Navigating Medicare with 70 Strong and HICAP

If you or your loved one are approaching the age of 65, it’s time to think about Medicare, the federal government program that provides health insurance for older adults and others who qualify.

Some people think that they don’t need Medicare because they have their own health insurance or worry that they won’t qualify because they haven’t worked enough.

Learning how Medicare can benefit you, how to navigate the Medicare system and how to understand the different Medicare plans can help you or your loved one make the most informed decisions possible. The 70 Strong directory offers extensive resources that will help you explore your options and get started, including links to the free resource known as HICAP –  the Health Insurance Counseling and Advocacy Program.

You can ask questions by talking to a 70 Strong Navigator, one of our friendly staffers. Call 650.780.7547.

Understanding Medicare

You will find extensive information at Medicare.gov. This is a terrific starting point.

Who is Eligible for Medicare Benefits?

  • U.S citizens or legal residents who have been in the United States for at least five years
  • Those who are at least 65 years old
  • Those who are under 65 but who have a qualifying disability
  • Those who have certain health problems

You can learn more about your eligibility here in both English and Spanish.

Enrollment Periods

There are several enrollment periods depending on your situation. Experts listed in the 70 Strong directory and available at no charge can help you navigate these periods and find the one that applies to you.

People who are currently enrolled in Medicare will need to renew or change their coverage as desired during the open enrollment period. Those approaching 65 will have a separate enrollment period. If you are currently receiving Social Security benefits, you should be signed up automatically.

What Medicare Covers

Medicare covers many medical services, but it doesn’t cover everything. That’s why it’s important to understand what type of coverage you need in order to maximize your benefits. Most Medicare plans don’t cover prescription drugs; however, a separate plan may be purchased that does cover prescription medication costs.

Medicare Original, as it’s called, does not typically cover:

  • Routine eye exams
  • Dental care
  • Medicare care provided outside of the United States
  • Caregiver services, such as help with bathing, eating or dressing
  • Hearing aids
  • Chiropractic care, acupuncture and alternative medicine
  • Cosmetic surgery
  • Long-term care

If these services are needed, they will either need to be covered under other types of Medicare plans or paid for out-of-pocket.

The Different Medicare Parts: A, B, C and D

Medicare has several different parts, which are known as Part A, B, C and D. Each different part has different benefits and costs:

Medicare Part A, also known as Original Medicare, offers coverage for hospital visits, in-patient hospital stays and skilled nursing facilities. It does not cover the costs of the doctors who treat you while you are in the hospital, however. Individuals with Medicare Part A usually don’t have to pay a premium but must pay the deductible and a co-pay when services are used.

Medicare Part B is also known as Original Medicare. It is medical coverage and covers outpatient doctor office visits, wellness checks, diagnostic tests, lab work, ambulatory services and emergency room visits. It also covers the costs of a doctor’s care if you require inpatient care. If you have Medicare Part B, you will typically be responsible for a yearly premium, a deductible and co-insurance.

Medicare Part C, also known as Medicare Advantage, combines Part A and Part B. It offers both inpatient hospital coverage as well as routine medical care. Medicare Advantage may also offer benefits not typically covered by Medicare Parts A and B, such as routine eye exams and dental care. Prescription drugs may be covered. Each Medicare Part C plan has varying premiums, deductibles, copays and coinsurance. There is a cap on how much you will be required to pay.

Medicare Part D is a prescription drug coverage plan. (Think D for Drugs). It can be used with either Medicare Parts A or B. Not all prescription drugs may be covered; however, certain types of common drugs are required to be covered.

Navigating Medicare

Tip: Sign Up Three Months Before Your 65th Birthday

Don’t wait: It’s important not to wait until you are 65 to apply for Medicare. You can start the application process three months prior to turning 65. You can apply for Medicare by contacting the Social Security office nearest you or by going on the Social Security website.

Paying for Medicare

If you or your spouse worked for 40 quarters, which is the equivalent of 10 years, you can receive Medicare Part A at no cost to you. Other plans vary depending on the type of plan, the insurance company and the desired benefits. You can pay your premium through the website, or it can be automatically deducted monthly from your account.

Contact HICAP for Health Insurance Counseling

HICAP, as noted, stands for Health Insurance Counseling and Advocacy Program. The HICAP network helps individuals navigate the Medicare system by offering free counseling and community education services. You can find a qualified HICAP person through the 70 Strong directory.

The HICAP network can help Medicare beneficiaries, assigned representatives and individuals who will soon be eligible for Medicare learn about Medicare and what parts are best for their individual situation. HICAP also can help you determine how to optimize your benefits if you already have health insurance through a union or workplace.

70 Strong can help you find more information about Medicare and help you locate a Medicare provider.

Enrolling in the best Medicare plan for you is the first step in taking charge of your health and enjoying your golden years.

70 Strong is a resource for adults ages 60 and above and is designed for seniors in Atherton, Belmont, Redwood City, Redwood Shores, Portola Valley, San Carlos, Woodside, and parts of Foster City, Menlo Park and San Mateo in San Mateo County, California.