PLATTSBURGH — In 1959, there were 4,295,000 babies born in the United States.
Those surviving Baby Boomers celebrate their 65th birthday this year, and ssa.gov and medicare.gov are their two new best friends.
Make an appointment with the Social Security located in Suite 230 at 14 Durkee Street in Plattsburgh. Phone: 1-866-964-7430.
It is critical for these seniors to sign up for Medicare, three months before the month of their birthday, the month of the their birthday, and three months after their birthday.
“Now is the time frame you have to sign up for Medicare,” Christa Tyler, health insurance information counseling and assistance program HIICAP coordinator, said.
“Everybody pays into it and when you turn 65, it’s something you have to do. If you don’t sign up for Part B when you’re supposed to, there is a 10 percent enrollment penalty. It’s based on the Part B premium. Part D as in drug penalty, that is 1 percent for every month that you do not have your Part D. That is based off the national base beneficiary premium.”
TERMINOLOGY
Source: Medicare.gov
– Part A (Hospital Insurance)
Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
– Part B (Medical Insurance)
Part B helps cover: Services from doctors and other health care providers, Outpatient care, Home health care, Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment), Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits).
– Part D (Drug coverage)
Medicare drug coverage helps pay for prescription drugs you need. It’s optional and offered to everyone with Medicare. Even if you don’t take prescription drugs now, consider getting Medicare drug coverage. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare drug coverage. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered.
– Medicare Supplemental Insurance (Medigap)
Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized, and in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.
– Original Medicare
• Original Medicare includes Part A and Part B.
• You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
• You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
• To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap), or have coverage from a former employer or union, or Medicaid.
Medicare Advantage (also known as Part C)
• Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
• In most cases, you’ll need to use doctors who are in the plan’s network
• Plans may have lower out-of-pocket costs than Original Medicare.
• Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
STILL WORKING
“If you’re still working and you have coverage through your employer, the only thing you need to sign up for is Part A,” Tyler said.
“You can put off part B and Part D. You just have to have proof when you go to sign up for Part B and Part D, that you have creditable coverage.
“You fill out a form that will be given to you by the Social Security Office and then you would have to bring it to your employer and the employer would fill out when you had coverage with them along with the end date of when that coverage would be ending. While you’re still working, it doesn’t matter. You can prolong Part B and Part D as long as you’re still working and have creditable coverage with your company.”
Seniors already collecting Social Security, should automatically be enrolled in the Part A and Part B through the Social Security Office.
“But if you’re not collecting it, then that’s when you would have to go in and actually apply for Part A and Part B with Social Security Office,” she said.
OPTIONS
At the Clinton County Office for the Aging, Tyler reviews clients’ options.
“Once you have Part A and Part B, you then have to decide, if you then don’t have creditable coverage with your employer still or have retiree coverage, you have to decide whether you want a Medigap policy, which is a supplemental policy, and a drug plan,” she said.
“That is Original Medicare. There are two sides. So there’s Original Medicare, which is a Supplemental Plan and a Part B or people can get Medicare Advantage Plan, which is A, B, C, D, all in one with some extra benefits. You can get some dental some vision, some over-the-counter benefits whereas with Original Medicare, there is no dental, there is no vision, and there is no over-the-counter.”
Tyler plugs people’s medications into the Medicare.gov site.
“And that pulls up the lowest out-of-pocket policies for drug plans and Medicare Advantage plans,” she said.
“It is very confusing, and that’s basically what we’re here to do is help people navigate it because also while we’re going over that, we are screening people’s income because there are programs out there that will pay the Part B premium that people are also responsible for once they sign up for Part B.”
This year, the cost is $174.70.
“Some people if they’re below the income guidelines, will be eligible for a program called QI1,” she said.
“And what that program does it pays the Part B premium and it also pushes them into a program called Extra Help, which lowers the cost of their medications. So, there’s a lot to it.”
Tyler says seniors come in and say, “I thought retirement was supposed to be easy.”
“It will be once we get everything in place,” she said.
“In the first three months if you sign up, it’s not going to be effective until the first of your birthday month anyways. But every month after that, it’s always effective the first of the following month.”
Clients can get “A New to Medicare” packet that Tyler put together.
“Generally, I will sit down and go over that with the individual in the office and give them their options and then let them make a decision from there,” she said.
“I just let them know they need to have that decision made before the end of their enrollment period.”