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Medicare Part A & Part B

Some things to keep in mind before applying for Medicare Part A & Part B…

• You are eligible for Medicare Part A and Part B on the first of the month in which you turn the age 65

  • Example: If you turn 65 on July 23, you are eligible for Part A and Part B on July 1st

  • Exception: If you turn 65 on July 1st, you are eligible for Part A and Part B on June 1st

• If you are currently collecting Social Security:  About 3 1/2 months before your 65th birthday, you will automatically receive your Medicare card assuming you want both Part A and Part B.  Watch your mail since it comes in a plain white envelope and can easily be mistaken for junk mail.  Your Part B premium will be deducted from your social security payment.

  • If you are going to wait to get Part B (usually because you are going to continue to be covered by a group plan that does not require Part B*), follow the instructions that come with the card and send the card back.  This will enroll you in Part A only.  If you keep the card, you keep Part B and will pay Part B premium.    * Plan insures 20 employees or more

• If you are not collecting Social Security:  About 3 months before you turn 65, contact Social Security at 1-800-772-1213 or go to socialsecurity.gov/medicare and apply for Part A and/or Part B.  If you are not going to be collecting Social Security, you will receive an invoice to pay premiums directly to Medicare.

  • If you will be covered by a group plan that does not require Part B, apply for Part A only.  There is no cost for Part A and you could realize a benefit if you are hospitalized.  If the employer group plan is an HSA and you are contributing to an HSA fund, let me know.

• If you have group coverage and declined Part B when you turned 65:  Two months before you expect to come off your group plan, contact Social Security and tell them you need to activate your Part B coverage.  A form will need to be completed by your group administrator verifying that you had group coverage after you turned 65 and the date your group coverage will end.

  • Your Part B effective date usually coordinates with the date your group coverage ends.  You will not have a Part B penalty because you have had coverage through a group.  If you do not have Part A, it will also become effective but it will be back-dated by 6 months.

Typical Approaches to Medicare Insurance

• Whether you choose a Medicare Advantage plan or a Medicare Supplement plan, you must have Medicare A and B active.

• Medicare Advantage Plans: Most Part C Medicare Advantage plans include Part D prescription drug coverage.  The insured pays copays and/or coinsurance according to the plan which includes an out-of-pocket maximum. Medicare Advantage plans have little or no premium and typically include a network. (pay as you go)

• Medicare Supplement Insurance Plans: Medicare pays first, then the Medicare Supplement insurance pays the remainder of Medicare-covered services after you pay your $226 Part B deductible. (Part B deductible coverage is no longer available if you turn 65 after 1/1/2020.) There is no network. Part D offers separate prescription drug coverage. (pre-pay for the unknown)

What is Part C?

• Medicare Part C is the Medicare program commonly known as Medicare Advantage.  It provides medical coverage through private insurance plans that is at least as good as Medicare A and B and usually include Part D prescription coverage. Medicare Advantage plans are provided by insurance companies that have contracted with the Federal Center for Medicare & Medicaid Services. Medicare Advantage plans have a cost associated with each service you have unless it is a covered preventive service and there will be a  network that you you need to be mindful of. 

• When you are enrolled in a Medicare Advantage plan, you do not use your Medicare card.  Put your Medicare card in a safe place at home. You only use the ID card from your Medicare Advantage plan.

• Part C plans are subject to change each year and should be reevaluated each year during the annual enrollment period (10/15 – 12/7).

Medicare Supplement or Medigap

• Medicare Supplement or Medigap plans are designed to supplement or fill in the gaps in the Medicare A and B benefits. The plans are provided by insurance companies, are required to provide Wisconsin-mandated benefits, and pay second after Medicare A and B. Traditional Medicare Supplement policies are designed to pay the deductibles and cost-sharing that are not covered by Medicare.

• If you are looking for Medicare Supplement Plans A – N, you will not find them in Wisconsin.  These plans “mix and match” optional rider combinations.  (Next page)

• Show both your Medicare card and your Supplement card when you use services.  Part D offers separate prescription drug coverage.