For Those Over 65

Healthcare Plans

Over 65 & People with Certain Disabilities

People who are aged 65 and older and have paid into either Social Security or the Railroad Retirement for enough work credits, will automatically be entitled to receiving Medicare Part A as soon as they turn 65. Medicare Part A is the part of Medicare that covers hospitalizations, hospice, and blood transfusions. This is considered an entitlement because there is no monthly premium for Part A if the person has earned enough work credits throughout their life, or if they qualify through their spouse’s credits.

They will also be eligible to also have Part B, which is the part of Medicare that covers doctors’ visits, outpatient surgeries, therapies, home health care, laboratories, and other diagnostic exams. Medicare Part B does have a monthly premium that is deducted from a beneficiary’s Social Security or Railroad Retirement Board retirement or disability benefits. If the beneficiary is not receiving any cash benefits, then the beneficiary will receive a billing statement directly from Medicare that is billed quarterly.

With certain exceptions, it is usually always to one’s benefit to accept both Medicare parts A and B as soon as one is eligible. The exception would be beneficiaries who are currently enrolled in an employer group health plan and will continue to remain in that plan until full retirement. In many cases though, the Part B premium and the options available for Medicare recipients will be much more cost effective than the premiums a 65+ year old may pay for an employer group plan. A person also risks getting a Late Enrollment Penalty on their Part B premium if they do not sign up for Part B when they turn 65. A person who delays their Part B enrollment past their 65 th birthday because they are enrolled in an employer group plan will not be penalized if they provide proof of employer coverage when applying for their delayed Part B. The experienced professionals at Health Plans of Texas have extensive experience in helping people apply for the Medicare through Social Security, including filling out the Employer Verification Forms required.

Medicare Plan Options

Once the person has both Medicare parts A and B, then they can choose one of a few options available for Medicare recipients. The Center for Medicare & Medicaid Services (CMS) does not require or mandate a Medicare recipient to choose any particular plan, though having creditable prescription drug coverage is a requirement to avoid incurring a Late Enrollment Penalty (LEP) for Part D. The three options a Medicare recipient has are:

Part D Prescription Drug Plan

Stay with Original Medicare and add a Part D prescription drug plan which will help pay for prescription drugs. This option will require the beneficiary to pay all of the Medicare cost-share out-of-pocket costs that they are responsible for. This includes the Part A hospital deductible ($1,484 as of 2021) and the Part B annual deductible ($203 as of 2021) and the Part B co-insurance of 20%.

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Medicare Supplement Plan

This option essentially adds a Medicare Supplement plan to original Medicare and the Part D prescription drug plan. Medicare supplements plans help pay some of the out-of-pocket costs that are associated with Original Medicare.

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Medicare Advantage Plan

These types of plans are offered by private companies. They combine Medicare Parts A and B into one convenient plan. Most plans will include prescription drug coverage and may offer additional benefits not provided by Original Medicare, such as routine dental and vision.

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