Three months or so before the happy occasion of your 65th birthday, you will receive a gift from the federal government — a little red, white and blue Medicare card. If you do nothing, you will be automatically enrolled in Medicare Parts A and B on your birthday. Part A, which was discussed in an earlier article, is for hospital care. Part B is what is called “major medical insurance,” and, unlike Part A, there is a monthly premium.

Anyone who participates in a group health plan, such as Local 802 Plan A or B, qualifies for a “Special Enrollment Period” for Part B. You may enroll anytime while you have the group coverage, or during the eight months after your employment ends or your group coverage ends, whichever comes first. This means you can defer the expense of Part B coverage until you need it.

However, there is some important fine print: take note of this. If you delay enrolling in Medicare Part B for more than eight months, the premium will rise 10 percent for each 12-month period you delayed enrolling. So you have to crunch the numbers carefully. If you are a 65-year-old musician who does enough union gigs to qualify for the Local 802 health plan, you can delay your Medicare Part B and thus delay the monthly costs. But if and when you do finally enroll in Medicare Part B, your premiums will be higher.

Medicare Part B covers medical services outside a hospital. These include physician care, lab tests, physical rehabilitation, ambulance services and some preventive care. It does not cover acupuncture, most chiropractic services, cosmetic surgery, most dental care, most eye care, long-term nursing home care, routine foot care, most prescription drugs or most routine physical exams. 

Upon enrollment you should schedule a “Welcome to Medicare” physical exam. This is the only routine physical exam covered by Part B, and it will only be covered within the first six months of enrollment. This exam is intended to establish a benchmark of your general health and is a chance to get counseling about what kinds of screenings, shots or referrals you may need.

While coverage under Part A is premium-free for most people, there is a monthly premium for Part B which depends on income. (See the chart below.)

By law, increases in these premiums may not exceed any beneficiary’s cost-of-living adjustment in his or her Social Security check.

The yearly deductible is $135, after which Medicare usually pays 80 percent of the covered charges, leaving you responsible for 20 percent. This applies to the “Welcome to Medicare” physical exam and most other services covered under Part B.

You may purchase a “Medigap” policy to help pay for the deductible and 20 percent co-insurance. As discussed in an earlier article, Medigap policies are sold privately, standardized and must be identified as “Medicare Supplement Insurance.” They cannot be used to pay Part B premiums and cannot be used with Part C, which will be discussed in a future article.

If you have an income of less than $1,169 a month for an individual or $1,561 for a couple, and have less than $4,000 in resources ($6,000 for a couple) other than a home, you may qualify for Medicaid. These income qualification levels may be higher in some states. Medicaid is jointly funded by federal and state governments and can be used to help pay your Medicare Part B premiums. Call Local 802’s Musicians’ Assistance Program at (212) 397-4802 to learn more about Medicaid and if you qualify.

If you are at least 55 years old and very frail, you may be able to make use of the Program of All-Inclusive Care for the Elderly (PACE). This is a joint Medicare/Medicaid program. Again, Call the Musicians’ Assistance Program to learn more.

LOWER COSTS

You may be able to avoid some medical costs if you “assign” Medicare payments to your health care provider. If your provider agrees to accept assignment, Medicare will pay him or her directly for the service and you will pay the deductible and co-insurance. If your provider does not accept assignment, he or she must submit claims to Medicare — but may then charge you up to 15 percent above the Medicare approved amount. Talk to your provider for more details.

One final note, which is sad to say. Some providers will not accept Medicare patients at all; you will have to pay them the full amount that they charge if you make use of their services.

Medicare presents an opportunity to reap the rewards of paying into the system all of your working life. May you live long and prosper.