Caroline Edlund, LCSW-R, is the Online Support Group Program Director at CancerCare. She provides supportive counseling and resources to people coping with cancer and people who have experienced the loss of a loved one.
Enrolling in Medicare can seem like a daunting process, especially if you have cancer—so much so that you may be tempted to put off the application or even give up on it entirely. However, this can lead to serious long-term consequences that affect your cancer care coverage and finances.
With a little patience and preparation, you can successfully navigate the Medicare enrollment process. Here are 5 tips to keep in mind.
1. Get an early start on your Medicare application
You become eligible for Medicare when you turn 65 and are a U.S. citizen or permanent resident. You can choose to sign up then or hold off on the process if you still work and receive benefits through your employer. Either way, it is important to note that enrollment is not automatic unless you already draw retirement benefits from Social Security.
The enrollment period begins 3 months before your 65th birthday and ends 3 months after. It’s very important that you meet the deadline. Missing the enrollment window can leave you without insurance coverage for months. It’s also common for penalty fees to be added to your plan costs. These fees are permanent, so you may find yourself paying higher rates for health care for the rest of your life.
The U.S. Social Security Administration handles Medicare enrollment and is your main point of contact for questions and concerns throughout the process. You can apply online on this U.S. government website or visit a local Social Security office. You can also call the main office at 1-800-772-1213 for more information.
2. Know your Medicare plan options
Everyone has different health care needs. The best Medicare plan for you may look different from what works for others in your life. Having a cancer diagnosis adds an additional layer to consider. Before making any enrollment decisions, it’s important to do your research and understand how Medicare is structured.
The U.S. government’s Medicare website offers helpful information. Or you can call 1-800-MEDICARE. You can also get free guidance through the State Health Insurance Assistance Program (SHIP). This federally funded counseling service offers objective support to help you understand your options. Call SHIP at 1-877-839-2675 or visit the SHIP National Technical Assistance Center website.
As you do your research, these are some of the Medicare plans you may encounter:
- Part A of original Medicare covers inpatient hospitalization, skilled nursing care, hospice, and some home care services.
- Part B of original Medicare covers outpatient services such as doctor’s visits, physical and occupational therapy, preventive screenings, and some medical equipment and supplies.
- Part D covers outpatient prescription drugs.
- Part C or Medicare Advantage is an alternative coverage plan offered through federally approved private insurance companies. These plans are required to provide at least the same coverage as Parts A and B and in most cases, Part D. However, they may have different rules, costs, and coverage restrictions.
- Private Medigap plans supplement the coverage offered by original Medicare. They also help pay out-of-pocket costs such as co-payments (the amount you pay each time you receive medical care) and deductibles (the amount you pay each year before health insurance kicks in). There’s a separate 6-month open enrollment period for these plans. While it’s possible to buy them outside of that timeframe, you may be denied coverage or be charged a higher rate for pre-existing conditions like cancer.
3. Consider which Medicare plan meets your needs
When reviewing Medicare coverage plans, it’s important to consider how your choices may impact your cancer care and finances. For instance, choosing original Medicare allows you to see any doctor you want, but can bring significant out-of-pocket costs. However, a Medicare Advantage plan limits your choice of doctors but tends to be less expensive. Consider whether you are willing to switch doctors. Be sure to ask any doctor you plan on seeing what plans they accept.
If you regularly take prescription medication, be aware that original Medicare does not offer drug coverage. You will need to buy Part D or choose from among the Medicare Advantage plans for that type of coverage. However, not all Advantage plans include drug coverage, and costs can be very different from plan to plan. Whatever plan you choose, make sure that it meets your health care needs and your budget.
And again, enrollment deadlines matter. While you can generally buy coverage after enrollment deadlines pass, you don’t want those permanent penalty fees to be added to your plan costs. So, do your best to meet the deadline dates.
4. Review your Medicare choices each year
Whether you enroll in original Medicare or a Medicare Advantage plan, you generally do not need to renew coverage every year. That being said, plans are sometimes discontinued or their benefits and costs may change to the point that the plan no longer meets your needs. It’s not unusual for pharmacy and provider networks to change, for costs to increase, or the list of covered prescription drugs to vary. That’s why it’s a good idea to review your plan each year and compare it against your current health care needs.
Your health insurer is required to send you an “Annual Notice of Change” by September 30 each year. The notice outlines any changes in coverage and costs expected to begin the following January. If you decide to change your health care plan after reviewing those updates, you can do so during Medicare’s open enrollment period. The period runs from October 15 to December 7. During this time, you can switch from original Medicare to Medicare Advantage or vice versa. You can switch from one Medicare Advantage plan to another or from one Medicare Part D plan to another. You can also enroll in Medicare Part D if you have not done so already, although late enrollment penalties may apply.
If you find that the new health care plan is not meeting your needs, you can reverse some plan decisions January 1 to March 31 of the following year. Guidance for the renewal process is offered through the U.S. government’s phone line at 1-800-MEDICARE or through your local SHIP.
5. Be patient with yourself as you navigate Medicare
Applying for Medicare coverage can seem overwhelming at first, but it’s something you can absolutely manage. If you give yourself plenty of time and use the available help and support, you can make the choices you need to ensure comprehensive coverage for yourself and your cancer care.