By Jackie Dover
My Friend Said I Should
Recently I had some sisters in my office to go over Medicare information and what each of them should do and when. They were from a big family and had many siblings and cousins who were all in the “talking about Medicare” stage of their lives and had been sharing information and what has worked for them. After talking for a little bit one of the sisters remarked “Medicare is going to look different for all of us”. Even though Medicare is a federal program and is pretty standardized it can look different for each person. What works for your friend or neighbor may not be the best thing for you.
Some things that affect Medicare depend on if you have other insurance coverage and where that coverage is from. If you are working and have insurance through your employer or your spouse is working and has coverage on you through their employer, you can delay taking Medicare Part B without penalty or waiting for an open enrollment period. It must be coverage through an Employee Group Health Plan (EGHP) with active employment. Retiree coverage does not count for this circumstance.
You can also have Medicare and Medicaid or a Medicare Savings Program, in this case, Medicare will pay first and then Medicaid. Medicare Savings Programs cover the Medicare Part B and Part A premium if there is one. One of these programs also covers co-pays and deductibles. Some beneficiaries have a Medicaid spend-down that has to be met before they have Medicaid. So even in Medicaid programs what coverage a person has can vary.
Medicare Advantage, Medicare prescription plans and veteran’s benefits are all things to look at when making Medicare choices. What benefits are important to you and what coverage you want is an individual decision. There is no one size fits all and it is important to discuss all your options and specific concerns you have when deciding on Medicare.
There are some changes for 2025:
- The Cost of Living Adjustment (COLA) for Social Security is 2.5%; you should notice the change already on your checks.
- The Medicare Part B premium: The standard premium amount for 2025 is $185. You could pay a higher amount if you are a high-income earner or if you qualify for one of the Medicare Savings Programs, you may not pay a Medicare Part B premium.
- The Medicare Part A deductible (Part A is the Hospital or in-patient part of Medicare) will go from $1,632 per benefit period to $1,676 per benefit period.
- The Medicare Part B deductible will increase to $257 per year.
- The Medicare Part D (prescription) has an out of pocket cap this year of $2,000 and there is a new Medicare Prescription Payment Plan to help spread out the cost of prescriptions over the course of the year.
- If you are enrolled in a Medicare Advantage Plan (Part C) and you would like to dis-enroll from that plan and return to Original Medicare, you have until March 31.
- Anyone on Extra Help can change their prescription or Advantage plan throughout the year, if you missed Open Enrollment we may still be able to help you.
- There are programs that could help those who have limited income and resources pay for the different parts of Medicare, call our office for more information.
As always for additional information or if you have questions, please call Aging Matters, 1-800-392-8771 or 573-335-3331.