Medicare and You

(This article first appeared in the January/February 2020 issue of the American Postal Worker magazine) 

Medicare is health insurance for people 65 and older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease.

What is Original Medicare?

Medicare Part A and Part B is referred to as “original” Medicare.

Medicare Part A is hospital insurance. It covers inpatient care in hospitals; it also includes coverage in critical access hospitals and skilled nursing facilities. It covers hospice care and home health care, though you must meet certain conditions to get these benefits. Medicare Part A is free for most people.

Medicare Part B is medical insurance. It covers medically necessary services like doctor’s visits, outpatient care, and other medical services that Part A doesn’t cover, such as lab work and durable medical equipment. Part B also covers many preventive services. Medicare Part B has a standard monthly premium for most people. The 2020 Part B premium is $144.60. People with higher incomes may pay a higher premium.

Original Medicare has deductibles for inpatient hospital stays, medical coverage and coinsurance. Medicare usually pays 80 percent of the Medicare-approved amount for medically-necessary care. The coinsurance is usually 20 percent of the Medicare-approved amount. Original Medicare does not pay for prescription drugs, long-term care, routine dental services, routine vision care, and other services.

Most postal and federal retirees also keep their Federal Employees Health Benefit Plan (FEHB) which covers the co-pays and deductibles that Medicare Parts A and B doesn’t cover. Medicare Parts A and B along with your FEHB plan should keep most out-of-pocket medical costs down.

When Can You Enroll in Medicare Part A and Part B?

There are three (3) possible enrollment periods for Medicare A and B: the Initial Enrollment Period, General Enrollment Period and Special Enrollment Period.

Medicare Initial Enrollment Period (IEP)

If you get Social Security retirement or disability benefits before age 65, the Social Security Administration will automatically enroll you in Medicare Parts A and B the month you turn 65. You’ll get a “Welcome to Medicare” booklet and your Medicare card about 3 months before your 65th birthday.

If you aren’t getting Social Security benefits or Railroad Retirement benefits you will need to enroll in Medicare Parts A and B during your Initial Enrollment Period. This is the period during the seven months surrounding the month you turn 65, when you’re first eligible for Medicare. This period begins 3 months before the month you turn 65, it includes the month you turn 65 and ends 3 months after the month you turn 65.

Medicare General Enrollment Period (GEP)

The General Enrollment Period is the time period from January to March 31 of every year when you can enroll in Medicare Part B for the first time.

If you enroll during the General Enrollment Period your Medicare Part A and B coverage will begin on July 1. In most cases, you’ll have to pay a late enrollment penalty.

Medicare Special Enrollment Period (SEP)

If you are turning 65 or over 65 and you or your spouse is still working and covered by an employer or union group health plan through your or your spouse’s current or active employment, you can enroll in Medicare Part A and B during the Special Enrollment Period. There is usually no late enrollment penalty.

This is the eight (8) month period from the month you retire or the employer/union group health plan ends to enroll in Medicare Parts A and B. There are other circumstances that will allow you to enroll in Medicare Parts A and B during the Special Enrollment Period.

For additional information, contact the Social Security Administration at 1-800-772-1213 or visit your local Social Security office. You may also go online at socialsecurity.gov.