Making informed decisions about Medicare can be hard. With the Arkansas Association of Area Agencies on Aging (5A) we strive to give you the guidance you need.
Elder Care in Arkansas
The state of Arkansas provides resources for the services that individuals above 60 need to ensure their quality of life and the ability to age gracefully. Enhancement of living is a top priority for the senior and elderly community throughout Arkansas. Each region specializes in certain resources including but not limited to respite and personal care, in-home services, transportation, Ombudsman, fitness classes, and more!
For people 65 and older, your Area Agency on Aging can also help with Medicare enrollment.
Eligibility Requirements and How to Enroll for Medicare
If you are within the seven months before or after your 65 birthday, likely, you have already enrolled for Medicare Part A or part B coverage! The initial enrollment period (IEP) happens within the first three months after your 65th birthday. If you have been enrolled in the program you will receive a Medicare card in the mail. If you do not receive a card you need to register before or after your 65th birthday to avoid any late penalties or a waiting period for coverage.
Enrollment for Medicare can be difficult to navigate so 5A has decided to take the stress out of the process with their enrollment guide. Within the guide, you can find the trained staff offering free Part D plan reviews while open enrollment lasts. On this site, you can find answers to multiple enrollment questions.
There are three ways to register for Medicare:
- Registering at SocialSecurity.gov
- Registering via phone call 1-800-772-1213, Mon-Fri from 7 am – 7 pm
- Registering at your local Social Security Administration office
When it comes to Medicare there’s a lot of information and it’s important to understand what all of it means. This guide to parts A, B, C, and D of Medicare breaks down what you need to know.
Part A: Hospital Insurance
Medicare Part A is available to any individual over the age of 65 and individuals with certain medical conditions under the age of 65. These medical conditions include end-stage renal failure or ALS, also known as Lou Gehrig’s disease. Part A allows for cost coverage of inpatient care along with:
- Semi-Private Rooms
- Meals and Nutrition
- Treatments and Medications
- Nursing Services
Part A Medicare also covers long-term in-patient expenses like:
- Mental Health Facilities
- Nursing Homes
- Hospice Care
- Home Health Care Services
Part B: Medical Insurance
Part B Medicare covers the costs of outpatient care. Part B covers the chronic, acute symptoms, and illnesses that require medical services.
Outpatient care covered by Part B:
- Doctor’s Office Visits
- Lab Work
- Outpatient Procedures
Part B Medicare also covers necessary medical equipment like wheelchairs, walkers, diabetic testing supplies, and blood pressure monitors.
Typically Part B Medicare does not cover 100% of the costs until a deductible is met. Once the deductible is met Part B Medicare covers approximately 80% of costs of all services listed above including the medically necessary equipment.
Part B Deductible Update
Because of updates made within the Medicare program to discourage over-utilization of the healthcare system, newly admitted members will no longer cover the remaining balance of the Part B Medicare Deductible. Those already receiving Medigap programs C or F will still be able to be fully covered by the Part B deductible, however, newly admitted members will have to pay out of pocket.
Part C: Medicare Advantage
Part C Medicare, or Medicare Advantage, provides Part A and B coverage through Medicare-approved private insurance companies. Some Part C Medicare programs offer prescription drug coverage and some cover dental insurance, which is not covered by traditional Medicare programs.
You can check what coverage is offered in your state through the official Medicare website.
Part D: Prescription Drug Coverage
Part D Medicare, or Medicare prescription drug benefit, has optional coverage for prescription drugs. You are not automatically enrolled in Part D Medicare coverage. If you are eligible you will need to enroll in a Part D Medicare plan to add the prescription drug coverage to your original Medicare coverage plan. If you do not enroll or are not eligible you will have to pay out of pocket for your prescription drugs unless you have other private insurance that covers these costs.
An important factor to keep in mind is the penalty for not having a Part D plan. For each month you delay enrollment in Medicare Part D, you will have to pay a 1% Part D late enrollment penalty (LEP). The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.
Part D Eligibility
Individuals who are already enrolled in Part A or B and live in a Part D service area are eligible for coverage. If enrolled in a Medicare Advantage plan, Part C, prescription drug coverage may or may not be included. If your Medicare Advantage plan does not cover prescription drugs then you can enroll in Part D, however, you must be enrolled in Part A and B.
When Can I Enroll in Part D Coverage?
You can enroll in prescription drug coverage when you first enroll in the Medicare program. Your eligibility to enroll in Part D medicare is open when your IEP for Medicare is open. This is a seven-month period, three months before your 65 birthday and three months after.
Didn’t Apply During IEP? No Problem!
If you didn’t apply for Part D coverage during your Initial Enrollment Period you can still enroll. Open enrollment for Part D coverage is from October 15 and ends on December 7.
How Do I Change My Medicare Plan?
As your health needs change over time, it is good to review your plan annually to ensure you have the best plan in place for you. Medicare plans can have changes annually, so it's good to see if you need to adjust your plan to meet those changes.
An important notion to also consider is that just because a pharmacy or a drug you are taking is covered for one year doesn't mean it will be the next year under your existing plan.
If you’re already enrolled but want to change your plan you can apply through the Annual Election Period from October 15 to December 7. During this time you can enroll or change Advantage Plans, switch back to traditional medicare from an Advantage Plan, or add a Medicare Supplemental plan.
While all of this new information can be overwhelming it’s important to know so you can find the right coverage for you and your loved ones. If you’re looking for more tips for caring for elderly parents at home or help to determine the medicare options they need, contact your Area Agency on Aging. We’re here to help you find the care and services your loved one needs to live a happy, healthy, and independent life.