Caring for Your Health: A 10-Step Guide for Baby Boomers Preparing for Medicare

Baby Boomers Preparing for Medicare

Congratulations! You’ve reached an exciting milestone in your life as a Baby Boomer preparing for Medicare – you are now eligible for Medicare benefits in Oregon. Medicare is a valuable federal health insurance program that covers many healthcare costs, but it doesn’t cover everything. That’s where Medicare Supplement Insurance, also known as Medigap, comes in. 

Medigap plans help fill the gaps in your Medicare coverage and provide you with added peace of mind. 

To help you navigate this process comfortably, we’ve prepared a comprehensive guide on how to prepare for shopping for Medicare Supplement Insurance in Oregon.

1. Baby Boomers Preparing for Medicare: Understanding Medicare Basics

First things first, let’s get familiar with the basics of Medicare. Medicare is divided into different parts:

Part A: Hospital Insurance – Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Though called “hospital  insurance” the coverage and care extends to in-home care that meets specific criteria. 

That criteria to meet in order to received in-home health care covered by your Medicare includes: 

  • Being considered “homebound” by the Medicare & Medicaid (CMS) definition. This definition is shaped by your difficulty leaving home without a walking device due to injury or illness; leaving your home is not recommended because of your condition; and you rarely leave home because of the immense struggles and difficulties you face when doing so. 
  • – In-home care is needed to improve, maintain, prevent, or slow your condition, and requires part-time or intermittent care of a skilled provider 
  • – Be placed under the care of a nurse practitioner, clinical nurse specialist, physician’s assistant, or doctor who documents care provided for in-person care within the needed timeline before or after the in-home healthcare program has begun. 

Part B: Medical Insurance – Covers doctor visits, outpatient services, preventive services, and medical supplies. This portion of Medicare is often seen as filling in the gaps that may leave a need open for your specific condition or health. Part B covers some in-home health care. It is an optional add on to your personal plan.

Part D: Prescription Drug CoverageHelps with the cost of prescription medications. As we age, we can look back over the years of experiences our body has carried with us. Sometimes, that comes with some pains, long term illnesses, or a heightened awareness of what we want to prevent further down the line. 

Medicare Advantage (Part C)An alternative to Original Medicare, offered by private insurance companies, and often includes prescription drug coverage and additional benefits. Plan C is commonly packaged as the pairing of Part A and Part B with the potential of added coverage, such as vision, hearing, dental, and/or health and wellness programs. Part D is often included as well

2. Baby Boomers Preparing for Medicare: Know the Medicare Enrollment Periods

For Baby Boomers new to Medicare, there are specific enrollment periods you need to be aware of:

  • Initial Enrollment Period (IEP): This is a seven-month window that includes the three months before and after your 65th birthday month. Signing up during this period ensures that you avoid late enrollment penalties.
  • General Enrollment Period (GEP): If you missed the IEP, the GEP runs from January 1 to March 31 each year. However, signing up during this time may lead to higher premiums.
  • Annual Election Period (AEP): Also known as the Fall Open Enrollment Period, it runs from October 15 to December 7. During this time, you can switch between Medicare Advantage and Original Medicare, or change Part D plans.
  • Special Enrollment Period (SEP): Certain life events, such as moving or losing employer coverage, may qualify you for a SEP. This allows you to enroll in or make changes to your Medicare coverage outside the regular enrollment periods

3. Baby Boomers Preparing for Medicare: Research Medicare Supplement Insurance Plans

In Oregon, Medigap plans are standardized, meaning the benefits are the same regardless of the insurance company you choose. Currently, there are ten standardized plans labeled with letters (e.g., Plan A, Plan B, etc.). Each plan offers a different combination of benefits, so it’s essential to research and compare the options to find the one that suits your needs and budget best.

4. Baby Boomers Preparing for Medicare: Compare Costs and Coverage

When shopping for Medicare Supplement Insurance, consider both the coverage provided and the cost of the plan. Remember that higher premiums may mean more extensive coverage, but it’s crucial to strike a balance between your healthcare needs and your budget. At this point in your fully lived life, you have navigated finding the right insurance plans multiple times over. You understand the differences between coverages and the associated gaps left behind. 

5. Baby Boomers Preparing for Medicare: Check for Guaranteed Issue Rights

During certain situations, you have guaranteed issue rights, which mean insurance companies cannot deny you coverage or charge you more due to pre-existing conditions. Often times in the search for health insurance, the phrase itself can be scary. It is often seen to bar individuals from affordable and effective care. Considering nearly 50% of Americans qualify to ail from “pre-existing conditions” its a fear that is rampant and real. Guaranteed issue rights help to ensure that very situation doesn’t play out in reality. 

Other situations that can trigger guaranteed issue rights include losing employer coverage, your Medicare Advantage plan leaving your area, or your Medigap company going bankrupt.

Regardless of the situation, care is available when you are covered by the right, fitting Medicare and/or Medigap plan. 

Baby Boomers preparing for medicare

6. Baby Boomers Preparing for Medicare: Look for Local Insurance Companies

While Medigap plans are standardized, the prices offered by insurance companies may vary. It’s a good idea to look for insurance providers in your local area as they may offer competitive rates and better customer service.

Its also worth noting, working with an independent agent means you get to work with the same agent who does the work searching for the right coverage from the right company, tailored just right for you. 

7. Baby Boomers Preparing for Medicare: Speak with a Medigap Insurance Specialist

If you find the process overwhelming, don’t hesitate to reach out to a Medigap insurance specialist or broker. These professionals can provide valuable guidance and help you find the best plan based on your unique needs. When it comes to something as important as finding the right coverage, speaking with a specialist can help ensure you and your health are covered in the ways they specifically need to be. 

8. Baby Boomers Preparing for Medicare: Attend Medicare Seminars and Workshops

Many organizations and community centers offer free seminars and workshops on Medicare and Medigap. These events can be informative and allow you to ask questions directly to experts.

In Oregon, SHIBA, or Senior Health Insurance Benefits and Assistance, offer in-person events where you can speak directly to your needs and how they are met here in Oregon. 

9. Baby Boomers Preparing for Medicare: Review Your Current Healthcare Needs

Before finalizing your decision, take some time to review your current healthcare needs. Consider your current medical conditions, prescription medications, and the doctors and hospitals you prefer. This assessment will help you choose a plan that covers your specific requirements.

There are a number of personal and bodily elements to consider, and it can also feel overwhelming. In the ever-changing landscape of both your health, and the state of offered healthcare, Harvard Medical School released a guide of the 11 things to consider in assessing where your health currently is, where it could improve or degrade, and what to take stock of in order to have the needed awareness to get the care you need, when you need it. 

10. Baby Boomers Preparing for Medicare: Avoid Common Scams

Unfortunately, there are scams that target Medicare beneficiaries. Be cautious of unsolicited phone calls, emails, or door-to-door salespeople claiming to offer “limited-time deals.” Always verify the legitimacy of any offers you receive and report suspicious activity to the proper authorities.

Alternatively, and sadly, if you are told that you have to verify your identity in any manner that divulges sensitive information to unfamiliar individuals, especially under the informal notification that your card is invalid, or your coverage is suddenly expiring, you may be the target of the most common scam approaches to Medicare recipients. 

Baby Boomers preparing for medicare

As a Baby Boomer entering the world of Medicare in Oregon, preparing to shop for Medicare Supplement Insurance doesn’t have to be daunting. Armed with this guide and some careful consideration of your healthcare needs and budget, you’ll be better equipped to make an informed decision. Remember to take advantage of available resources, seek expert advice when needed, and don’t rush the process. Medicare Supplement Insurance can be a valuable investment in your health and well-being for years to come.

With so many questions to consider, and so many resources to tap into, you can give us a call to review your policy, discover the options that fit best for you, or discuss available discounts.

541.482.0831 Ashland

541.857.0679 Medford