What Older Adults Need to Know About Medicare
Why Pre-Planning Is Essential
Here is one topic that is not likely to come up at the holiday dinner table: Medicare. For many, understanding and navigating Medicare can feel confusing and overwhelming. However, we believe it is so important for all older adults to feel comfortable and confident discussing their Medicare eligibility and electing a plan that is right for them—at the right time.
McGregor PACE is here to help you in any way we can, starting with dispelling some of the most common myths and misunderstandings about Medicare.
Myth: Medicare covers all of your expenses.
Medicare is not a free service. While Original Medicare covers a portion of costs, you pay the premiums, deductibles, coinsurance, and copays. There is no limit on the amount you pay for out-of-pocket costs in a year and no coverage for annual hearing or eye exams. For this reason, many people choose to enroll in a Medicare Advantage plan. This can help provide coverage for services that Original Medicare does not cover and keep your costs lower.
For more information, see this comparison of Original Medicare vs. Medicare Advantage.
Myth: You are automatically enrolled in Medicare at a certain age.
You do not automatically become enrolled in Medicare. You must enroll through the Social Security office. One exception, as detailed by Medicare:
“When you apply for retirement or disability benefits from Social Security (or the Railroad Retirement Board), it also serves as your application for Medicare. Once you get approved for Social Security or Railroad Retirement Board benefits, you’ll automatically get Part A coverage (without having to pay a premium for it) once you’re available for Medicare.”
Myth: You must apply for Medicare when you turn 65.
If you work past the age of 65, and receive benefits through your employer, you likely don’t need Medicare yet. You can defer your Medicare application until you retire or your current health care coverage through your employer expires.
Myth: You can be enrolled in Medicare through your spouse.
This is not the case. Medicare is not like the health insurance benefits you receive through an employer. You cannot receive Medicare coverage through your spouse.
Myth: Medicare will tell me when it is time to enroll.
You need to sign up for Medicare on your own. The timing depends on your unique situation. Again, you may not need to enroll in Medicare right when you turn 65. There are also some unique circumstances that could give you eligibility to enroll in Medicare before you turn 65. You must do your research and understand what timing is best for you.
Determining Your Medicare Eligibility
Where Do You Start?
Many seniors reach retirement age without doing adequate planning for their future—including gaining a knowledge and understanding of Medicare and their eligibility. There is no “one size fits all” process for determining your eligibility and enrolling in Medicare. So much depends on your unique circumstances, including your employment status, the benefits you may or may not receive from your employer, and your health care needs.
If you have questions about Medicare, we will do our best to answer them. You can reference the resources below from Medicare.gov:
We also highly recommend speaking with a local Medicare consultant, like KAZ Company, as they specialize in Medicare enrollment and can help you navigate your specific situation, whether you are looking for coverage for yourself, a parent, or a loved one.