Simplifying the Medicare Process

Q. I am a few months away from my 65th birthday, and I am aware that it is time to begin thinking about enrolling in Medicare. I started researching Medicare online, and I realized that enrollment is much more confusing than I anticipated. I’m not sure where to begin, who to contact, and which plan is best, and I would hate to make a costly misstep. Is this common and do you have any tips for people like me? Thanks!

A. Medicare Open Enrollment began a couple weeks ago and goes through 12/7/17. It’s a good idea to begin educating yourself about Medicare at least three or four months before you apply, as it seems you are already doing. Many who don’t do their research in advance find themselves quite confused when they are ready to enroll.

A recent analysis of AARP’s helpline data concurs with your experience that many people are struggling to navigate the complexities of the Medicare program and to afford their coverage. The report, “Medicare Trends and Recommendations: An Analysis of Call Data from the Medicare Rights Center’s National Helpline,” recommends laws requiring earlier and more detailed information to newly eligible Medicare beneficiaries, as well as other policy changes.

Below are some tips for finding your way through Medicare once you’re 65 or older. With a careful approach, you can become knowledgeable about Medicare and the rules and get all the benefits to which you’re entitled.

  1. Who to contact: Everyone signs up for Medicare through the Social Security Administration, and that agency will be your contact point for questions as well as your actual registration.
  2. When to start: You can begin the process of applying for Medicare up to three months before you turn 65. At that point, you can contact Social Security by phone, visit your local Social Security office or sign up for benefits online, depending on your preference.
  3. Which plans are available: The types of coverage you need to understand include: Part A (covering medical facilities); Part B (covering medical providers); Part C (Medicare Advantage plans, which mimic private insurance plans and function as an alternative to a Part A/Part B package); and Part D (prescription drug plans).
  4. What does the terminology mean? The government’s website is a good place to start. has a primer or you can watch a six-minute video by a Medicare trainer on Parts A and B.
  5. Find someone to assist you with your research (if you think that would help). A trusted family member or friend might be of assistance, especially if he or she is someone who’s already dealt with Medicare and health insurance issues. He or she could be a good resource if you feel confused or intimidated by Medicare’s lingo and long list of regulations. If you’re a Virginia resident, no-cost insurance counseling assistance is available through the Virginia Insurance Counseling and Assistance Program (VICAP). To get in touch with a VICAP counselor in your area, contact your local Area Agency on Aging (AAA); you can find your local office here. If you’re a Maryland resident, the same service is available through the Maryland State Health Insurance Assistance Program (SHIP); can find a local counselor here. DC residents can make use of the George Washington University Health Insurance Counseling Project by calling (202) 994-6272.
  6. Call Social Security with any specific Medicare questions. If there is something you don’t understand or if you are unsure how the rules would affect you, you can also call Social Security and ask. Stay on the line until all your questions have been answered and all your doubts erased. The phone number is 800-772-1213. Similar to other government offices, Social Security can be difficult to reach. Be sure to pick the right time to call so you can avoid long delays. The busiest times for Social Security (and the hardest times to get through) are on Mondays, Fridays, early in the morning and on, or near, the first of the month. The best time to call for information or to let Social Security know about your Medicare plans is from Tuesday through Thursday, preferably between 10 a.m. and 3 pm Eastern Time. If you do get put on hold during those times, it shouldn’t be for long.
  7. Don’t stress yourself out. Applying for Medicare coverage and benefits is not as scary or difficult as you think. Despite the bureaucracy and confusing terminology, there is a logical, rational system that can be understood once you’ve done your research, asked questions, and asked for assistance (if needed) to get a better understanding.

A couple important things to understand

You mentioned costly missteps in your question. Below are some mistakes that others have made that you should try to avoid or they could become costly:

  • People who fail to enroll in Medicare Part B when they first should will face lifetime penalties, a coverage gap and disruptions in care. The penalty is hefty: an extra 10% for each full year you could have had Part B but didn’t apply and were not covered beyond 65 by health insurance from a current employer.
  • If you have primary coverage through a current employer (your own or your spouse’s), you can delay Part B without penalty until the job ends. If your coverage is from a small employer (fewer than 20 employees) or a former employer, find out how it works with Medicare. Check out the AARP article “Medicare When Working Beyond 65” to avoid complex problems that can arise in coordinating Part B and an employer’s plan.
  • Medicare doesn’t cover everything. Decide whether traditional (also called original) Medicare and a supplement Medigap plan or a Medicare Advantage plan, which combines Medigap and prescription coverage, is best for you. Learn more about Medicare Advantage plans and search for a Medigap plan here.

Remember, No Matter What Plan You Choose, Medicare Doesn’t Pay a Penny for Long-Term Care

Medicare and private health insurance ONLY pay for short-term therapy and skilled care in a nursing home for up to 100 days; they don’t pay for long-term care. For long-term care, the main government benefit is Medicaid, but medicaid laws are the most complex laws in existence! There are strict financial requirements that must be met in order to qualify for Medicaid, including the requirement of having less than $2,000 of countable assets to your name. However, with proper Medicaid asset protection planning, almost everyone can qualify for Medicaid when needed, without having to be broke or to first spend down your life savings. If you or a loved one is nearing the need for long-term care or already receiving long-term care, please call us to make an appointment for a no-cost initial consultation:

Fairfax Medicaid Planning: 703-691-1888
Fredericksburg Medicaid Planning: 540-479-1435
Rockville Medicaid Planning: 301-519-8041
DC Medicaid Planning: 202-587-2797

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