WEDNESDAY, APRIL 29, 2015 ❚ SIUSLAW NEWS
9B
Medicare Open Enrollment: What Baby Boomers Need To Know
This model is more like a traditional HMO. The coverage is
more expansive than the Part A/B/D model, and there are
caps on how much an individual will be asked to pay out-of-
pocket, unlike the Part A/B/D model, which has no out-of-
pocket cap. But with Part C, there is less patient control over
doctor choice. The trade-offs essentially mirror the HMO
vs. PPO trade-offs we make in the private insurance market.
To avoid penalties, anyone turning 65 must choose to
enroll in Medicare A, B and D, or Medicare C. Part A is free
to anyone who has worked for at least 10 years. There are
monthly payments associated with Parts B and C.
There are a number of different coverage plans under
Part D, each with a different level of coverage and patient
co-pay for prescription drugs.
Deadline
Those who do not enroll in Medicare within three
months of their 65th birthday are subject to penalties and
higher monthly fees after enrollment. For example, if some-
one misses the initial enrollment period for Part B, he or she
faces an additional monthly premium of 10 percent for every
full 12 months he or she was eligible but did not enroll.
Registration for Part C is available during initial enroll-
ment period or during annual enrollment periods, without
penalty, once Medicare coverage is in place.
What Does Medicare Cover?
Part A (Hospital Insurance)
Medicare Part A covers hospitalization expenses, includ-
ing hospital care, nursing home care, hospice and home
health services. It is free if you already receive or are eligible
to receive Social Security benefits, if you or your spouse has
worked and paid taxes for at least 40 quarters (10 years), or
if you are the parent of a fully insured deceased child. There
may be other circumstances, such as specific medical condi-
tions, that allow an individual to qualify for Medicare Part A
before he or she turns 65.
Part B (Medical Insurance)
Medicare Part B covers medical and preventive care serv-
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covered by Medicare Parts A, B and D. These are not a gov-
ernment benefit, but rather insurance policies sold by private
companies.
Medigap plans are not necessary if you are covered under
Part C.
Affordable Care Act
It is important to note that individuals who use Medicare
are not affected by the ACA and DO NOT HAVE TO
CHANGE their coverage.
For the complete Medicare Guide or for more informa-
tion on the Transamerica Center for Health Studies, visit
www.transamericacenterforhealthstudies.org/affordable-
care-act/medicare-guide.
• The Transamerica Center for Health Studies(r) is a
division of the Transamerica Institute(r), a nonprofit, pri-
vate foundation. The Transamerica Center for Health
Studies (TCHS) is focused on empowering consumers and
employers so that they can achieve the best value and pro-
tection from their health coverage, as well as the best out-
comes in their personal health and wellness. Although care
has been taken in preparing this material and presenting it
accurately, TCHS disclaims any express or implied warranty
as to the accuracy of any material contained herein and any
liability with respect to it.
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Understanding your options when it comes to signing
up for Medicare can help you save time, trouble and
money.
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ices, such as lab tests, flu shots, ambulance services, clinical
research, medical bills and medical equipment. The majori-
ty of Part B benefits are subject to a yearly deductible ($147
in 2015) and out-of-pocket co-payments, co-insurance and
monthly premiums. The standard Part B monthly premium
for 2015 will be $104.90.
Your actual payment will depend on your income and
assets. Those with a lower income or assets may be eligible
to receive assistance with Part B payments through a variety
of programs, such as Medicaid.
Part C (Medicare Advantage)
Medicare Advantage Plans are offered by private compa-
nies approved by the Centers for Medicare & Medicaid
Services and are similar to private insurance that’s available
through the traditional health insurance marketplace.
Medicare Advantage Plans cover emergency and urgent care
needs and may offer extra coverage for vision, hearing, den-
tal, and health and wellness programs. Most Medicare
Advantage Plans include prescription drug coverage similar
to Medicare Part D.
Monthly premiums for a Medicare Advantage Plan are
separate from the Part B monthly premium. Medicare
Advantage Plans, by law, have an out-of-pocket maximum
of no more than $6,700 per year, while Original Medicare
(Parts A and B) does not have an out-of-pocket maximum.
Part D (Prescription Drug Coverage)
Medicare Part D is prescription drug coverage.
Enrollment in Part D is not automatic and there is a late
enrollment fee for signing up after the initial enrollment
period. All the prescription drug plans vary in cost and cov-
erage options.
Medigap
If you decide to go the Part A/B/D route, it’s important
to know that Medicare doesn’t cover everything, and there is
no cap on what you might be asked to pay out-of-pocket. To
help, you have the option of buying what is called a Medigap
plan. These are supplemental policies that cover services not
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CYAN MAGENTA YELLOW BLACK
(NAPSA)-Don’t look now, but the baby boomers are
starting to retire. Between 8,000 and 10,000 of them will
turn 65 each day for the next 15 years. As more and more
Americans near this milestone age, important decisions
about when to retire and when to sign up for Medicare ben-
efits will be on the minds of millions of Americans.
This new generation of retirees is living and working
longer than the generations before. Increasingly, new seniors
are looking for guidance on health insurance options,
including Medicare benefits, as they consider delaying retire-
ment or continuing to work part-time past age 65.
In an effort to inform Americans nearing their mid-60s
(and their families) about Medicare benefits, enrollment
deadlines and tips for avoiding penalties, the Transamerica
Center for Health Studies (TCHS) has developed a helpful
guide that lays out the key information in one place.
Medicare Open Enrollment
Medicare offers health coverage for anyone 65 or older,
regardless of income, if he or she worked or paid taxes for at
least 40 quarters (10 years). Seniors are eligible to enroll in
Medicare for the three months leading up to and after their
65th birthday. So if you were turning 65 in April 2015, for
example, you would be eligible to enroll in Medicare from
January through July of this year.
Anyone else seeking to sign up in the program or make
changes to his or her Medicare benefits can do so only dur-
ing an eight-week period every fall known as Open
Enrollment. The period typically begins in early October
and runs until early December.
Medicare ABCs
There are two essential options for Medicare coverage.
One option is to obtain Part A, B and D coverage. Part A
covers hospital insurance. Part B is medical insurance. Part
D is prescription drug coverage. These three parts work
together to create an insurance package that is similar to a
fee-for-service/PPO model that many health plans offer.
The other option is to obtain coverage under Part C.