OPINION: TONI SAYS: Please simplify Medicare's enrollment process

May 14—Toni: I need to make the right Medicare decision because I turn 65 in August and have not had a health plan for 2 years. I do not know where to start or what to do. My friends are advising me that if I do not sign up for Medicare when I turn 65, I will be making a major Medicare mistake.

Can you please simplify the Medicare enrollment process? Thanks, Toni.

_—Cynthia from Alvin, Texas

Hi Cynthia: Medicare is exploding with an American turning 65 every 8 seconds. This means 10,000 baby boomers are entering Medicare every day for the next 7-plus years. Simplifying enrollment and understanding Medicare is what the Toni Says Medicare team specializes in. No one wants to make the wrong Medicare or medical decision, which only adds stress to getting older. The Medicare basics America needs to know are:

1. Remember to enroll at the right time:

a. If turning 65 and receiving your Social Security check, your "Welcome to Medicare" kit will be mailed to you with your Medicare card 90 days before you turn 65.

b. If turning 65 and NOT receiving your Social Security check and not working full time with true employer group health insurance from either you or your spouse's work, you will want to enroll in Medicare Parts A and B online via www.ssa.gov.

c. If turning 65, working full-time with "true" employer group health insurance whether through your or your spouse's employer benefits, you may want to delay enrolling in Medicare until you or your spouse retire or are laid off.

2. Medicare is NOT Free: Medicare covers a lot and there is a cost associated with Medicare Parts A and B. The premium for Part A is at no cost if you worked 10 years or 40 quarters and paid Medicare taxes. Medicare Part B has a premium which is means-tested depending on your annual income. In 2024, most Medicare beneficiaries pay $174.70 each month for their Part B premium. The deductible for Medicare Part A (hospital) for 2024 is $1,632, not once a year but is every 60 days or 6 times a year. The 2024 Medicare Part B deductible is $240 once a year with Medicare paying 80% of the Medicare-approved amount and you paying the remaining 20%.

3. Learn the different Medicare Parts (A, B, C and D): Original Medicare is Medicare Parts A and B which covers hospital, medical and provider expenses. Medicare Part C, known as Medicare Advantage plan, is another way of receiving your Medicare benefits. Part D is the Medicare Prescription Drug plan that can be a stand-alone plan with Original Medicare and a Medicare Supplement or with a Medicare Advantage plan that includes a prescription drug plan.

4. "Original" Medicare: Original Medicare Parts A and B have no network. Medicare Part A covers in-patient hospital, skilled nursing/rehab facility, home health and hospice care. Medicare Part B covers doctor services whether at the office or surgical care, outpatient surgery/services, lab/X-rays, MRIs, durable medical equipment, and preventative services.

5. Medicare Advantage Plan (MAPD): You must be enrolled in Original Medicare to qualify for a Medicare Advantage Plan and can select various Medicare Advantage plans (Medicare Part C) such as an HMO or PPO plans that are offered by private insurance companies. A MAPD plan has an insurance provider network with health care professionals or facilities that provide lower in-network rates. You do not use your Medicare (red, white, and blue) card because Medicare will pay the MAPD plan for your care. You will have co-pays, deductibles and maximum out-of-pocket costs associated with your medical care.

Remember, Cynthia, with Medicare it's what you don't know that WILL hurt you!

Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email [email protected] or call 832-519-8664. The "Medicare Survival Guide Advanced" edition and her new "Confused about Medicare" video series are available at www.tonisays.com.