Prior to providing you with the overview of these programs, we are going to do something different and provide you with first with the take-away.

The takeaway:

  • You have to enroll into Medicare.
  • The timing of your enrollment into Medicare is important. Failing to do so in accordance with Medicare rules, may cost you extra money. Failure to enroll into Medicare in accordance with the Health and Benefit Plan’s provisions may disqualify you from having Health and Benefit Plan and Plan P benefits in retirement.
  • If you are a retiree and have coverage through the United Healthcare’s Medicare Advantage Program you neither pay any Part A or Part D deductible nor any coinsurance for any covered Medicare medical expense.
  • If you were utilizing or receiving a discount pharmaceutical coupon or were on a program that reduced your pharmaceutical co-insurance payment prior to becoming Medicare eligible, you will not receive the benefit of that discount once Medicare becomes your primary insurance carrier. Unlike the Lake County Indiana, NECA – I.B.E.W. Health and Benefit Plan which allowed the use of such programs, consequently lowering the actual cost of a participant’s co-insurance, Medicare prohibits those types of programs. Accordingly, participants may be responsible for the full co-insurance cost of the drug or drugs that they utilize.

The “down & dirty” synopsis:

  1. You become Medicare eligible when:
    • You obtain the age of 65. Or,
    • You are receiving Social Security Disability Benefits for twenty-four (24) consecutive months.
  2. You have to enroll into Medicare Part A and Part B.
    • The enrollment period for Medicare spans seven (7) months. Typically, the seven (7) month period begins three (3) months prior to the month you turn sixty-five (65). It also includes the month you turn sixty-five (65) and the subsequent three months after the month you obtained the age sixty-five (65).
    • If you do not enroll in Part A and Part B during Medicare’s Initial Enrollment Period, you may have to wait to sign up. This may cause a gap in your coverage with Medicare. The result of which is that Medicare may assess a lifetime late enrollment penalty. By the way, the penalty increases the longer you delay enrolling in Medicare. So, you do not want to miss your enrollment period.
    • Equally important, enrollment into Medicare at the time of first being eligible to do so is a prerequisite for eligibility for retirement benefits under the Lake County Indiana, NECA – I.B.E.W. Health and Benefit Plan. This is very important and as such, the preceding sentence warrants that you reread it again.

      Should you or your spouse not enroll in Medicare Part A and Part B when you or they first become eligible for Medicare benefits, then you or your spouse will no longer meet the eligibility requirements for retiree benefits under the Lake County Indiana, NECA – I.B.E.W. Health and Benefit Plan. Should this occur, coverage under the Plan will terminate, and unfortunately, it cannot be reinstated.

  3. There are several “Parts” of Medicare that cover different types of claims. They are:
    • Part A- Covers hospital stays, skilled nursing facility stays, some home health visits and hospice care. Part A benefits are subject to a deductible. Part A also requires coinsurance for extended inpatient hospital and skilled nursing facility stays.
    • Part B- Covers physician visits, outpatient services, preventive services, and some health visits. Many Part B benefits are subject to a deductible, and typically, coinsurance of twenty percent (20%). There is no limit on an individual’s out of pocket expense (coinsurance) for services covered under Parts A and B. With that said, no coinsurance or deductible is charged for an annual wellness visit or for preventive services that are rated “A” or “B” by the U.S. Preventive Services Task Force, such as, but not limited to, mammography’s or prostate cancer screenings.
    • Part C- Alternate ways of receiving Medicare benefits, such as, but not limited to a Medicare Advantage Plan. Participants in these types of Plans receive all Medicare-covered Part A and Part B benefits, and typically also Part D benefits.
    • Part D- Covers outpatient prescription drugs through either a Medicare Advantage plan with prescription drug coverage (like the United HealthCare Medicare Advantage Plan with Part D coverage and supplemental drug coverage through SavRX) or through stand-alone prescription drug plan.
    • Other “Parts”. Other Parts is individual or group supplemental coverage that helps cover the costs and fills benefit gaps not covered under the other parts of Medicare. Such services would include, but is not limited to dental services, eyeglasses, hearing aids and long-term care and support.
  4. Some parts of Medicare cost you money
    • Part A
      • As most people paid Medicare taxes for long enough, Part A is generally “premium free.” However, if you and your spouse worked very little throughout your lifetime, and hence paid very little Medicare taxes, you may have to pay a monthly premium.
      • Annual Medicare Part A deductible. Generally, Medicare changes the annual deductible amount each year, and as evidenced by the Part A deductible going from $1,364.00 in 2021 to $1,408.00 in 2022, the change is generally not downward. Individuals without a secondary coverage, such as a Medicare Advantage Plan, that picks up the cost of the annual deductible, will be responsible for that expense.
    • Part B
      • Has a monthly premium expense and everyone has to pay it. With that said, the amount of each individual’s premium is different as the government bases that expense on your yearly income. Consequently, the monthly premium can fluctuate along with an individual’s income.
      • This premium is automatically deducted from your Social Security check.
      • Similar to Part A, Medicare Part B also has an annual deductible. Currently, the Part B deductible is $185.00. However, it will be increased to $198.00 effective January 1, 2022. Therefore, and unless an individual has a secondary insurance that covers the Part B annual deductibles and the twenty percent (20%) Medicare coinsurance, or they belong to a Medicare Advantage Plan, individuals will be responsible for making payments towards those expenses.
    • Part C
      • If you belong to a Medicare Advantage Plan, such as the one provided by the Lake County Indiana, NECA – I.B.E.W., Health and Benefit Plan, you still must pay your monthly Part B premium (and your Part A premium, if you have one).
    • Part D
      • Enrollees pay monthly premiums and cost sharing for prescriptions, with those costs varying by plan.
      • Participants are reminded that Medicare does not permit the use of “discount cards”, “discount coupons” or similar co-insurance reduction programs for the reason that pharmaceutical companies create and utilize said programs to artificially keep participants using their drug instead of looking for lower cost alternatives.