When should I sign up for Medicare?

If you’re turning 65 soon, you probably have many questions about Medicare.

There are a few things you need to know about the different parts of Medicare and when to enroll.

When Do I Sign Up?

Most people become eligible for Medicare at age 65. If you’re already collecting Social Security, your enrollment in Medicare is automatic. You’ll receive your Medicare card in the mail about three months before your coverage starts, the 1st of the month you turn 65. Your card will show your Medicare ID number and the effective date for Parts A and B.

If you are not collecting Social Security, you must sign up for Medicare Parts A and B during your Initial Enrollment Period. This is a seven-month period that includes your birthday month, the three months before, and the three months after. Your coverage will start the first of the month you turn 65 or, if you enroll in the months after your birthday, the first of the monthfollowing your enrollment.

How Do I Enroll?

To enroll, you need to contact Social Security. You can enroll over the phone by calling 1-800-772-1213 Monday through Friday between 7am and 7pm, online at SocialSecurity.gov, or in person at your local Social Security office. You can search by ZIP code for the closest office at Social Security Office Locator.

What If I Don’t Sign Up When I’m Supposed To?

Usually, if you don’t sign up when you should, you have to pay a higher monthly premium. As these late penalties continue to increase the longer you delay enrollment, signing up on time or as soon as you realize you’ve missed your Initial Enrollment Period is important.

Do I Need to Sign Up If I’m Still Working?

Whether you need to sign up while you’re still working depends on the size of your employer. If you have coverage through your job or spouse’s job and your employer has fewer than 20 employees, Medicare will be your primary insurance when you turn 65.

If you have coverage through an employer with 20 or more employees, you can delay enrolling in Medicare with no late penalties until you (or your spouse) retire or leave your job. Since most people who have worked for 10 years or more qualify for premium-free Part A, signing up as soon as possible makes sense.

The delayed enrollment rules do not apply if you are covered under COBRA. You need to enroll during your Initial Enrollment Period to avoid late penalties.

Are Parts A and B All I Need?

Medicare Parts A and B (collectively known as Original Medicare) don’t cover everything. Part A covers 80% of inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers 80% of your doctor visits, outpatient care, medical supplies, and preventive services. You are responsible for the other 20%.

With Original Medicare, there are other out-of-pocket expenses, such as deductibles, copays, and coinsurance. There is no dollar cap as to how much you might have to pay out of pocket in a year. Original Medicare also provides no Part D prescription drug coverage.

You can pick up prescription coverage and reduce these non-covered expenses by enrolling in a Medicare Advantage plan that includes Part D coverage or by enrolling in a Medicare Supplement plan and separate Part D plan.

Medicare Advantage or Medicare Supplement Plan?

Medicare Advantage plans (also known as Part C) are an all-in-one alternative to Original Medicare. These plans cover everything covered by Parts A and B. Most Advantage plans also include Part D coverage.

- When you enroll in an Advantage plan, you must use the doctors and hospitals in the plan’s network. Out-of-network coverage will have a higher out-of-pocket cost.

- Most services require a copay or coinsurance. There is an annual out-of-pocket maximum for how much you can spend each year.

- Many Advantage plans include supplemental benefits, such as dental, hearing and vision, and gym memberships.

- Monthly premiums vary. Many insurers now offer $0 premium plans. In general, the lower your monthly premium, the higher your copays and coinsurance.

- Each insurer has its own unique drug formulary for covered drugs. Drugs are grouped into tiers that determine out-of-pocket costs such as copays or coinsurance.

Medicare Supplement plans (also known as Medigap plans) help fill coverage gaps from Original Medicare Parts A and B.

- There are 10 different standardized Medigap plans to choose from, each identified by a letter. Each plan provides a different level of coverage to supplement Original Medicare.

- There is no single best plan. You should compare plans and choose one you can afford that covers most of what you need. Some plans are not available in every state.

- Monthly premiums vary based on the plan you choose, your ZIP code, and the insurance carrier. Other factors such as your gender, marital status, and whether you are a smoker will also influence cost.

- The best time to apply for a Supplement plan is during your six-month open enrollment period, which begins during the first month you turn 65. This is the only time you have guaranteed issue rights – meaning you can’t be denied coverage.

Which Option Is Best for Me?

Several factors can help determine which option is best for you, including your lifestyle, overall health, and finances. A Medicare Advantage plan can be less expensive, but you’ll need to use the plan’s network of doctors and hospitals. If you travel extensively or want to be able to see any Medicare-approved doctor or use a hospital anywhere in the country, Original Medicare with a Medigap plan might be right for you. If you have a chronic health condition or take specialty medications, you’ll need to do your due diligence to find out what coverage you’d receive under both options.

Part D Prescription Coverage

If you opt for Original Medicare, you will need to enroll in a separate Part D prescription plan during your seven-month Initial Enrollment Period.

Medicare Resources

Every fall, Medicare mails out its annual Medicare and You Official Handbook. This helpful guide includes a summary of Medicare’s benefits and has answers to frequently-asked questions. You can request the 2023 Handbook by calling 1-800-633-4227 (1-800-MEDICARE).

There’s No Need to Navigate Medicare Alone

Medicare can be complex and confusing. The independent, licensed agents at O’Neal Insurance Group are here to help. We can help you evaluate your options and find the right Medicare coverage to suit your needs.

Medicare Coverage After Losing Insurance

What should I do when I lose work benefits?

You’re no longer working, which means you no longer have health insurance through your job. Now what? If you’re 65 or older, you may qualify for a special enrollment period to elect Medicare coverage after losing job-based insurance.

Who is eligible for Medicare?

According to HHS, Medicare is generally for people aged 65 or older. However, you may be eligible for Medicare before you turn 65 if you have end-stage renal disease, ALS, or another qualifying disability.

Most people who are eligible for Medicare are also eligible for premium-free Medicare Part A. This applies if you paid Medicare taxes for at least 10 years. You can also qualify for premium-free Medicare Part A based on a spouse’s or former spouse’s work history or if you receive retirement or disability benefits from Social Security or the Railroad Retirement Board.

If you qualify for Medicare but don’t qualify for premium-free Medicare Part A, you can pay to enroll. In either case, you will still have to pay a premium for other Medicare plans, including Medicare Part B.

When can I enroll in Medicare?

Your Medicare Initial Enrollment Period lasts for seven months. CMS says it covers the month of your 65th birthday, the three months before, and the three months after. People who qualify for Medicare due to disability also receive an Initial Enrollment Period, which covers the seven months surrounding the 25th month of disability payments.

You can also enroll in Medicare during the General Enrollment Period, which runs from January 1 to March 31 every year. In addition, some people qualify for Special Enrollment Periods based on their individual circumstances – for example, if you lose job-based health insurance.

Do I need to enroll in Medicare as soon as I become eligible?

If you don’t enroll in Medicare when you become eligible, you may face expensive late enrollment penalties. However, you may be able to avoid these penalties if you had qualifying job-based coverage. According to Medicare.gov, the penalties are as follows:

- Medicare Part A Late Enrollment Penalty: Your monthly premiums increase by 10% for twice the number of years you didn’t sign up. For example, if you delayed signing up for three years, you’ll have to pay the penalty for six years.

- Medicare Part B Late Enrollment Penalty: Your monthly premiums increase by 10% for each year you could have signed up but didn’t. For example, if you delay signing up for two full years, you’ll pay a 20% late penalty.

- Medicare Part D Late Enrollment Penalty: You’ll pay 1% more each month if you didn’t join a Medicare drug plan when you signed up for Medicare or if you went 63 days without creditable drug coverage.

To avoid these expensive late enrollment penalties, you need to sign up as soon as you’re eligible – unless you qualify for an exception. According to Medicare.gov, if you have health insurance from your job or your spouse’s job, you can wait until you stop working or lose health insurance to enroll in Medicare Part B and won’t incur a late enrollment penalty. However, you need to be careful – some private health plans don’t pay or pay less if you qualify for Medicare, and not all prescription drug plans are considered creditable.

If you’re thinking about delaying enrollment, talk to your health insurance sponsor to make sure you’ll qualify for penalty-free late enrollment and find out whether your prescription drug plan offers creditable drug coverage under Medicare rules.

Also note that you can decide to enroll in Medicare even if you have employer-based coverage. However, you might not want to pay for Medicare Part B if you have coverage already. In addition, Medicare coverage will disqualify you from contributing to an HSA, even if you just have Medicare Part A coverage.

If I lose my job-based coverage, when can I enroll in Medicare?

If your job-based health insurance ends, you will have an opportunity to enroll in Medicare. According to Medicare.gov, your special enrollment period ends eight months after your group health plan coverage ends or your employment ends, whichever happens first. (Note that COBRA does NOT count as a group health plan.)

You can also enroll in a Medicare Advantage, Part D, or Supplement Insurance plan. According to Medicare.gov, you’ll have two months after your job-based insurance ends to join a Medicare Advantage or prescription drug plan. If you want a Medicare Supplement Insurance (Medigap) policy, you’ll have a six-month Medigap Open Enrollment Period after you enroll in both Medicare Part A and B.

What happens if I miss my Special Enrollment Period?

If you miss your Special Enrollment Period, you may have to wait until the next General Enrollment Period. This runs from January 1 to March 31 every year. Late enrollment can lead to coverage gaps and late enrollment penalties.

How can I avoid coverage gaps?

If your job-based coverage ends before your Medicare coverage begins, you will be responsible for any health expenses you incur during the coverage gap. To avoid this, make sure your coverage is continuous.

- Don’t wait until your coverage has ended. Medicare.gov says you can sign up for Medicare and pick a plan before your job-based insurance ends if you want coverage to start when your job-based coverage ends.

- Understand that Medicare coverage won’t start immediately. Coverage typically starts on the first of the month after you sign up. This means if you sign up on May 5, your coverage won’t start until June 1. If you sign up during your Initial Enrollment Period before you turn 65, coverage will start during the month you turn 65.

What happens if I lose my job-based coverage but I’m not 65 yet?

If you decide to retire before you turn 65 or are laid off before your 65th birthday, you won’t qualify for Medicare. You will need to wait until the Initial Enrollment Period around your 65th birthday. In the meantime, you have several coverage options, including private health plans you purchase on your own, a health plan you purchase on the Healthcare.gov Marketplace, or your state Marketplace and COBRA continuation coverage.

How can I sign up for Medicare?

If you are receiving Social Security benefits for at least four months before you turn 65 and live in the U.S. (but not Puerto Rico), you should be signed up for Medicare Part A and Medicare Part B automatically when you turn 65. If this does not apply, you’ll need to sign up.

To sign up for Medicare, contact the Social Security Administration. You can go to your local Social Security Administration office, call 1-800-772-1213 (TTY: 1-800-325-0778), or go to https://www.ssa.gov/medicare/sign-up.

You can also enroll in a Medicare Advantage, Part D, or Insurance Supplement Plan. Receive guidance from an agent or search and compare plans on your own.

Do I need a Medigap plan?

If you’re enrolled in Original Medicare, a Medicare Supplement Insurance Plan can help you manage your costs. Also called Medigap plans, these policies can help with out-of-pocket costs and provide additional benefits.

If you decide to stay in Original Medicare, you could face unlimited out-of-pocket costs. A Medigap policy can help you control your costs and stay within your budget. However, if you don’t enroll when you first become eligible, you may be unable to find affordable coverage later.

What are Medicare Supplement Insurance Plans?

Medicare Supplement Insurance plans (or Medigap plans) are supplemental health insurance plans you can buy from private insurance companies. These do NOT replace Original Medicare – they are designed to work with Original Medicare to provide additional coverage and help control costs.

Is Medicare Supplement Insurance the same as Medigap?

Yes, Medigap is just another name for Medicare Supplement Insurance. Medicare Supplement Insurance is a mouthful, which makes a short nickname useful!

Is Medicare Supplement Insurance the same as Medicare Advantage?

No, Medicare Supplement Insurance is NOT the same as Medicare Advantage.

- Medicare Supplement Insurance works with Original Medicare (Medicare Parts A and B).

- Medicare Advantage (also called Medicare Part C) is an alternative to Original Medicare that combines the coverage provided under Medicare Part A and B into one plan and may offer other benefits.

Can I have Medicare Supplement Insurance and Medicare Advantage?

No, Medicare Supplement Insurance and Medicare Advantage do NOT work together. You will not be able to buy a Medigap policy if you are enrolled in a Medicare Advantage plan.

Why should I consider buying a Medigap policy?

There are two main reasons for buying a Medigap policy.

First, Medigap policies can help you control your out-of-pocket costs. Original Medicare does not have an out-of-pocket cap. In addition to the Medicare Part B premiums, you are responsible for your deductible, copays, and coinsurance, and there is no limit to how much you may pay in copays and coinsurance. Medigap plans can help with these out-of-pocket costs, which can make your healthcare expenses more predictable to help you budget accordingly. If your medical costs are high, Medigap can also save you a substantial amount of money.

Second, some Medigap policies offer additional benefits. For example, some Medigap plans provide foreign travel coverage. In addition, the Commonwealth Fund says around 7% of Medigap plans provide dental, vision, or hearing benefits. (If you want more benefits like these, you might be interested in a Medicare Advantage plan instead. Plus, Medigap plans have NOT provided any prescription benefits since 2005. If you need prescription drug coverage, you’ll need to enroll in a Medicare Part D plan or a Medicare Advantage Prescription Drug Plan.)

When can I enroll in a Medigap plan?

The best time to enroll in Medigap is during your Medigap Open Enrollment Period. This lasts for six months, beginning when you enroll in Medicare Part B and are aged 65 or older. During this period, private insurance companies that sell Medigap policies cannot deny you coverage or charge you more based on your pre-existing health conditions. You can apply to buy a Medigap policy after your open enrollment period ends, but insurers could charge you more or deny you coverage.

This means you should consider enrolling in a Medigap plan when you become eligible for Medicare if you think you may need one in the future. It also means switching Medigap plans can be tricky. Medicare.gov says you may have a guaranteed issue right to enroll in a Medigap plan under certain circumstances, such as if your Medigap coverage ends through no fault of your own. If you don’t qualify, however, insurers could deny you coverage.

Some states have additional rules that give some individuals more flexibility regarding Medigap enrollment, especially people who are currently enrolled in a Medigap plan and want to switch to a new one. According to Think Advisor, Connecticut, Maine, Missouri, New York, Washington, California, Oregon, Illinois, and Nevada have rules that make it easier for people to switch Medigap plans. If you want to buy a different Medigap policy and your Medigap Open Enrollment Period has passed, check the rules in your state.

How much does Medigap cost?

The cost of Medigap plans varies. Some plans are available for less than $100 (sometimes significantly less), whereas others cost several hundred dollars. When comparing plan costs, don’t just look at the premium – also look at your expected out-of-pocket costs. Sometimes, you can save money in the long run by choosing a higher premium.

What if I have a chronic or pre-existing condition?

If you have a chronic health condition, you need a Medicare plan that gives you access to certain treatments and specialty doctors. You may also need extra benefits to help you manage your health. Medicare chronic conditions coverage is available.

It’s important to find a plan that meets your coverage needs while remaining within your budget. This is critical if you have a chronic health condition. The right Medicare plan can make it easier for you to manage your condition and avoid extra costs. Start comparing your options for Medicare chronic conditions coverage below.

Does Medicare provide coverage for pre-existing conditions?

Original Medicare provides coverage for pre-existing conditions. If you have diabetes, heart disease, cancer, or another condition, insurers will not deny you Medicare coverage or enrollment. Medicare Advantage also covers pre-existing conditions.

However, enrollment in Medigap (Medicare Supplement Insurance) plans is sometimes subject to medical underwriting, meaning pre-existing conditions may impact your eligibility and costs. According to Medicare.gov, your Medigap Open Enrollment Period lasts for six months, beginning the first month when you have Medicare and are 65 or older. During this period, you can buy a Medigap plan without medical underwriting. You can still apply for coverage after your Medigap Open Enrollment Period ends, but insurers could deny you coverage or charge you more based on your pre-existing chronic health conditions. Furthermore, your Medigap policy may exclude pre-existing conditions for the first six months of coverage.

(Note: In the past, Medicare enrollees with end-stage renal disease could not enroll in Medicare Advantage plans. However, this changed in 2021.)

Which Medicare plans cover chronic conditions?

All Medicare plans have some coverage for chronic health conditions. Medicare Advantage plans must generally cover all of the services covered under Original Medicare, although their costs may be different and they may offer additional benefits. Variations in benefits offered mean some plans may provide better coverage for certain chronic conditions.

Some Medicare Advantage plans offer non-medical benefits to help people with chronic conditions. According to the U.S. Government Accountability Office (GAO), as of 2022, approximately one in three Medicare Advantage plans provided at least one benefit designed to improve the health or function of chronically ill enrollees or reduce avoidable health care use. These supplemental benefits include food and meals, transportation for non-medical needs (such as a ride to the grocery store), social needs benefits (such as access to plan-sponsored programs), general support for living (such as subsidies for rent or utilities), and pest control.

Some Medicare Plans specifically cater to specific chronic conditions. These plans are called Chronic Condition Special Needs Plans (C-SNPs). Each C-SNP focuses on a different chronic condition. You can only enroll in a plan if you suffer from the condition. For example, if a C-SNP in your area serves enrollees with diabetes, you can only enroll if you have diabetes.

Medicare SNPs cover all the services Medicare Advantage plans are required to cover. They may also provide additional benefits to meet the needs of the groups they serve. All SNPs provide prescription drug coverage; some also have care coordinators who help enrollees manage their health. For example, in a C-SNP that serves people with diabetes, Medicare.gov says a care coordinator could help enrollees monitor their blood sugar, follow their diet, stick to a suitable exercise regime, schedule preventative services, and receive the right prescriptions to prevent complications.

What is the Medicare chronic conditions list?

The Medicare chronic conditions list consists of 15 chronic conditions. If you have one of these conditions, there may be a C-SNP in your area that caters to it.

The 15 SNP-Specific chronic conditions are:

1. Chronic alcohol and other drug dependence

2. Autoimmune disorders – limited to polyarteritis nodosa, polymyalgia rheumatic, polymyositis, rheumatoid arthritis, and systemic lupus erythematosus

3. Cancer – excluding pre-cancer conditions and in-situ status

4. Cardiovascular disorders – limited to cardiac arrhythmias, coronary artery disease, peripheral vascular disease, and chronic venous thromboembolic disorder

5. Chronic heart failure

6. Dementia

7. Diabetes mellitus

8. End-state liver disease

9. End-stage renal disease requiring dialysis

10. Severe hematologic disorders – limited to sickle-cell disease (excluding sickle-cell trait), aplastic anemia, hemophilia, immune thrombocytopenic purpura, and myelodysplastic syndrome

11. HIV/AIDS

12. Chronic lung disorders – limited to asthma, chronic bronchitis, emphysema, pulmonary fibrosis, and pulmonary hypertension

13. Chronic and disabling mental health conditions – limited to bipolar disorders, major depressive disorders, paranoid disorder, schizophrenia, and schizoaffective disorder

14. Neurologic disorders – limited to amyotrophic lateral sclerosis (ALS), epilepsy, extensive paralysis (such as hemiplegia, quadriplegia, paraplegia, or monoplegia), Huntington’s disease, multiple sclerosis, Parkinson’s disease, polyneuropathy, spinal stenosis, and stroke-related neurologic deficit

15. Stroke

When can I join a C-SNP?

You may be able to enroll in a C-SNP at any time.

Medicare plan selection is normally limited to certain periods, such as the Medicare annual election period. However, if you have been diagnosed with a chronic condition and there is a C-SNP for that chronic condition in your area, you may qualify for a Special Enrollment Period to enroll in the plan.

What if I have a chronic condition but there are no C-SNPs that serve my condition in my area?

Unfortunately, if there are no C-SNPs that cater to people with your chronic condition in your area, you won’t be able to enroll in a C-SNP. However, you should stay alert for new C-SNPs during the next annual election period – there is always a chance a new plan will offer coverage in your area.

In the meantime, you can look for a regular Medicare Advantage plan that meets your needs. Although the plan won’t cater to your condition specifically, it may still offer the coverage you need. If you need to see specialist doctors to manage your condition, check whether these providers are in the plan’s network and find out how much it will cost you out of pocket to make an appointment. In addition, check the cost and coverage for any prescriptions you need to manage your condition. If you need other treatments or services, check the costs and coverage for them, too. You might also like to consider plans that offer non-medical supplemental benefits to help with your general well-being, such as transportation and food delivery services.

What happens if I no longer have the chronic condition my C-SNP serves?

That’s fantastic news! However, if you no longer have the chronic condition your C-SNP serves, you are no longer eligible to be enrolled in that plan. You will be disenrolled and will have a Special Enrollment Period to select a new plan that meets your needs.

What if I have a tight budget?

If you’re worried about Medicare costs, you want to find the cheapest Medicare plan. You also need to make sure you have the coverage you need – otherwise, your out-of-pocket costs may be higher than you expected. There are a few things you need to know about low-cost Medicare plans to make sure you choose the right option.

Is Medicare free?

Medicare is NOT free.

Most people who enroll in Medicare qualify for premium-free Medicare Part A based on their work history. However, Medicare enrollees need to pay a premium for Medicare Part B. Enrollees may also need to pay additional premiums for Medicare Part D and either Medicare Advantage or Medicare Supplement Insurance plans.

In addition to premiums, it’s important to consider the out-of-pocket costs you may face when receiving care. These costs can include deductibles, copays, coinsurance, and out-of-network fees. Choosing the lowest premium may not be your cheapest option in the long run, such as if you end up having to pay more in out-of-pocket costs.

How much does Medicare cost?

Medicare is broken into parts (Part A, Part B, Part C/Medicare Advantage, and Part D) as well as Medicare Supplement Insurance. The different parts and policies have different costs.

Most people don’t pay a premium for Medicare Part A, but you still have to pay the deductibles and coinsurance costs when you receive care. CMS says the 2023 inpatient hospital deductible is $1,600 – this is how much you have to pay before coverage kicks in. After that, there is no copay for the first 60 days of inpatient hospital care. For the 61st to 90th day of inpatient hospital care, the daily coinsurance cost is $400.

The base monthly premium for Medicare Part B is $164.90 in 2023. Individuals who earn more than $97,000 a year and couples who earn more than $194,000 a year pay a higher premium due to the income-related monthly adjustment surcharge. The annual deductible is $226 in 2023. There’s also a 20% copay on most doctor services.

Since private insurance companies sell Medicare Advantage, Medicare Part D, and Medicare Supplement plans, the premium and out-of-pocket costs vary. CMS estimated the average basic monthly premium for Medicare Part D to be $31.50 for 2023, whereas the average monthly premium for Medicare Advantage is $18.

Are some Medicare Advantage plans free?

There are some zero-premium Medicare Advantage plans, but these plans still aren’t free.

If you buy a Medicare Advantage plan, you will still be responsible for the Medicare Part B premium. For example, if you pay $164.90 a month for Medicare Part B and enroll in a $0 Medicare Advantage plan, you still pay $164.90 a month for coverage ($164.90 + $0). If you enrolled in a Medicare Advantage plan with a $20 premium, you would pay $184.90 a month ($164.90 + $20).

Medicare Advantage enrollees are also responsible for out-of-pocket costs, including the deductible and copay.

Does Medicare have an out-of-pocket maximum?

Many health plans have an out-of-pocket maximum. This is the annual cap on what you can pay for covered services. Once you reach this cap, you won’t have to pay any more copays, coinsurance, or deductibles for covered services.

Original Medicare does NOT have an out-of-pocket maximum. If you are enrolled in Medicare Parts A and B, there is no limit to what you can pay in out-of-pocket costs. If you become seriously ill, costs can add up fast – which is why the cheapest premium isn’t always the most affordable option in the long run.

You can buy a Medicare Supplement Insurance plan (also called Medigap) to help with your out-of-pocket costs in Original Medicare. The cost of these plans varies, but the premiums can be expensive.

Another option is to buy a low-cost Medicare Advantage plan, which will have an annual out-of-pocket maximum. In 2023, the out-of-pocket maximum for covered services is $8,300.

What is the cheapest Medicare plan?

In terms of premium, the cheapest Medicare plan would be either Original Medicare or a $0 premium Medicare Advantage plan.

However, Original Medicare does not include prescription drug coverage. You’ll need to buy a separate Medicare Part D plan if you want prescription coverage, which will raise your total premium costs.

Many (but not all!) Medicare Advantage plans include prescription drug coverage. These plans are sometimes called Medicare Advantage Prescription Drug plans.

You also need to consider your out-of-pocket costs, as these can add up to more than your premium costs. If you don’t consider your out-of-pocket costs, you may find you are paying for coverage you can’t afford to use.

How can I limit my costs under Medicare?

To limit your total costs under Medicare, you need to find a plan that provides the care you need at the lowest cost. This will require some work, but it can pay off.

- Determine which services you are likely to need during the year. How often do you think you’ll go to the doctor? Will you need specialty care? Is there a good chance you’ll require inpatient hospital care?

- Compare plan costs for the services you’ll need. Add up the copays for hospital stays, primary doctor visits, and specialty doctor visits. If you want to see particular doctors, make sure they’re in the network – otherwise, you may pay higher out-of-network fees.

- Make a list of your prescriptions.

- Compare plan costs for the prescriptions you’ll need. What is the copay for each prescription?

- Add up all of your expected copays, deductibles, and premiums. Now you can compare your total costs under each plan.

What if I can’t afford Medicare?

If you can’t afford Medicare, help may be available.

- Medicaid: You can enroll in Medicare and Medicaid at the same time. To apply for Medicaid, you need to go through your state Medicaid agency. If you qualify, Medicaid will provide secondary insurance coverage to reduce your costs. You can then enroll in a Dual Eligible Special Needs Plan (D-SNP) to simplify your coverage and costs.

- Medicare Savings Programs: There are four Medicare Savings Programs you may qualify for depending on your income and resources. As with Medicaid, you need to apply through your state.

- Extra Help: Medicare’s Extra Help is a low-income subsidy that can help with prescription drug costs. You can apply through the Social Security Administration by going to https://www.ssa.gov/medicare/part-d-extra-help.

If you’re unsure whether you meet the eligibility limits, go ahead and apply. You may find you qualify for some aid.

What if I spend time in a different state or country?

You always planned to travel during your retirement. Now you are retired, you’re wondering whether your Medicare policy will cover you when you’re traveling out of your state or out of the country. The answer can be complicated – it depends on whether you’re talking about Original Medicare, Medicare Advantage, or a Medicare Insurance Supplement plan.

Does Original Medicare cover you when you travel?

Original Medicare is a federal program that includes Medicare Part A and B. Since it’s a federal program that doesn’t use networks, you can use your Medicare coverage anywhere in the U.S. – you just need to go to a healthcare provider or facility that accepts Medicare.

If you want to travel outside the U.S., things are different. Medicare does not typically provide coverage outside of the U.S., which includes the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

However, Medicare.gov says there are three exceptions. Medicare can pay for services you receive in a foreign hospital if you:

- Are in the U.S. when you have a medical emergency, but the foreign hospital is closer than the nearest U.S. hospital that can treat you.

- Live in the U.S. and a foreign hospital is closer to your home than the nearest U.S. hospital that can treat you. (Unlike the previous example, this applies even if you’re not having a medical emergency.)

- Are traveling from through Canada between Alaska and another state, you’re taking the most direct route “without unreasonable delay,” and the Canadian hospital is closer than the nearest U.S. hospital that can treat you. (Medicare decides what counts as “without unreasonable delay” on a case-by-case basis. Be aware that stops in Canada could mean you don’t qualify for coverage.)

Does Medicare Advantage cover you when you travel?

Medicare Advantage plans are sold by private insurance companies and most use networks of providers and facilities. If you go to a facility or provider not in your network, you may not have coverage or you may have higher out-of-pocket costs. Since rules vary, it’s important to find out who’s in your network and how much you’ll pay if you go outside your network.

Network restrictions can be an issue if you’re traveling outside the plan’s service area – you could end up having to pay most or all of any medical costs out of pocket. However, there are exceptions for emergency care.

In addition, some Medicare Advantage plans offer supplemental benefits that cover emergency and urgent services when you travel outside of the U.S. Since not all plans offer this benefit, you should check for foreign travel coverage before you enroll if this is something you want.

Does Medicare Supplement Insurance cover you when you travel?

Some people buy a Medicare Supplement Insurance plan (also called a Medigap plan) to supplement their Original Medicare coverage. These plans are sold by private insurance companies and help control the out-of-pocket costs associated with Original Medicare. Some Medigap plans also provide emergency medical coverage when you travel outside the U.S. According to Medicage.gov, these plans typically have a lifetime limit of $50,000 and pay 80% of billed charges for medically-necessary care outside of the U.S. after you meet a $250 deductible.

However, not all Medigap plans provide foreign travel emergency coverage. If this is something you need, make sure you pick a plan that provides this coverage.

What happens if you don’t have medical coverage?

If you need medical care while traveling and don’t have health insurance, you may be held financially responsible for any medical costs. This is true even in countries that have national healthcare systems with no costs for citizens. As a tourist, you may have to pay the full cost.

As a result, you could face medical bills of tens of thousands or even hundreds of thousands of dollars. You could even be detained in the country. An AP News investigation found that “an astonishing number” of hospitals around the world detain patients who are unable to pay their medical bills. It may be illegal, but this doesn’t stop some hospitals from using armed guards and other measures to keep patients until they’ve paid their bills.

What can I do if I want to travel but my Medicare plan won’t cover me?

Traveling without emergency medical coverage is a huge risk. However, you don’t need to let a lack of foreign Medicare coverage stop you from seeing the world: you can purchase travel health insurance. The CDC says anyone who is traveling should consider travel health insurance. It is especially important if you are traveling for more than six months, have an existing health condition, or are participating in adventurous activities that could result in injury.