I Qualify for Medicare This Year… Now What?


In the blink of an eye, time passes, and you finally qualify for Medicare this year… A significant mile marker, indeed! Chances are you’re sitting there, head in hand, thinking “Now what?” Up to this point, you’ve likely heard about the alphabet that is Medicare, and you may have even done some homework of your own, which (if you’re like most folks) probably created more confusion. Never fear! Below are five key considerations to help you work your way through the maze of Medicare.

Medicare Medical & Hospital Plans (Part A, B & C):

Your available options under Original Medicare include two parts – Part A (hospital insurance) and Part B (medical insurance). An alternative to Original Medicare is Medicare Advantage (also known as Part C), which is offered through private insurance health companies. Think of Part C like a “bundled” plan. It includes all the benefits of Original Medicare Parts A & B plus additional coverage such as vision, dental, hearing aids, among others. Importantly, Original Medicare and Medicare Advantage have different costs and rules, so it’s important to thoroughly research both options, comparing each plan’s benefits and potential out-of-pocket costs, to make the right healthcare choice for you.

Medicare Prescription Drug Plan (Part D):

Original Medicare Part B coverage offers limited drug coverage and may not cover the medications that you need. To help fill this gap, private healthcare insurance companies offer a prescription drug plan (Part D), which is usually part of the Medicare Advantage Plan or can be purchased as a standalone plan. It’s important to understand what specific prescriptions drugs are covered by Original Medicare and whether your needs require a supplemental drug plan.

Supplemental Plan (Medigap):

Just because you’ve elected Medicare, doesn’t mean you can close your wallet. It’s important to note that Medicare doesn’t cover all healthcare costs, e.g., Part B only covers 80% of physician’s bills, leaving the remaining 20% to be paid by you through copayments or coinsurance. Supplemental insurance plans (also known as Medigap Plans), offered by private healthcare insurance companies, can help fill your gap in insurance coverage, including covering your applicable healthcare copayments and deductibles.

Medicare Enrollment:

It’s crucial to enroll in a Medicare plan on time! Missing the deadline can cost you a lifetime of penalties, so be sure to keep track of the Medicare enrollment period while reviewing your options. The Initial Enrollment Period, for age-related eligibility, is seven months long. It starts three months before your 65th birthday, includes the month you turn 65, and ends three months after you turn 65. If you miss the initial enrollment period, you may enroll in a General Enrollment Period, which starts from January 1st to March 31st, however late registration may result in a permanent penalty fee even after you’ve enrolled.

Medicare Help:

Medicare is not a one-size-fits-all approach. The enrollment procedure requires investigating your options, making an informed decision, and enrolling into a plan on time. Because of the importance of this decision and the need for medical assistance as we age, many people ask for help from a trained professional (insurance agent, atorney, or financial advisor) to help them make a well-informed decision.

Qualifying for Medicare is a significant milestone in the journey of life. To find the plan that best fits you and your healthcare needs, it’s essential to understand the services provided under Original Medicare and supplemental plans, the enrollment procedure, the cost-sharing factors, and the deadline. Most importantly, when in doubt, don’t hesitate to ask for a helping hand from your trusted professional. Understanding Medicare can feel overwhelming. A call or meeting with your trusted guide may be just what the doctor ordered to help put your mind at ease.

LSIA is here for you to help address your financial questions. CLICK HERE to contact us.

Data Source: Centers for Medicare and Medicaid Services (cms.gov); Health Partners (healthpartners.com – “What are the parts of Medicare? And what do they cover?”, Amy Schultz); New York Daily News (nydailynews.com – “Medicare Guide: Original Medicare only covers 80% of Part B services”, Jordan Galloway); National Council on Aging (ncoa.org – “When Is the Medicare General Enrollment Period?); RetireMed (retiremed.com – “Medicare Late Enrollment Penalty Explained” and “What is Medicare Part C?”); eHealth (ehealthinsurance.com – “Why Doesn’t Medicare Cover 100% of my Medical Bills?, Jill Halloran, and “What Does Medicare Part C Cover?”, Maria Masters); and Medicare.gov (“When does Medicare coverage start?”). Photo courtesy of Adobe Stock.

LS Investment Advisors, LLC (dba LSIA) is a registered investment adviser.  Neither the firm, nor its employees, are licensed healthcare insurance agents/brokers.  Information presented is for educational purposes only and does not intend to make an offer or solicitation for the sale or purchase of any specific healthcare insurance plan, securities, investments, or investment strategies.  Investments involve risk and unless otherwise stated, are not guaranteed.  Be sure to first consult with a qualified healthcare insurance agent/broker, financial adviser, and/or tax professional before implementing any strategy discussed herein.  Past performance is not indicative of future performance.