7 Steps to Understand Medicare

Whether you’re enrolled in a Medicare plan or not, consider these seven steps to make Medicare work for you!
steps to understand medicare

Step 1: The ABCs of Medicare and different plan types

First things first: what is Medicare? Medicare is a federal health insurance program that pays for several covered health services. Generally, you’re eligible for Medicare if you (or your spouse) worked for at least 10 years and contributed taxes to fund your Medicare benefits, are 65 years or older, and a U.S. citizen or permanent resident.

Choosing the right plan is not only important, it’s personal. To sort things out, it is best to know all your options. When it comes to Medicare, there isn’t a one-size-fits-all option. So, what are the differences between Medicare Parts, A, B, C, and D?

  • Part A is hospital coverage.
  • Part B is medical coverage – you must pay a premium each month.
  • Part C combines your hospital, medical, and typically your drug coverage into one complete plan. Think of Part C as all-in-one coverage.
  • Part D is prescription drug coverage only.

Step 2: What's your medication situation?

Many of us take one or more medications on a regular basis. It is important to review the annual drug formulary to ensure there haven’t been any coverage changes.

Step 3: Choosing the right plan for you

Remember to review your plan and coverage every year. What may have been a great plan last year may not suit your needs anymore. Keep an eye out for in-network versus out-of-network providers, review monthly premiums and annual deductibles, examine referral requirements, and look for bonus perks. What options, tools, and services are included in your plan. Find out about gym memberships, wellness, discounts, vision and dental, and other extras.

Step 4: Be in good company

When choosing the right plan for you, consider looking at what insurance companies offer. Evaluate if they are not-for-profit versus for-profit and local versus national. Look at the level of customer service. Is the person you talk to local? When comparing options, make sure to check the plan network. Are your current providers and facilities in the network? Finally, the Centers for Medicare and Medicaid Services (CMS) use a five-star quality rating system to evaluate health plans. That star rating can tell you a lot about the company’s customer service, member satisfaction, benefits, and overall quality.

Step 5: Dates to remember

The Annual Enrollment Period occurs every year from October 15 to December 7. This is a great opportunity to review your coverage annually to make sure it still works for you.

Step 6: What you need to know about SSA, HSAs, and delaying Medicare

If you are still planning to work and not retired by the time you turn 65, there are still a few things you need to know. You can continue to work and delay Medicare by staying on your employer’s health plan. Even if you plan on working past 65, it’s a good idea to verify your coverage status and avoid any lifelong penalties.

Once you are on Medicare, you can no longer contribute to a Health Savings Account (HSA). However, anything you saved in your HAS can be used towards qualifying medical expenses for the rest of your life.

If you are receiving Social Security benefits prior to age 65, your Medicare card will automatically arrive in the mail about 90 days before your 65th birthday. Remember, every situation is unique. Talk to an expert to walk you through your options.

Step 7: Ready, set, go! What's next?

Need expert advice on Medicare? Join KUTV and Intermountain Healthcare’s Ask the Expert program on November 12 when experts from the SelectHealth will discuss health insurance and Medicare. Tips and suggestions will be offered throughout the day on Channel 2 during the news and other broadcasts.

If you have questions, SelectHealth will be answering your phone calls from noon to 5:30 p.m. at 1-877-908-0680. You can also submit questions via Facebook and Twitter using #kutvasktheexpert. The SelectHealth Answer Team can also help during the Annual Enrollment Period for Medicare from October 15 to December 7 by calling 1-855-442-9940.