Golden Opportunities

There’s a birthday milestone that everyone should celebrate – no, it’s not the big 4-0, or 5-0, or even 6-0. It’s the big 6-5. Why the hoopla over turning 65? Because Uncle Sam has a special gift just for those who reach this milestone. You’re eligible to receive Medicare benefits. Aaron Morrow is here to unwrap the details of Medicare Parts A, B and D. Aaron is with Kaiser Permanente.

Question:This is a gift that can keep on giving. So, tell us what we get.

Answer: Medicare is a Federal health insurance program for almost all Americans age 65 and older and many adults with certain disabilities. It is divided into three parts:

• Medicare Part A, helps pay for inpatient hospital care, skilled nursing facilities [up to 100 days, not long term], some home health care, and hospice care. Medicare Part A is usually available at no cost to people who have worked in the U.S. for 10 years or 40 quarters or more, contributing to social security. You can also purchase Part A if you don’t qualify to receive it free.
• Medicare Part B, helps pay for physician services, outpatient hospital care, and other medical services not covered by Part A. Medicare Part B is purchased from the federal government.
• Medicare Part D, also known as Medicare prescription drug coverage, is purchased through private insurance plans.

Question:We know that 65 is the age to qualify for Medicare. Are there any other requirements for eligibility?

Answer: Generally, you are eligible for Medicare

• if you are a U.S. citizen, or have been a permanent legal resident for five continuous years, and
• You are age 65 or older and eligible to receive Social Security;
• or you are under 65, permanently disabled, and have received Social Security disability insurance payments for at least two years;
• or you receive dialysis for ESRD (end stage renal disease).

Question:Okay, so I'm 65 and I'm ready to apply. What do I do?

Answer: For Part A, you don’t have to apply; it’s automatic.
For Part B, you must apply through your local Social Security office; they are waiting for you to contact them.
If you are turning 65 you qualify for what is called an “Initial Election Period”. This means the federal government gives you a period of time to enroll that is as early as 3 months before your birthday, the month of your birthday, and 3 months after your birthday.
There is a premium you pay for Part B: In general, it’s $110.50 per month. For singles whose income is more than $85,000 – or for couples’ whose income exceeds $170,000 – the amount it is based on your income.

Question:What if I miss my window of opportunity to enroll? Will I be penalized?

Answer: When you enroll in Medicare you pay a premium to the federal government for Medicare Part B that is contingent upon your income. If you miss your window of opportunity to enroll you may be assessed a penalty on top of that premium.

Question:Okay, but what if I'm turning 65 and I'm not ready to retire? Can I continue on my employer sponsored health coverage?

Answer: That’s a good question because the rules are a little different depending on the size of company you or your spouse works for.
If your company has more than 20 active employees you will most likely be allowed to remain on the company plan and defer your Part B enrollment without being assessed a penalty. If the company has less than 20 active employees you may be required to take Medicare Part B even if you continue to work. You’ll want to ask your benefits administrator which rules apply to your company.

Question:I know many insurance companies, including Kaiser Permanente, offer a variety of Medicare health plans. Are these really necessary? Or can I just be covered under original Medicare?

Answer: When you’re turning 65 it is a good idea to explore all the Medicare options available to you. Many insurance companies contract with the Federal Government to provide health care benefits to Medicare beneficiaries that go above and beyond what original Medicare covers, in other words Part B.
It may be in your best interest to evaluate your health care needs and shop around to see what the market has to offer.

As you blow out those 65th birthday candles, don’t blow the chance to get Medicare health insurance! If you have questions, give Aaron a call. His information is next.