As an Elder Law Attorney, clients often come to me when nearing 65, overwhelmed by the many alternatives available to them in choosing their healthcare. They ask: Do I need both Medicare A and B? Do I need a Prescription Drug Plan? What about a Supplement Plan? or Medicare Advantage Plan? In this Blog we answer these important questions asked by seniors as they approach Medicare eligibility.
Medicare is a government sponsored healthcare plan available to those at least 65 years of age (any age if disabled), who are either US citizens, or permanent residents living in the United States for at least 5 years. Medicare A (Hospital Insurance) covers things such as hospital stays, short-term stays in a nursing home, hospice care and limited home health care. Medicare B (Medical Insurance) covers Doctors, outpatient care, some types of medical equipment and other preventive services. Medicare A is free, provided that you or your spouse have worked 40 quarters or more during your lifetime. Medicare B is optional and the premium is deducted from your social security. The standard Part B premium is $134 for 2017, but will be higher if your income is greater than $85,000 per year and you are single, or greater than $170,000 per year and you are married and file jointly.
Medicare doesn’t cover everything (typically 80% of costs) and you will probably want a supplemental policy. These policies are offered by qualifying private insurance companies to help with coinsurance, copayments and deductibles. There are several different types of Supplement Policies available, and they are all standardized (lettered A thru N). Although premiums may vary for the same lettered plan depending on the carrier, each lettered plan must contain the same coverage. When signing up for Medicare A and B, you will probably also want to sign up for some type of prescription drug plan (Medicare Part D). If you don’t and need it later, you will pay a penalty.
But what if you prefer private insurance? In that event, you can choose to forego Traditional Medicare entirely and sign up for a Medicare Advantage Plan. All Medicare Advantage Plans must contain all the coverages in Medicare A and Medicare B. In addition, these plans also often contain additional coverages not available with Traditional Medicare, such as vision and dental care. In some instances, these plans may appear less expensive, but — unlike Traditional Medicare policies — these policies are not standardized. They vary dramatically from company to company and each has its own coverage rules and costs.
If you are nearing retirement, but still working, and have your own private insurance, or you are covered by your spouse’s plan, you may choose to delay signing up for Medicare Part B and continue with the plan you have. You should still sign up for Medicare Part A. Not only is it free, but some company policies only insure employees 65 and older as a secondary insured, covering only what Medicare will not.
The government’s web site www.medicare.gov contains valuable information to assist you in making these health care choices. If you need further assistance, however, as Elder Law and Estate Planning Attorneys, at The Law Offices of Clifford M. Cohen, we are well versed in all Medicare and Medicaid related matters. Please contact us at any time to discuss your estate planning and elder law needs.