8 Medicare tips that everyone needs to know

Dear Toni: I am a confused baby boomer who needs to make my Medicare decision by November when I turn 65. I do not know where to start or what to do. Can you please help simplify this ordeal? — Stephanie, Phoenix

Dear Stephanie: You’re not alone: Someone will enroll in Medicare every eight seconds for approximately the next 10 years. Most boomers feel an urgency to learn all of their Medicare options, because they know that one wrong move can jeopardize their retirement savings.

Here’s some Medicare advice that everyone needs:

Enroll on time: If you are turning 65, Medicare enrollment is automatic only if you are already receiving a Social Security check. If you are not receiving Social Security and not working full time with employer benefits from your or your spouse’s work, then you will want to enroll in Medicare Parts A and B at ssa.gov/medicare/sign-up. Those working full time with employer benefits or who are covered under their spouse’s benefits may want to delay enrolling in Medicare Parts A and B until they retire or lose their benefits for any other reason. If the employer’s benefit is a health savings account, important Medicare rules apply.

Medicare is not free: There is a cost associated with Medicare Parts A and B. You have been paying tax dollars for Medicare, and the premium for Part A is at no cost. Medicare Part B has a premium based on how much you have earned for that year. In 2023, an average Medicare beneficiary pays $164.90 each month for Part B. The 2023 Medicare Part A (hospital) deductible is $1,600 — not once a year but every 60 days, or six times a year. The 2023 Medicare Part B deductible is $226 once a year, with Medicare thereafter paying 80 percent of the Medicare-approved amount and you paying the remaining 20 percent (many people purchase insurance to cover this 20 percent gap).

Learn about Medicare’s alphabet soup — Parts A, B, C and D: Parts A and B cover hospital, medical and provider expenses. Part C, known as Medicare Advantage, is another way of receiving your Medicare benefits. Part D is a Medicare prescription drug plan that can be enrolled in as a stand-alone plan with a Medicare supplement with original Medicare or bundled in a Medicare Advantage plan.

Medicare covers a lot: Part A covers inpatient hospital, skilled nursing facility care, home health and hospice care. Medicare Part B covers physicians’ services, outpatient surgery/services, lab/X-rays, MRIs, durable medical equipment, preventative services, etc.

Medicare doesn’t cover everything: Medical services not covered under Medicare include vision, hearing and dental expenses, as well as long-term care.

There’s no network with original Medicare (with Medicare supplement/Medigap): Your health care professional or facility bills Medicare directly.

Medicare Advantage may be a good option: Know that you can choose between original Medicare (Parts A and B) or Medicare Advantage plans offered by private insurance companies.

Medicare also serves people under 65: Those under 65 on Social Security disability or with end-stage renal disease qualify when they meet Medicare’s requirements.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.