New to Medicare? 8 Coverage Questions You Should Ask

Are you getting ready to turn 65? Whether it’s a few years away or right around the corner, there are some critical coverage questions you should ask.

From understanding the parts of Medicare to uncovering your best coverage options, these are 8 questions to run by a Medicare agent before enrolling in any plan.

1) What are the parts of Medicare, and what do they cover?

Medicare has four main parts:

1. Part A: your hospital insurance

2. Part B: your medical insurance

3. Part C: an all-in-one alternative to Parts A and B; also called Medicare Advantage

4. Part D: prescription drug insurance

Parts A and B together are often referred to as Original Medicare, and it’s very common to add on a Medicare Supplement to fill in the coverage gaps. If you choose to get your health insurance through Original Medicare, you’ll probably also want to add a Part D plan to help cover the costs of prescriptions.

The alternative is to choose Part C, more commonly referred to as Medicare Advantage. Medicare Advantage plans are sold by private insurance companies and typically include your hospital, medical, and prescription drug coverage in one bundled plan.

It’s important to ask your agent about these key parts of Medicare so you can fully understand what they cover and which path is right for you.

Learn more: Parts of Medicare

2) When do I need to start Medicare enrollments to avoid penalties or delays in coverage?

Timing is critical when it’s time to enroll in Medicare. Missing deadlines could result in higher premiums, delays in coverage, and lifetime penalties.

It’s best to reach out to a licensed insurance agent at least 6 months before you turn 65. This will give you time to get educated on your Medicare options, decide which plan you want, and apply in plenty of time.

Learn more: Enrollment Periods

3) What are my coverage options?

There are dozens upon dozens of plans available in Macon County, including Medicare Advantage, Medicare Supplements, and Part D drug plans.

Your most critical decision is to decide if you want Original Medicare with a supplement and Part D plan or a Medicare Advantage plan.

Learn more: Central Illinois Medicare Supplement vs. Medicare Advantage

Once you make that decision, you’ll need to select specific plans. For example, do you want a Medicare Supplement Plan G or Plan N? And which company has the most competitive rate?

A licensed insurance agent can explain the pros and cons of these options and run price comparisons for all of the major insurance companies in our area. Be sure to work with a broker, or an agent with access to all carriers (not just one).

Sams/Hockaday is a brokerage, so you know you’ll always have access to all of the carriers, and thus, the most competitive prices. You can schedule an appointment with us online or by calling our office at 217-423-8000.

You can learn more about what a broker is by watching this short video:

4) How do I know if Medicare with a supplemental policy or Medicare Advantage is right for me?

Original Medicare (Parts A and B) with a Medicare Supplement policy is the most common route our clients take.

However, Medicare Advantage is gaining popularity and offers some enticing perks, like low or even $0 premiums and add-on benefits like no-cost dental cleanings and credits for eyeglasses and contact lenses. With those perks come drawbacks, such as provider networks, managed care, and higher out-of-pocket costs.

We have some resources to better help you decide if Medicare Advantage is right for you, but you should also consult with one of our local, licensed agents.

• 6 Simple Ways to Tell If Medicare Advantage Is Right for You

• 6 Reasons to Make a Change to Your Medicare Advantage Plan

5) What if I’m still getting health insurance through an employer group plan?

When deciding if you should stay on your group plan or switch to Medicare, the best place to start is to lay out your current coverage.

Write down what you pay in premium, your deductible, coinsurance, and copays. How much did you pay out of pocket for medical expenses last year?

Once you have those numbers mapped out, you can compare them to the costs of Medicare. One of our agents can run quotes for you so you can do a side-by-side comparison.

Sometimes, it’s best to stay on your group plan, and other times, you can save thousands by switching to Medicare.

You can read more here: Working Past 65?

6) Do I need a Part D drug plan if I don’t take any prescriptions?

We do recommend you have a Part D drug plan to avoid the penalty for not having credible drug coverage. Plus, you’ll also have coverage if you are prescribed a medication during the year.

Part D plan premiums start as low as $8 per month.

Note: you likely will not need a Part D plan if you choose to enroll in a Medicare Advantage plan.

7) Will I have to pay higher premiums because of my income?

Medicare does adjust premiums based on income. If you have a high income, you could pay more for Medicare Part B, which everyone is required to pay – whether you get your coverage from Original Medicare or Medicare Advantage.

In addition, Part D drug plan premiums are higher for those with a high income.

Depending on how high your income is, you could pay between 40-240% more for Medicare Part B and 61-388% more for your Part D plan.

Check out our article How Income Affects Your Medicare Costs for more information and the current year’s income tables.

8) Is the agent I’m working with licensed with all the major companies?

It’s critical that you compare Medicare plans from all of the different companies before you enroll for the first time.

When you first turn 65, you have special privileges, which includes skipping medical underwriting. This is your free pass to choose any plan without fear of being declined or having to pay a higher rate due to pre-existing conditions.

If you make a choice you regret, you may be stuck later on.

Make the best decision for your needs and budget now to ensure you’re happy for years to come. Working with an agent that’s licensed with all the various Medicare companies will ensure you can do a fair comparison and truly pick the most competitive company for you.

Conclusion

If you’re new to Medicare, you’ll want to ask plenty of questions! It’s important to have a basic understanding of how the program works so you can choose the right Medicare plan for your needs and budget.

Our licensed agents can work through these questions with you and help you make an informed decision.

We recommend reaching out to us at least 6 months before you turn 65. You can schedule an appointment with us online or by calling our office at 217-423-8000.