Turning 65 & Medicare in Nevada

Diving into the world of Medicare can often feel like navigating a vast sea of information, where distinguishing between helpful guidance and mere noise becomes a daunting task. With so much information at our fingertips, it's easy to feel overwhelmed. But fear not! My aim is to be your beacon through the fog, providing clear, simple steps that you can take right now to make this journey less intimidating.

Embarking on your Medicare adventure is less about memorizing every detail and more about following a set of clear, actionable steps designed to steer you towards your goals. It's about making the complex simple and the overwhelming manageable.

New-to-Medicare: 12-Step Checklist

1. Choose between navigating Medicare independently or seeking professional help
2. Verify your eligibility for Medicare
3. Evaluate your intention to work after age 65 and its impact on Medicare
4. Identify whether you'll be automatically enrolled in Medicare
5. Confirm receipt of your Welcome to Medicare package and Medicare card
6. Explore your eligibility for any government assistance programs
7. Select your preferred enrollment path into Medicare
8. Analyze the impact of Medicare costs on your monthly budget
9. Assess how Medicare integrates with your current providers and prescriptions
10. Determine the optimal time and method for your Medicare enrollment
11. Schedule a yearly session to review and adjust your Medicare plan as needed
12. Implement strategies to minimize unwanted Medicare-related calls

Let's embark on this journey together, transforming the way you view and manage your Medicare experience with clarity and confidence.

What is Medicare?

Before we dive deeper, let's clarify what Medicare is and how it's structured. Given its complexity, I'll guide you through its various components throughout this guide.

Remember, Medicare comes with its nuances, and there might be exceptions to the general rules based on specific situations.

Step 1: Choose between navigating Medicare independently or seeking professional help

Everyone's approach to learning and handling new information differs. Some prefer to dive deep, mastering every detail with full control over their decisions. Others find peace of mind in tapping their support resources who can guide them through the maze.

For the DIY enthusiasts, your first port of call is the Medicare & You guide. Think of it as your comprehensive map to everything Medicare.

If professional guidance sounds more your speed, connecting with a licensed insurance agent who focuses on Medicare could be your best move. These agents, like myself, offer their support at no extra cost to you, simplifying your journey into Medicare. They're compensated by insurance carriers, meaning you get personalized advice without any added expense.

Drawing from my experience assisting numerous Medicare beneficiaries, I've noticed that those who navigate alone often miss out on valuable insights and support. Partnering with a trusted agent from the start can smooth out your path considerably.

And if you're in Nevada, consider me your local guide through the Medicare landscape.

Step 2: Verify your eligibility for Medicare

Turning 65 typically marks your entry into Medicare, but there are exceptions. Individuals with certain disabilities or medical conditions, like ESRD or ALS, may qualify earlier.

Rather than read through all the eligibilty requirements, you can use the eligibility calculator on the Medicare website to quickly review eligibility conditions.

In addition, you can also login to the Social Security Administration website and view your benefit vericiation letter to view the status of your Medicare eligibility.

Step 3: Evaluate your intention to work after age 65 and its impact on Medicare

If you plan to still work past the age of 65, you two options:

Option 1: You can delay your Medicare Part B and/or Part D enrollment when you are covered by an employer group health plan that offers coverage that is equivalent or better than Medicare coverage. However, if you work for a really small employer, see option 2.

Some people will delay enrollment to save the Part B and/or Part D premiums, if they feel their employer group coverage is adequate.

However, when you lose that coverage from your employer (e.g. retirement), you will want to work quickly to get enrolled in Medicare so you are not assed a late enrollment penalty.

For more information, check out the Enrolling in Medicare Part & Part B from Medicare.

Option 2: You can enroll in Medicare, even if you have group coverage from your employer. However, you will want to ask your HR department how your plan worrks with Medicare.

If you are working for an employer with more than 20 employees, your employer group coverage will be the primary payer, and your Medicare will be the secondary payer.

If you are working for an employer with fewer than 20 employees, your Medicare will be the primary payer, and your employer coverage will be the seconary payer. In this scenario, you need to enroll in Medicare, and then you can decide if you want to keep your group coverage or not.

For more information, check out Your Guide to Who Pays First from Medicare.

Step 4: Identify whether you'll be automatically enrolled in Medicare

If you are already claiming Social Security retirement benefits prior to turning 65, you will automatically enrolled in Medicare Part A and Part B.

If you are not claiming Social Security retirement benefits when you turn 65, you will not be automtically enrolled in Part A and Part B. You will need to make a decision to enroll or to delay enrollment if you are still working with group health coverage.

For more information, check out the Enrolling in Medicare Part & Part B from Medicare.

Step 5: Confirm receipt of your Welcome to Medicare package and Medicare card

If you are getting Social Security retirement benefits before you turn 65, you will get a Medicare Welcome package (automatically enrolled) 3 months prior to your 65th birthday that will include your red-white-blue Medicare card.

If you were not automatically enrolled, then you will receive the Medicare Welcome package (not automatically enrolled) about 2 weeks after you sign up for Medicare & Social Security beneifts.

If you haven't started getting benefits from Social Security when you enroll in Medicare, then Medicare will send you a premium bill in the mail to pay for your premiums.

If you are missing your welcome package and/or Medicare card, call 1-800-MEDICARE. If you need your Medicare ID number and effective dates to enroll in a plan before the replacement card arrives, you can get that information by logging into ssa.gov and reviewing the benefits verification letter.

Step 6: Explore your eligibility for any government assistance programs

There are several programs to help you pay for your healthcare costs once you become eligible for Medicare, if your income and resources are below a certain threshold.

• Extra Help (help with prescription drug costs)
• Medicare Savings Program (may include Part A premiums, Part B premiums, deductibles, coinsurance, and copays)
• Medicaid (may include benefits defined at the state-level)

However, if you qualify for a program, the payment assistance may not be immediate at first. For example, in Nevada, the state welfare office has to coordinate with Social Security to automate payments for Part B premiums; and, this can take up to a 120 days to get fully automated (this means the money will come out of your Social Security check until it gets automated).

If you believe you qualify, you should immediately get an online application submitted with Extra Help as your first step (takes about 15 minutes). This will start the process does two things: 1) it will screen your eligibility for prescription drug assistance, and 2) the application will be forwarded to the state welfare office to screen you for the other programs). This is important, because often people wait to contact the state welfare office too late, possibly creating some extra work when they enroll in some Medicare plans, or worse, you have Part B premiums deducted from your Social Security check in the short-term that would otherwise be paid for, because the state welfare office hasn't had enough time to get your premium payments automated.

In the state of Nevada, the state welfare office handles the enrollment into Medicare Savings Programs and Medicaid. You can call them toll-free at 1-800-992-0900.

If you are currently receiving Medicaid prior to turning 65 in Nevada, you are not automatically enrolled in these programs sadly. You have to call the state welfare office to advise them that you are aging into Medicare and that you need to confirm your eligibilty and enrollment into the new program. Ideally, you should contact the state welfare two months prior to your birthday month to get this process started (e.g. if you turn 65 in March, then call them in January).

Step 7: Select your preferred enrollment path into Medicare

You have 2 main ways to get your Medicare coverage:

• Original Medicare—includes Part A and Part B. You can buy supplemental coverage from a private company to help pay your out-of-pocket costs (referred to as a Medicare supplement or Medigap). You can also add Medicare drug coverage (Part D).

• Medicare Advantage—a Medicare-approved plan from a private company that bundles your Part A, Part B, and usually drug coverage (Part D). Plans may offer some extra benefits that Original Medicare doesn’t cover, like vision, hearing, and dental services.

Here's a visual to help make more clear:

If you want to understand the key differences between Original Medicare and Medicare Advantage, check out pages 4 and 5 of the Understanding Medicare Advantage Plans to see a comparison.

If you're interested in a Medicare supplement, you may want to check out the Choosing a Medigap Policy guide. If you want to learn about prescription drug coverage, you may also want to check out Your Guide to Medicare Drug Coverage.

Step 8: Analyze the impact of Medicare costs on your monthly budget

Many Medicare beneficiares are surprised to learn that Medicare isn't entirely free. There are costs, and for individuals on a fixed income, it's important to know what these costs are and how they will affect you.

Here's are the simplified details for 2024:

You likely won't have to pay a Part A premium as long as you have 40 credits on your Social Security earnings record. You can login to ssa.gov and check to see how many credits you have, as well as read your benefit letter.

You will have a Part B Premium of $174.70 each month. If you qualify for a Medicare Savings Program, you may have that paid for by the government. If your income is over a certain threshold, you may be subject to IRMAA (income-related monthly adjustment amount), where you pay an additional amount above the $174.70.

If you opt to remain on original Medicare (Part A & B), then you may want to supplement your coverage with a Medicare supplement, also known as Medigap. This will likely come at additional monthly cost of $125+ a month.

If you opt for Part C (Medicare Advantage), you will likely have some cost sharing (premium, deductible, copay, coinsurance, and out-of-pocket maximum). However, across Nevada, we have some of the most competive Medicare Advantage plans available nationwide, including many options with $0 premiums, deductibles, copays, and very low out-of-pocket maximums. In this scenario, you would still continue to pay your Part B premium.

If you remain on original Medicare you may or may not have a Part D premium. In Nevada, we do have some plans with $0 premiums. Some Medicare Advantage plans also have $0 premiums for Part D too. If you are low income though, you should apply for Extra Help, as this will help reduce your cost sharing for prescription drugs.

However, people generally want to know what will be the fixed out-of-pocket monthly costs for these premiums. To illustrate this better using the visual in the previous step as a guide...

Option 1 - Original Medicare with Medicare supplement + Prescription Drug Coverage

In this scenario, assuming you opted for all the options, you would likely pay in the ballpark of $300 to $419 each month in fixed costs + potentially some cost sharing depending on the plan options.

- Part A premium (likely free)
- Part B premium ($174.70)
- Part D premium (as low as $0 or as much as $120)
- Medicare supplement (starts at about $125+ a month)

Option 2 - Medicare Advantage

In this scenario, assuming you opted for all the options, you would likely pay in the ballpark of $174 to $206 each month in fixed costs + costs sharing depending on how the plan benefits are defined (unless you qualify for any governement programs).

- Part A premium (likely free)
- Part B premium ($174.70)
- Medicare Advantage premium (as low as $0 or as much as $32)

Step 9: Assess how Medicare integrates with your current healthcare providers and prescriptions

If you stay on Original Medicare, there are no networks. This means you can go to any doctor who accepts Original Medicare. Nationwide, about 98.9% of doctors accept Original Medicare (however only 70% are accepting new patients).

If you opt for Medicare Advantage, you will need to work within the network of the plan to get the lowest cost on your healthcare. Some plans will let you go outside the network, but at a higher cost. Natonwide, about 46% of doctors accept Medicare Advantage plans.

When you evaluate your options, you need the following information to make a fair evaluation on what plans will work best for you:

1. Get a list of all your providers and the street locations of the offices they practice
2. Get a list of all your medications with the dosage and refill schedule
3. Get the name and address of your preferred pharmacy
4. Notate eligibility for special needs plans (Medicaid or chronic conditions)
5. List of upcoming health needs where you want to verify coverage (e.g. do you need dental implant? new eye glasses? expecting a surgery?)

Many people are often willing to change their primary care provider for one reason or another. If this is you, then you may want to consider the senior primary clinics available in your community. They are designed to exclusively service the unique needs of the senior population. In Las Vegas, we have more than 60 retail locations available.

Step 10: Determine the optimal time and method for your Medicare enrollment

As you approach your 65th birthday, you have a 7-month window to get enrolled in Medicare. There are course some nuances to this based on various circumstances (e.g. if you are delaying Part B enrollment). Check out Special Enrollment Periods to see the other scenarios.

You have multiple options in terms of where you can enroll. You can enroll:

• With a licensed insurance agent (preferrably one who focuses on Medicare)
• Through medicare.gov
• With assistance through the Nevada State Health Insurance Program (SHIP)

And there are many other websites online that facilitate enrollment into Medicare plans.

Step 11: Schedule a yearly session to review and adjust your Medicare plan as needed

There are several factors that may impact the Medicare plan option you've selected. These include:

• Changes in legislation at national- or state-levels that affect the Medicare program
• Rate increases on Medicare supplement (Medigap) premiums
• Changes to Medicare Advantage benefits, cost-sharing, and network

For this reason, it's a good idea to review your Medicare plan each year (ideally with a licensed insurance agent), to see if there are any changes that impact your plan, or changes in your health that require adjusting your plan to an option that better aligns with your needs.

Changes to Medicare legisliation can happen at anytime, but we often see new changes announced two weeks prior to the start of the annual enrollment period on October 1. Rates increases for Medicare supplements (Medigap) maybe happen on an annual basis or sometimes longer. As for Medicare Advantage, plan changes are announced October 1 of each year to coincide with the upcoming annual enrollment period that occurs October 15 to December 7.

Generally speaking, October 1 is a good time to review your needs each year.

Step 12: Implement strategies to minimize unwanted Medicare-related calls

One of the biggest pain points I hear from y clients is the amount of unsolicited or unwanted calls they receive related to Medicare from telemarketers. There is a massive industry around Medicare with tons of marketing, so if you want to help shield yourself from these activities there are a few actions you can take.

• Add phone number to the National Do Not Call Registry
• Enroll in the do-not-mail service and the email opt-out service from DMA Choice