Turning 65 and becoming eligible for Medicare can pose a lot of questions. Rightfully so, Medicare is confusing. However, if you focus on learning the basics first, the rest won’t seem as complex.

Here are the top points for Medicare you should know in 2019.

Medicare Isn’t Free

Original Medicare consists of two parts, Part A and Part B. Throughout your career, you pay towards your Part A hospital coverage. If you work at least 10 years in the United States, you will earn premium-free Part A. 99% of beneficiaries pay nothing for Part A during retirement.

However, you have not been paying into Part B, which means you’ll have a monthly premium while enrolled. In 2019, the base premium for Part B is $135.50. Some beneficiaries who have a higher income will have to pay a higher premium. The Social Security Administration will let you know what your Part B monthly premium is each year.

Part D is a voluntary part of Medicare that covers your retail prescriptions. There is a wide range of Part D premiums, but the national average is $35/month.

There Are Late Enrollment Penalties

Each beneficiary has their own initial enrollment period. This period lasts for a total of seven months, starting three months before your 65th birthday month and ending three months after your birthday month.

Unless you have a form of creditable health coverage, you must enroll in Medicare during this time frame, or you will accumulate late penalties. The most popular form of creditable coverage is insurance through your active employer.

You Have Two Main Forms of Supplemental Coverage

Because Medicare has gaps that you must pay for out-of-pocket, there are additional plans you can enroll in to help cover these gaps. These gaps include, but are not limited to, deductibles, coinsurance, and copays.

The two main forms of supplemental coverage are Medigap plans and Medicare Advantage plans. Medigap plans pay secondary to Medicare, while Medicare Advantage plans take over your Medicare coverage completely. You are only allowed to be enrolled in one of these plans at a time. Therefore, you should research the types of coverage to figure out which is best suited for you.

Medigap Plan F Is Being Discontinued Soon

There are currently ten standardized Medigap plans. Medigap Plan F is the most comprehensive plan as it covers all the gaps in Medicare. However, 2019 is the last year Plan F will be available to new Medicare enrollees. This is true for Medigap Plan C as well.

Although Plan C and Plan F will be phased out as of 2020, beneficiaries who were eligible for Medicare before 2020 will still be able to apply for these two plans.

There Are Specific Election Periods for Each Part of Medicare

The period beneficiaries can make changes to Medicare Advantage and Part D drug plans is the Annual Election Period. This election period begins October 15th and ends December 7th every year. You can either enroll in one of these plans or make changes to your current one.

A big misconception of this period is that beneficiaries can enroll in a Medigap plan without having to answer health questions. This, however, is not true. You can apply for a Medigap plan at any time of the year, but unless it is during your personal Medigap open enrollment period, then you will most likely have to answer health questions.

Beginning in 2019, there is a new Open Enrollment Period that goes from January 1st to March 31st. This is a time when beneficiaries can either change their current Medicare Advantage plan to a new one or disenroll from it and enroll in a Part D drug plan.

Verify Your Doctor’s Participation with Medicare

Most doctors in the country accept Medicare. However, there are some who do not. Also, there are some doctors who accept Original Medicare but don’t accept Medicare Advantage plans. Some doctors that do accept Medicare Advantage plans may not accept yours since Medicare Advantage plans have networks.

It’s always best to verify with your doctors that they participate in Medicare as well as determining which Medicare Advantage plan networks that are in if any. Doing this makes sure that you are choosing the right coverage, so you can continue to see all your favorite doctors.

Any doctor that accepts Original Medicare must also accept Medigap plans. Medigap plans do not have networks. For example, if your doctor only accepts Medicare Advantage plans from United Healthcare, but your Medigap plan is through Aetna, they still must accept it.

Medigap plans are billed differently than Medicare Advantage plans. Doctors bill Medicare Advantage plans directly, whereas Medicare bills Medigap plans. If you have a Medigap plan, your doctor will bill Medicare first. Medicare will pay its portion and then send the bill to your Medigap plan so they can pay their part.

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Danielle Kunkle is a founding partner and senior executive at Boomer Benefits, a national agency specializing in Medicare-related insurance products since 2005. Serving thousands of Medigap policyholders in 47 states, her team teaches baby boomers how to navigate Medicare. She is a nationally-recognized expert in the Medicare-sector of the health insurance industry and a member of the Forbes Finance Council.

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