San Diego Medicare 101
Joining Medicare, can be overwhelming! With all of the plans, companies, what Medicare itself covers and what you have to pay, most if not everyone needs help. I believe the best to way to tackle Medicare is to be informed of all the parts and options, then you can make an educated decision on what fits your lifestyle and needs best. What works for Cousin Julie may or may not work well for you. This page, San Diego Medicare 101 is dedicated to educate you on the parts covered by Medicare and goes over those details. Take a read, watch the videos and if you have any questions, Contact me, I’m here to help!
Signing up for Medicare
Let’s start with the basics, if you are already collecting Social Security, when you’re getting close to age 65, you will get your Medicare Card about 3 months before the month of your 65th Birthday.
It will have both Part A & Part B on it with an effective date, usually the 1st day of the Month of your Birthday. There is a Medicare Number which is automatically generated by Medicare, that number is unique to you, just like a Social Security number.
If you are NOT collecting Social Security, you will have to request your Part B to become effective. Part A, will be automatically effective on the 1st day of the Month of your Birthday.
There are a few ways to sign up for Part B. You can go into your local Social Security office and fill and they will be happy to help you. Here is a link to their Office Finder. You can also call Social Security at 1-800-772-1213 and request Part B. Lastly, you can go online and fill out the form electronically. Here is the link to fill out Part B online. Toward the bottom of that page, click the “Apply for Medicare Only” button and it’s pretty straightforward from there.
Keep in mind that you MUST have a Part B effective to sign up for any Medicare insurance. Also, if you are going to keep working and have employer provided coverage, you don’t HAVE to join Medicare, although sometimes it is the best move, depending on the situation. You can read more about that situation on our Blog posts.
Medicare Part A
Medicare Part A is considered Hospital Insurance. This part of Medicare is “Free” for most people because as a working person, you have been paying into the Medicare system through your working years. You have to have worked and paid into the system for 40 quarters in order to qualify for Part A with no extra cost. If you did not work this amount of time, and you do not qualify for spousal Medicare benefits, you will have to pay a premium.
Part A covers:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
- Hospice care
- Home health care
There are co pays and deductibles to be aware of if you do not have other insurance involved which most folks do either through work, Medicare Supplement or Medicare Advantage Plan.
Medicare Part B
Part B of Medicare does have an extra premium. For most people joining Medicare this year, 2023 the monthly premium is $164.90. It was actually lowered this year! It can be more or less depending on your income. If you make under a certain amount of money, the State will pay for either all or part of your Part B.
If you are a higher income earner, you will have to pay more. This is called IRMAA, Income Related Monthly Adjustment Amount. This is calculated on your income 2 years ago. To start, if your income was over $98,000 an an individual filer or if you filed jointly and it was over $195,000, you will pay more. This amount is adjusted yearly so as your income drops, so will your premium. You can read more about IRMAA Here on the Medicare website or HERE on our blog.
Part B of Medicare is considered Dr. Insurance and covers
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health
- Partial hospitalization
- Limited outpatient prescription drugs
You pay nothing for most preventive services if you get the services from a health care provider who accepts Medicare Assignment.
Again, if you have no other insurance, you can expect co pays and deductibles with no cap!!
Medicare Part C
In this part of San Diego Medicare 101, we’ll go over Medicare Part C, also known as Medicare Advantage are offered from private insurance companies. Every plan must offer the basic benefits of Part A and Part B along with the 20% not covered by Medicare. Most of these plans also come with prescription coverage and extra benefits like hearing, vision, gym memberships and more!
In San Diego there are many plans to choose from, most are HMO’s and there are a few PPO’s as well. In picking a plan that may be a good fit you have to consider several things. Namely:
- Doctors in Network
- Co pays
- Prescription coverage
- maximum out of pocket costs
- extra benefits like Hearing, Vision & Dental
- and more!
We assist folks in finding a plan that will work for them! You can read more about Medicare Advantage on our page dedicated to them HERE!
Medicare Part D
Medicare Part D plans cover your prescriptions only. Unlike Medicare Part C which combines your Health coverage and Medications.
There are different tiers for different medications and co-pays, deductibles, coverage gaps and more that you should be aware of.
The most important thing to know is that you will need one of these plans if you choose to go with a Medicare Supplement Plan for your Health care coverage. The most appropriate plan will take into account the Medications you take and the Pharmacy you prefer. There are over 30 plans to choose from so it’s easy to get confused!
These plans change annually so it is important to review the plan changes and make sure they don’t affect you negatively in the coming year. If you would like help picking a plan or would like a complementary review of your current plan, Contact us, we’re happy to help and like all of our services, there are no fees or charges!!