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What Exactly Is Medicare?

Medicare serves as a federal health insurance program primarily for individuals who are 65 years old or older. However, it’s also available to younger people under certain conditions, such as those with disabilities, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.

Eligibility for Medicare begins three months before your 65th birthday, allowing for early registration.

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Medicare Part A
(Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B
(Medical Insurance)

Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare Part D
(Prescription Drug Coverage)

Helps cover the cost of prescription drugs (including many recommended shots or vaccines).

What Is Medigap Insurance?

Medigap insurance, also known as Medicare Supplement Insurance, is a type of private health insurance that helps cover some of the costs that Original Medicare (Part A and Part B) doesnt cover, such as copayments, coinsurance, and deductibles. Medigap policies are sold by private insurance companies and can help beneficiaries manage their outofpocket expenses related to Medicarecovered services.

Medigap plans are standardized, offering various benefit levels identified by letters (e.g., Plan A, Plan B) to make comparison easier for consumers.

Eligibility and Enrollment

Individuals are eligible for Medigap if they are enrolled in Medicare Part A and Part B.

The best time to buy Medicare Supplement Insurance is during the Medigap Open Enrollment Period, which starts the first month an individual is 65 or older and enrolled in Part B. During this period, individuals have a guaranteed right to buy any Medigap policy sold in their state, regardless of health status.

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Retiring At 65

Generally, you’re first eligible to sign up for Part A and Part B starting 3 months before you turn 65 and ending 3 months after the month you turn 65.

  • You have an 8-month Special Enrollment Period to sign up for Part B when you stop working, even if you choose COBRA or other coverage that’s not Medicare.
  • If you lose your job-based health coverage before you or your spouse stop working, you have 8 months to sign up.

Getting Medicare The Month After You Retire

If you want Medicare coverage to begin the month after your job-based health insurance expires, you must enroll in Part B the month before you or your spouse expect to retire.

Your coverage will begin the month after the receipt of your completed documents by Social Security (or the Railroad Retirement Board). You’ll need to fill out an additional form proving that you or your spouse had job-based health insurance while working.

Working Beyond Retirement Age and Medicare

For individuals who continue working past the age of 65 and have health insurance through their employer, Medicare provides a Special Election Period (SEP) once retirement occurs. This SEP grants a two-month window to enroll in a Medicare plan, ensuring continuous health coverage without a lapse. This provision is particularly important for those who may have delayed Medicare enrollment due to existing employer health benefits. It allows for a smoother transition from an employer’s health plan to Medicare, ensuring that health insurance needs are met without interruption.

Where To Sign Up For Medicare

To apply for Medicare, contact Social Security. You have the option of enrolling in both Part A (Hospital Insurance) and Part B. (Medical Insurance). Make an application for Social Security benefits (or the Railroad Retirement Board). You will automatically receive Part A once you begin receiving benefits. When you apply for benefits, you’ll be asked if you want Part B.

Contacting Social Security

  • Online (at Social Security) – It’s the easiest and fastest way to sign up and get any financial help you may need. (You’ll need to create your secure my Social Security account to sign up for Medicare or apply for benefits.)
  • Call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
  • Contact your local Social Security office.
  • If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.

Recognition from HealthCare.gov

Being named an Elite Plus member of the 2024 Marketplace Circle of Champions highlights SASid’s significant accomplishment of enrolling over 500 consumers during the Open Enrollment Period. The Elite Plus status represents the highest level of achievement within the Marketplace Circle of Champions.

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Understanding the COBRA Trap

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. While COBRA can be a vital bridge for maintaining health insurance coverage, it also presents a potential trap for the unwary, often referred to as the “COBRA Trap.”

Key Aspects of the COBRA Trap

  • Cost: The most significant aspect of the COBRA trap is the cost. COBRA allows individuals to keep their employer-sponsored health insurance after leaving a job, but it requires them to pay the full premium amount, including the portion previously covered by the employer. This can lead to a substantial increase in monthly expenses, often at a time when income may be reduced due to job loss.
  • Temporary Nature: Another critical aspect of the COBRA trap is its temporary nature. COBRA coverage typically lasts only 18 months, after which individuals must find alternative health insurance coverage. This temporary solution can delay the search for more sustainable and affordable health insurance options, such as through the Health Insurance Marketplace or Medicare, for those who are eligible.
  • Missed Enrollment Opportunities: Relying on COBRA can also cause individuals to miss open enrollment periods for other health insurance plans. This can result in being uninsured after COBRA coverage ends, or having to choose a plan quickly without adequate time to consider the best options for their health care needs and financial situation.

Avoiding the COBRA Trap

To avoid falling into the COBRA trap, individuals should carefully consider their health insurance options and costs before electing COBRA. Exploring other health insurance marketplaces or programs for which they may be eligible, such as Medicare for those over 65 or individual plans through the Affordable Care Act’s Health Insurance Marketplace, can provide more affordable and longer-term solutions. Planning ahead and understanding the implications of COBRA coverage are crucial steps in making informed decisions about health insurance during transitions.

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