What you need to know

Fall is here and that means open enrollment for Medicare begins on October 15th. There are several changes for 2024 that you should know about before enrolling or updating your Medicare coverage. Even if you’re still a few months away from turning 65, now is the time to learn your Medicare options. Informing yourself now will help you make the right choices when you’re ready to enroll.

What’s new in Medicare?

Several Medicare changes went into effect in 2024 to help lower your out-of-pocket costs. These include:

• Your Medicare drug plan cannot charge a deductible or more than $35 for a one-month supply of any insulin product that Part D covers.
• Recommended vaccines for adults are now available to you at no cost.
• Medicare now covers monthly services to treat chronic pain if you live with it for more than three months.
• Medicare now covers more intensive outpatient mental health program services in hospitals, community mental health centers and other locations.
• Medicare covers the COVID-19 vaccine and some related tests and treatments.

New changes for 2025 include:

• Part D plans must limit out-of-pocket costs for covered drugs to $2,000 per year. That includes deductibles, copays and coinsurance. Your Part D coverage may have a maximum deductible of $590.
• Dementia patients and their caregivers could get more help through the Guiding an Enhanced Dementia Experience (GUIDE) program, which offers a 24/7 support line, a care navigator to help you find services, training for caregivers and as much as $2,500 per year for in-home respite services, night care or adult day care.

It is imperative to assess all plans and options before making a decision. You can compare plan coverage, costs, and quality ratings side by side at medicare.gov.

The Basics of Medicare

Medicare is health insurance offered by the federal government. To qualify for Medicare, you must meet one of the following requirements to enroll:

• be 65 years or older
• Have a qualifying disability or
• Have end-stage kidney disease

Medicare coverage includes hospital, medical, and drug coverage in three parts:

Part A, hospital insurance

Part A includes hospital stays, nursing home stays, hospice care, and some home health care services. Anyone who has paid and paid Medicare taxes for at least ten years will not pay a premium for Part A. If you are required to pay a premium, the maximum monthly premium for Part A in 2024 is $505.

The deductible for Part A coverage is $1,632 for each benefit period. A personal contribution is required for hospital stays longer than 20 days. Skilled child care facilities require a co-payment for stays longer than 20 days; once you reach 100 days you will be responsible for all fees.

Part B, health insurance

Part B covers eligible doctor visits, preventive services, medical supplies, and outpatient treatments and services. Most people pay the standard Part B premium, which will be $174.70 in 2024. However, if your adjusted adjusted gross income was at least $103,000 for an individual or had $206,000 filed jointly on your tax return two years before you enrolled in Medicare, your monthly premium will be higher.

For 2024, the Part B deductible is $240 per year.

Part D, Prescription Drug Plans

Part D is your prescription drug coverage, purchased separately from Parts A and B, known as Original Medicare. Costs, including premiums, deductibles, copayments and coinsurance, vary by plan. If you choose a Medicare Advantage plan or Part C, prescription drug coverage may be included. Medicare Advantage plans may also include additional coverage such as dental and vision.

When do I register?

Medicare enrollment is available at specific times, so knowing these time frames is essential not only to get the coverage you need, but also to avoid being fined if you don’t enroll when you’re in eligible for Medicare.

Initial enrollment period

This period includes the three months before the month in which you turn 65 and the three months after the month in which you turn 65. For example, if you turn 65 on June 15, your initial enrollment period starts in March and ends in September. An exception is birthdays on the first of the month. Then your initial registration period starts four months before your 65th birthday and ends two months after you turn 65.

Your coverage starts on the first of the month, depending on when you registered. If you enroll before your 65th birthday, coverage generally begins on the first of your birthday month.

If your birthday falls on the first, coverage typically begins on the first day of the previous month. If you enroll after your 65th birthday, coverage generally begins on the first day of the month after your enrollment date.

Special registration period

When you become eligible for Medicare at age 65, it is important to sign up for Part A coverage to avoid a penalty. However, if you plan to continue working and have insurance through you or your spouse’s employer, you can delay enrolling in Part B coverage. While you can enroll in Part B while on a group insurance plan, you can wait until that coverage ends to enroll in Part B, provided you enroll within eight months after you or your spouse stop working.

If you don’t sign up for Medicare during your initial enrollment period or a special enrollment period, you may have to pay a penalty.

General registration period

If you do not enroll in Medicare during the initial or enrollment period, you can enroll in the general enrollment period from January 1 to March 31 each year. However, you may have to pay higher premiums due to late registration.

Under 65 years of age and incapacitated for work

If you have a disability and receive monthly Social Security or Railroad Retirement (RRB) benefits, you will automatically receive Medicare Part A and Part B after 24 months. There is no waiting period for individuals diagnosed with amyotrophic lateral sclerosis or Lou Gehrig’s disease, who have a receive disability benefits.

What is the difference between Medicare Advantage and a Medicare Supplement Insurance plan?

Medicare Advantage plans include Part A and Part B coverage and are offered by private companies. Most, but not all, Medicare Advantage plans include drug coverage or Part D. Although these private companies must provide all the benefits of Parts A and B, premiums, deductibles, co-pays and coinsurance costs vary by plan. They may also offer additional coverage such as fitness programs and some hearing, vision and dental coverage.

A Medicare Supplement Insurance plan, known as Medigap, helps cover expenses not covered by Original Medicare, such as deductibles, coinsurance, and co-pays. They are available through private companies and premiums vary depending on the plan. Medigap plans are not available if you have a Medicare Advantage plan.

Medicare provides essential health care coverage to meet your medical needs as you age. That’s why it’s important to fully research all your options so you get the right coverage for you.

Start researching before you turn 65 so you’re ready when your first enrollment period begins. The best starting point is medicare.gov, where you can create an account and start searching for health and drug plans and providers. You can also talk to Medicare representatives or connect with Georgia’s State Health Insurance Assistance Program for free health insurance advice.

2024 The Atlanta Journal Constitution. Distributed by Tribune Content Agency, LLC.