When you apply at 65 there is no pre existing condition disqualification as long as the insured chooses a plan at that time.
The application will ask you about certain health issues but they are required to accept the applicant regardless.
If you wait then the rules are very strict if not impossible if you have any of the conditions in the first group of conditions they take you through and then if you answer to the positive on the second group they will insure you at a premium cost. Some of these questions reach back five years.
They don’t want you if you have these problems at 65 but they don’t have a choice. If you develop them and then apply they will either refuse to take your business or they will charge you a lot more.
Please think long and hard about what you need more than good health insurance going into your senior years.
We just do not know, our crystal balls don’t advise us, as to when we will develop one of these issues that given a choice a company won’t insure.
This is great info EXCEPT there are a few states where they can't refuse you later for a pre-existing condition. NY is one but I don't remember the rest of them. You are right it is super important!
I believe there is some incomplete info in some of these replies. The period of time to sign up for Medicare when you are turning 65 is your birthday month and 3 months before and after that month ( 7 months total). If you sign up for original Medicare you will probably want a supplemental insurance policy (Medigap) at the same time. I don't think there is an exclusion for underwriting due to pre-existing conditions. I believe that does kick in if you first sign up for a Medicare Advantage plan and then switch to original Medicare with a Medigap policy. If anyone has access to Sirius XM Radio on Channel 110 they have Doctor Radio broadcast from NYU in New York. One of their shows is ALL about medical insurance and they answer questions live and from emails. The live show is repeated several times during the week. Excellent source of information. They answer these Medicare questions endlessly, every show. The Medicare covered population is split just about 50/50 between people who have original Medicare ( with a supplemental policy and Part D for drugs) and the other half who sign up for a Medicare Advantage (aka Part C) program. Your situation, your choice.
Most people who stick with Original Medicare (i.e. not an Advantage Plan) get what's called a "MediGap" insurance plan or "Supplemental Insurance." (From what I've read, some people's former employers will pay for this). This, in principle, covers the 20% that you are "out of pocket" for, for your medical bills. (With Medicare, it's an 80%/20% split, with Medicare paying the 80%). But what a lot of people don't know or didn't know (in my case) is that there is a "qualifier" for these plans: "Pre-existing conditions" may apply which can disqualify you from getting a Medigap/Supplemental Insurance. (If they allow it, you might be able to do "underwriting" but some plans won't even allow that, depending on what your "pre-existing condition" is.) But here's the most important thing with getting a Supplemental Plan. There's a very, very short "window" when you first start getting Medicare, when you can get one of the Supplement Plans without a check on any pre-existing condition by the insurer -- it's very short, something like 3 months. (I believe there's a law about this).
All of the above, is not based on my experience -- I don't have a Supplement Plan but I wish I did. You have to do your own research, but be especially aware of the short "window" referred to above for the Medigap/Supplement Insurance if you're going to stick with Original Medicare (not an Advantage Plan). Then, of course, you have to do your research/get help finding correct information on the best Medigap/Supplement insurance carriers. There can be a fairly steep learning curve in all of this so it's best to get started early.
This is very important. Also it varies by state. In NY and a couple of other states, the supplemental plans are NOT allowed to reject you because of pre-existing conditions. Elsewhere, they are allowed to, except as noted on initial sign-up.
This is hugely important because you will be solicited by Advantage plan sales people, who will tell you that you can always switch to regular Medicare down the road if you want to, That is true, BUT you might we not be able to get the supplemental plan you need "down the road." This is a big important fact and an important thing to ask for.
Many Advantage plan salespeople are devious as to what they tell you. If one of them tells you what I just said -- you can switch down the road -- I would never do business with them.
It’s extremely important that your mother signs up for Medicare three months before she turns 65 years of age. If your mother does not sign up for Medicare at 65 years of age she will incur a penalty from Medicare.
You need to go to Medicare.gov to sign up for your mother and get all of the information you need about Medicare.
Also, I live in New Jersey and I have a Medicare Advantage plan and I love, love, love it. This Advantage plan comes with lots and lots of perks like $70 every three months to purchase OTC products. It also includes dental service, fitness benefit, flex benefits of $275 for acupuncture, weight management program, nutritional/dietary benefit, therapeutic massage, bathroom safety devices, additional hours of in-home support services, health-related transportation, outpatient diagnostic tests and therapeutic services, and much, much more. Also, if you are elderly with a chronic condition like heart disease, diabetes, etc, they give you $75 every three months to purchase fruits and vegetables. The Advantage plan that I have gives me the opportunity to select either a PPO or a HMO. I do not have to pay any co-payment when I go to my PCP, but I only pay $25 co-pay for any specialist’s visit. Before I found this Medicare Advantage plan, I did a lot of research on the internet to see which was the best Medicare Advantage plan for me and the plan I have now fits my needs.
Your can do research on the internet to see which Medicare Advantage plan will be suitable for your mother’s needs then give them a call and they will explain everything to you.
FWIW It is beyond mucho importante that you sign up for MediCARE at age 65 - EVEN IF - you do not activate it. Like you still have employer sponsored health insurance coverage. You will get the Medicare Part A card & it is “in force” even though it may not necessarily be used as you have employer sponsored coverage.
If you don’t do this, you will have a penalty attached to your Medicare later on in the form of a premium to Part A, which is usually free for like 95++% of us and additional cost to the Part B premium. This is what Barb posted about. It’s permanent!
IRS Form 1095-C Employer Sponsored Health Insurance should be provided to you for every tax year from your employer. This proves you had a fully comparable health insurance to Medicare for every year once age 65. And when you finally do fully activate MediCARE, they may ask for these otherwise the penalty can get affixed. 1095-C should have the names and last 4 SS# on everyone covered under the employer policy and if fully covered all 12 months.
Also personally I would never ever, like no way, do a Medicare Advantage plan. At least for where I live, Advantage Plans are not at all in a competitive marketplace, so they are very narrow on providers & clinics. The whole “in network” requirement on Advantage is waaaay restrictive if you do any degree of travel or find yourself with needing complex care (so need to see several actual specialists and sub-specialists). Advantage needs to run on least costly care which overwhelmingly means Family Medicine docs & NPs - which can be fine - but are no substitute for a Rheumatologist, Endocrinologist or an actual Internal Medicine doc as your PNP if ya need that level of diagnostic care. Unless you’re in a big big city over 1M with lots of competition, Advantage Plans are shite, imho. Plus when ya finally fit that eventuality of needing a facility Advantage plans won’t carry over into NH. So you if you’re still cognizant enough or your kids - if you’re not - end up having to deal with getting out of the Medicare Advantage maze.
Thank you for the detailed explanation. I be waiting on hold for awhile, but I am calling SS and Medicare next week. I turn 65 next month and am still working. By the way, I like airline gift cards, 27 year old scotch, and fishing gear. :)
There are people specially trained to help people select the "package" (or no added supplemental options) Called SHIP counselors (Senior Health Insurance Program)It might be worth your time to talk to them They are not "beholden" to any company so they should give you the options that are best for your mom. Search SHIP counselor and then your State. I am surprised that she is not getting 1000 phone calls a day and your mailbox is not overflowing with cards and letters. (some looking very official)
Start with the Medicare website. It will tell you what you need to know.
As to supplemental there are many different types of insurance. In some you can only see certain doctors and go to certain hospital systems. On others (read more expensive) you can go to any doctor and any hospital. It is an education in and of itself. Start once again, on the web with supplemental insurance.
AARP and others will have good information to help as well.
If you have regular Medicare (not an Advantage plan), you need an additional supplemental policy. The supplemental policies, alss called Medigap, do NOT restrict you as to what doctors and hospitals are covered. For any doctor or hospital that accepts Medicare, your supplemental insurance will also be in effect. They vary as to how much they pay and things like that.
If you choose an Advantage plan, you are definitely restricted about where you can go for health care. An Advantage plan is a totally different thing from a supplemental plan that goes with regular Medicare.
My Medicare was automatic because I was receiving Social Security. The card came with parts A&B. B has a premium and that comes out of my SS payment. My supplement is provided by my retired husbands employer.
Is Mom working? If not, her SS has nothing to do with how much she brings in. Is she divorced, widowed? Age 67 is probably where Mom would receive 100% but she can receive SS anytime after 62, widows 60. She will get a % if collecting at 65.
Call your Office of Aging. Ask if you can sit down with them. They usually have a handle on what supplementals are available in your State and the best one for Mom.
Be careful when it comes to Medicare Advantages. Medicare contracts out to these insurance companies. They are suppose to abide by parts A&B but don't. Sometimes its a fight. Also, Medicare you can go to any doctor who accepts it. MAs are network, meaning u use their doctors. So make sure the doctor Mom uses, accepts that insurance.
Office of Aging should be good at explaining this all to you and pointing u in the right direction.
Its that if she is still working, her SS benefit will be reduced according to a formula. SS is a benefit she has earned.
If she has employee health insurance, she should check with her HR department about whether she needs to take Medicare part B. It is VERY important to get this right; there is a LIFETIME penalty if you don't take Part B at 65, unless you can show that you have comparable employee coverage.
Medicare for Dummies is a great book. Read it to understand the instructions and outs.
opensocialsecurity.com is a free online calculator that tells you your best SS claiming strategy.
www.bogleheads.org is the best site for good financial advice.
She is not drawing yet because she still works and I believe makes "too much" We are currently working on a plan to help her move out, but with rent prices so high it is difficult and quite stressful. She's still healthy and I'd like to have her on her own for a few years before I have to take her in permanently.
There are Medicare insurance agents that will be free. She can enroll 4 months ahead of her birthday. You can go to Medicare.gov to view plans. Sign on as a guest, and plug in her zip code and prescription meds if asked.
MedicAID is for people with low income.
Care is for the old
Aid is for the poor.
Badly named, too alike.
When you apply at 65 there is no pre existing condition disqualification as long as the insured chooses a plan at that time.
The application will ask you about certain health issues but they are required to accept the applicant regardless.
If you wait then the rules are very strict if not impossible if you have any of the conditions in the first group of conditions they take you through and then if you answer to the positive on the second group they will insure you at a premium cost. Some of these questions reach back five years.
They don’t want you if you have these problems at 65 but they don’t have a choice.
If you develop them and then apply they will either refuse to take your business or they will charge you a lot more.
Please think long and hard about what you need more than good health insurance going into your senior years.
We just do not know, our crystal balls don’t advise us, as to when we will develop one of these issues that given a choice a company won’t insure.
Medicare.gov is where you go to learn about the benefits or compare plans.
All of the above, is not based on my experience -- I don't have a Supplement Plan but I wish I did. You have to do your own research, but be especially aware of the short "window" referred to above for the Medigap/Supplement Insurance if you're going to stick with Original Medicare (not an Advantage Plan). Then, of course, you have to do your research/get help finding correct information on the best Medigap/Supplement insurance carriers. There can be a fairly steep learning curve in all of this so it's best to get started early.
Good luck.
This is hugely important because you will be solicited by Advantage plan sales people, who will tell you that you can always switch to regular Medicare down the road if you want to, That is true, BUT you might we not be able to get the supplemental plan you need "down the road." This is a big important fact and an important thing to ask for.
Many Advantage plan salespeople are devious as to what they tell you. If one of them tells you what I just said -- you can switch down the road -- I would never do business with them.
You need to go to Medicare.gov to sign up for your mother and get all of the information you need about Medicare.
Also, I live in New Jersey and I have a Medicare Advantage plan and I love, love, love it. This Advantage plan comes with lots and lots of perks like $70 every three months to purchase OTC products. It also includes dental service, fitness benefit, flex benefits of $275 for acupuncture, weight management program, nutritional/dietary benefit, therapeutic massage, bathroom safety devices, additional hours of in-home support services, health-related transportation, outpatient diagnostic tests and therapeutic services, and much, much more. Also, if you are elderly with a chronic condition like heart disease, diabetes, etc, they give you $75 every three months to purchase fruits and vegetables. The Advantage plan that I have gives me the opportunity to select either a PPO or a HMO. I do not have to pay any co-payment when I go to my PCP, but I only pay $25 co-pay for any specialist’s visit. Before I found this Medicare Advantage plan, I did a lot of research on the internet to see which was the best Medicare Advantage plan for me and the plan I have now fits my needs.
Your can do research on the internet to see which Medicare Advantage plan will be suitable for your mother’s needs then give them a call and they will explain everything to you.
If you don’t do this, you will have a penalty attached to your Medicare later on in the form of a premium to Part A, which is usually free for like 95++% of us and additional cost to the Part B premium. This is what Barb posted about. It’s permanent!
IRS Form 1095-C Employer Sponsored Health Insurance should be provided to you for every tax year from your employer. This proves you had a fully comparable health insurance to Medicare for every year once age 65. And when you finally do fully activate MediCARE, they may ask for these otherwise the penalty can get affixed. 1095-C should have the names and last 4 SS# on everyone covered under the employer policy and if fully covered all 12 months.
Also personally I would never ever, like no way, do a Medicare Advantage plan. At least for where I live, Advantage Plans are not at all in a competitive marketplace, so they are very narrow on providers & clinics. The whole “in network” requirement on Advantage is waaaay restrictive if you do any degree of travel or find yourself with needing complex care (so need to see several actual specialists and sub-specialists). Advantage needs to run on least costly care which overwhelmingly means Family Medicine docs & NPs - which can be fine - but are no substitute for a Rheumatologist, Endocrinologist or an actual Internal Medicine doc as your PNP if ya need that level of diagnostic care. Unless you’re in a big big city over 1M with lots of competition, Advantage Plans are shite, imho.
Plus when ya finally fit that eventuality of needing a facility Advantage plans won’t carry over into NH. So you if you’re still cognizant enough or your kids - if you’re not - end up having to deal with getting out of the Medicare Advantage maze.
I turn 65 next month and am still working.
By the way, I like airline gift cards, 27 year old scotch, and fishing gear. :)
Search SHIP counselor and then your State.
I am surprised that she is not getting 1000 phone calls a day and your mailbox is not overflowing with cards and letters. (some looking very official)
https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship
As to supplemental there are many different types of insurance. In some you can only see certain doctors and go to certain hospital systems. On others (read more expensive) you can go to any doctor and any hospital. It is an education in and of itself. Start once again, on the web with supplemental insurance.
AARP and others will have good information to help as well.
This isn't easy. I wish you luck.
If you have regular Medicare (not an Advantage plan), you need an additional supplemental policy. The supplemental policies, alss called Medigap, do NOT restrict you as to what doctors and hospitals are covered. For any doctor or hospital that accepts Medicare, your supplemental insurance will also be in effect. They vary as to how much they pay and things like that.
If you choose an Advantage plan, you are definitely restricted about where you can go for health care. An Advantage plan is a totally different thing from a supplemental plan that goes with regular Medicare.
Is Mom working? If not, her SS has nothing to do with how much she brings in. Is she divorced, widowed? Age 67 is probably where Mom would receive 100% but she can receive SS anytime after 62, widows 60. She will get a % if collecting at 65.
Call your Office of Aging. Ask if you can sit down with them. They usually have a handle on what supplementals are available in your State and the best one for Mom.
Be careful when it comes to Medicare Advantages. Medicare contracts out to these insurance companies. They are suppose to abide by parts A&B but don't. Sometimes its a fight. Also, Medicare you can go to any doctor who accepts it. MAs are network, meaning u use their doctors. So make sure the doctor Mom uses, accepts that insurance.
Office of Aging should be good at explaining this all to you and pointing u in the right direction.
Its that if she is still working, her SS benefit will be reduced according to a formula. SS is a benefit she has earned.
If she has employee health insurance, she should check with her HR department about whether she needs to take Medicare part B. It is VERY important to get this right; there is a LIFETIME penalty if you don't take Part B at 65, unless you can show that you have comparable employee coverage.
Medicare for Dummies is a great book. Read it to understand the instructions and outs.
opensocialsecurity.com is a free online calculator that tells you your best SS claiming strategy.
www.bogleheads.org is the best site for good financial advice.
Is she already drawing Social Security benefits?