ORIGINAL MEDICARE
WHAT IS MEDICARE?
Medicare is basic, affordable health coverage for eligible beneficiaries. It’s divided into four parts: A, B, C, D and is administered by the Centers for Medicare and Medicaid Services (CMS). Parts A & B are called Original Medicare.
Medicare Part A is referred to as in-patient or Hospital Insurance. The part A deductible is $1484 (2021) and typically covers you for up to a 60 day stay in the hospital. It does cover additional days for a predetermined daily cost (see Medicare.gov). Part A also covers the first 20 days of skilled nursing care for $0/day with days 21-100 costing $185.50/day (2021).
Medicare Part B is referred to as out-patient or Medical Insurance. The part B deductible is $203/year (2021) and then it goes 80/20 coinsurance with Medicare paying 80% of the approved amount and you paying the other 20% for the rest of the year. There are some other cost associated with part B as well (see Medicare.gov).
To learn more about Medicare Part A and B click here.
How to sign up
You have two opportunities to go onto Medicare. The first one is when you turn 65 which is referred to as your Initial Enrollment Period (IEP). This “window of opportunity” lasts for 7 months - 3 months before your birthday, your birthday month, and 3 months after your birthday. Enrollment outside of this window could result in a part B penalty that could stay with you for the rest of your life. If you are turning 65 and are already receiving social security benefits, then you are automatically enrolled into original Medicare and your card should arrive 3 months before your 65th birthday.
If you are not receiving social security then you will have to apply for Medicare by contacting the Social Security Administration either by phone (877-274-5241 local office in Sioux Falls) or visiting their website (www.ssa.gov/benefits/medicare/). Because of COVID they are currently not allowing in-person appointments.
If you decided to delay going onto Original Medicare because you stayed on your or your spouse’s group plan then you will be able to sign up during a Special Enrollment Period (SEP). You can sign up for part B anytime prior to going off your group insurance plus 8 additional months after going off it; however, you will need to sign up for part D coverage within 2 months of losing your group plan. You will need to contact the Social Security Administration by either calling them or sending in an application for your part B as well as having your employer fill out a form showing proof of employer coverage and sending that in along with your application.
ANNUAL ELECTION PERIOD (AEP)
• October 15th – December 7th
• All enrollment and disenrollment options are available
• AEP changes become effective January 1st
MEDICARE ADVANTAGE OPEN ENROLLMENT PERIOD (OEP)
• January 1st – March 31st
OEP allows individuals enrolled in an MA plan, including newly MA-eligible individuals, to make a one time election to go to another MA plan or back to Original Medicare.
ARE YOU ELIGIBLE?
To be eligible for Medicare you must be 65 years of age or older, on disability if younger, or diagnosed with End Stage Renal Disease (ESRD)
SPECIAL ELECTION PERIOD (SEP)
There are several opportunities available to you to make changes to your Medicare advantage or prescription drug (part D) plan when certain events happen in your life such as moving or losing your current coverage. (See Medicare.gov for a complete list.)
