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If you get your health insurance through the public market and you’re close to age 65, don’t forget Medicare.

The general rule is that you must enroll when you reach this age, unless you have eligibility security elsewhere – and exchange plans (federal or state) do not count.

“You have to be prepared to make this change,” said Kaiser Pollitz, a senior member of the Kaiser Family Foundation. “Otherwise, you may face [costs] delays in enrolling in Medicare and delays in leaving the market. “

Of the approximately 12 million people with health insurance on the market, approximately 3.4 million are between the ages of 55 and 64 – meaning that some of them are approaching Medicare eligibility and have to register.

“If you got support for a market plan … Uncle Uncle can bill you for all the dollars in support you’ve received since you turned 65 and left the plan,” said Danielle Roberts, founder of insurance company Boomer Benefits. .

Individuals who are already receiving Social Security contributions – that is, they started these benefits before the full retirement age set by the government – tend to automatically enroll in Medicare, but still have to cancel their insurance through the marketplace, Pollitz said.

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Your first Medicare enrollment period begins three months before your 65th birthday and ends three months after that (seven months in total).

Although most people do not pay a fee for Part A (hospital coverage), it does not apply to Part B (outpatient care). For 2021, this standard amount is $ 148.50 per month, although those earning higher will pay more.

In addition to Parts A and B – also called the original Medicars – there is Part D, which provides coverage for prescription drugs. It also includes additional monthly payments to beneficiaries with higher incomes (see Charts).

Some people choose to stick with basic Medicare and combine it with a stand-alone Plan D and perhaps a Medicare supplement (aka “Medigap”). Others opt for a benefit plan (Part C) that includes the benefits of Parts A and B and typically Part D, as well as some additional features such as limited dental and vision benefits.

Some areas of Medicare have penalties for late enrollment.

If you do not register for Part B when you should, you may receive a fine that is 10% higher than the basic Part B monthly fee for each 12-month period that you should have registered but did not. And these punishments are usually lifelong.

You can face [costs] delays in enrolling in Medicare and delays in leaving the market.
Karen Pollitz
Senior member of the Kaiser Family Foundation

Although Part D is optional, you may receive a penalty if you decide you want coverage after you have not registered for the first time. This late enrollment fee is 1% of the monthly national base fee ($ 33.06 in 2021) for each full month you should have covered but did not. As a Part B penalty, this amount usually lasts as long as you have drug coverage.

Whether you pay more or less than your current marketplace program depends on factors such as how much financial help you have received.

In 2021 and 2022, subsidies available through the market will be expanded, which means that many more people will be eligible for subsidies that would not have existed before. Some pay little or no fees for commissions, and they may get help with cost sharing, such as deductibles or payments. Of course, if your income is low enough, you may be able to get programs to help cover the cost of your Medicare program.

In addition, the coverage choices you make through Medicare also determine what you pay for. Medigap plans include a monthly fee that can range from less than $ 100 to about $ 400, depending at least in part on the specifics of the plan. These policies generally also cover a large portion of the cost-sharing of Medicare Parts A and B, including copies or co-insurance.

Advantage plans may or may not have a fee in addition to what you pay for Part B. for different cost structures. For a ten-day stay, 72% of Advantage enrollers would pay more.

“Once you’re healthy, Advantage plans are cheaper than the original Medicare, but if you really get sick, it can change,” Pollitz said.

You can compare drug coverage options or benefit programs by visiting the Medicare plan finder.

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