Adjusting to Medicare

Sometimes migraine or other headache disorders become so severe that we are unable to work. Some of us must make the painful decision to apply for disability benefits. Those benefits may come from private insurance or from Social Security. When the benefits are from Social Security, recipients also qualify for Medicare after 2 years.

For some, especially those without health insurance, the wait to finally get coverage can feel like an eternity.  Others find that the time flies. When the letter with that enclosed red, white, and blue card finally arrives, it can trigger a lot of different emotions. In my case, it took about 30 seconds to go from surprise, relief, confusion, and feeling completely overwhelmed.

Medicare basics

New recipients have 30 days from the date of eligibility to choose from many options. Luckily, the letter arrived 90 days before the date of eligibility.  That gave me plenty of time to familiarize myself with the Medicare website and make my choices.  It took many hours.

There are three parts to a Medicare plan:
Part A – Hospital, nursing home, hospice, and home health care
Part B – Preventive services, doctor visits, surgery, medical equipment, mental health,
Part D – Prescription medications

Medicare basics

I was surprised to learn that there are a lot of preventive services that are covered 100%. Plus, all yearly physicals and vaccines are covered 100%. There is generally no premium or deductible for Part A coverage, but there are co-pays and co-insurance costs. Most of these services are covered 80%. The base premium for Part B coverage is $104.90 with a $147.00 annual deductible.

That’s why it’s important to find a Medicare Supplement or Advantage plan. You can find plans that cover both Part D prescriptions and services not covered by Medicare. Some of these plans act like a typical 80/20 plan while others cover 100% after deductible. Of course, the greater the coverage, the higher the price will be. Premiums and deductibles for Supplement or Advantage plans vary widely with the level of coverage.

If your income is limited, you may be able to get help paying for the costs not covered by Medicare. There are tools on Medicare’s website that will help you find federal, state, and private resources.

It is important to pay attention to the open enrollment deadlines. If you do not choose a plan by the deadline, you will be enrolled in traditional Medicare with no prescription medication coverage.  That could end up costing you a lot of money.

My experience

I took a lot of time using the Medicare Plan Finder tool. It allowed me to enter all my doctors and prescription medications. I was able to compare only those plans that covered what I needed. I could compare premiums, co-pays, and medication costs to find the plan that best suited my needs.

Because I am tech savvy, these tools were easy to use.  The website is well-organized and easy to navigate. However, I can understand how someone with limited computer skills might have a lot of trouble.  There’s just a lot of information to sift through.

My assessment

In the long run, I’ve had a positive experience transitioning to Medicare.  Before Medicare, I had to purchase an individual plan. The premium was expensive and the company was difficult to work with. It wasn’t always clear what was covered and what wasn’t. Now with my Medicare Advantage plan, I can know exactly what my costs are going to be in advance. There are no more surprises at the pharmacy counter.  I can call or check the website to verify coverage before any procedure. Plus, I have a lot of perks not available with my other plan.  A monthly stipend for OTC medications and free access to a health coach are just two of my favorites. Overall, it’s been a positive change that I believe will help me stay as healthy as possible.



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