCare coverage level.
Call Our Team for More!
At Retirement Service Solutions, we are committed to helping you achieve your healthcare and financial goals. Whether you need help choosing a Medicare plan or enrolling in the ACA's Health Insurance Marketplace, our team is here to guide you every step of the way. Contact us today at 715-379-3778 to learn more about our Medicare and Marketplace plans and how we can help you achieve financial and healthcare security in retirement.