Published on July 05, 2023

Medicare 101

If you are going to be new to Medicare, or even if you have had Medicare for awhile but you have some questions, there are some great resources through the Ohio Department of Insurance Ohio Senior Health Insurance Information Program (OSHIIP). 

When applying for Medicare you can accomplish a lot on the Social Security website www.ssa.gov/benefits/medicare, or you can contact the Social Security Office near you to make an appointment.  

You can also sign up for webinars to learn more https://register.gotowebinar.com/rt/3732369598404203024

Looking around www.medicare.gov is also a good idea, as is setting up a user name and password. 

Enrollment into Medicare is automatic if you get Social Security (SS) or Railroad Retirement (RR) benefits prior to Medicare eligibility.  If you are not getting SS or RR benefits already, you would need to apply for Medicare 3 months before your 65th birthday, the month of your 65th birthday or 3 months after your 65th birthday. 

You can delay signing up for Medicare A & B if you are covered under your (or your spouse’s) current employer group health plan (which does NOT include COBRA).   You can sign up for Part A & B while you’re still covered by your or your spouse’s group health plan, or you can wait to sign up during the 8 month period that begins the month after employment ends or the coverage ends, whichever happens first.

When signing up or reviewing your Medicare options, one of the first decisions you should make is how do you want to receive your Medicare benefits; there are two options.

Option 1 Includes

  • Medicare Part A (hospital, inpatient hospital, skilled nursing facility, home health care, hospice) and Medicare Part B (outpatient services, doctors/providers, preventive benefits, durable medical equipment)
  • Secondary Insurance (from a former employer or union), Medicaid, Medicare Supplemental plan (no network, private insurance that coordinates with Medicare)
  • Medicare Part D/Prescription Drug Coverage (offered by private companies that contract with Medicare)

 Option 2 – Medicare Advantage Plans

  • They are alternatives to Option 1/Original Medicare and are offered by private companies
  • Available to those who are enrolled in Medicare A & B and live within the plan’s service area
  • HMO & PPO Networks
  • Most plans have a Part D (prescription) benefit
  • Networks, premiums and co-pays vary from plan to plan

Some of the other questions you might want to look into are:

  • If you are going with Option 1, which category of supplemental plan do you want?  They are categorized by letter and each category covers different things.
  • If you are going with Option 1, be sure to have a Prescription Plan/Part D comparison done. You can enter your zip code and the medications you are on and www.medicare.gov with rank all the plans in your area from least to most expensive.
  • If you are going with Option 2, check with your doctor, specialists, hospital etc. to see what Medicare Advantage plans they take.
  • If you are going with Option 2, are there any limitations if you want to switch to Option 1 at some point.

 

During Open Enrollment, October 15 through December 7 each year, there are opportunities to change your plans, but there are varying deadlines and restrictions.

All of the options, and categories and deadlines can seem overwhelming at first.  That is why it is always a good idea to talk with OSHIIP, an OSHIIP volunteer in your community, or a trusted insurance agent to ensure you have all the information you need to make the right decision for you. 

You can reach OSHIIP at 1-800-686-1578 or go to  www.insurance.ohio.gov