Upon reaching the age of 65, individuals are required to enroll in the federal health program known as "Medicare". Medicare offers medical benefits to individuals aged 65 and above who are eligible for Social Security retirement benefits, as well as individuals under 65 with permanent disabilities. Spouses and former spouses can also apply through their partner's Social Security benefits. Medicare consists of three main parts: Part A (Hospital Insurance) covers hospital stays, skilled nursing facility services, hospice care, and home health care. Part B (Medical Insurance) provides coverage for outpatient care and doctor visits. Part D is the prescription drug coverage.
To enroll in Medicare, individuals like Chris Kim, who will turn 65 next year, need to apply during the Initial Enrollment Period (IEP), which starts three months before their birthday month and ends three months after. If the IEP is missed, individuals can enroll during the General Enrollment Period (GEP) from January 1 to March 31 of each year. A Special Enrollment Period (SEP) is provided to those who have employer group health insurance coverage, allowing enrollment without penalties within eight months of terminating their workplace health insurance.
For individuals like Paul Song, who have paid Social Security and Medicare taxes for at least 10 years with 40 or more work credits, Part A premiums are exempt. However, those with 30 to 39 credits pay $278 per month, and those with fewer than 30 credits pay $506 per month for Part A. Starting in 2023, the standard Part B premium is $164.90 per month, a decrease from the previous year. However, higher-income Medicare beneficiaries pay more.
Medicare generally doesn't cover services such as dental care, hearing aids, eyeglasses, and non-specialist nursing care. It also requires beneficiaries to share costs through co-payments and deductibles. To reduce these expenses, individuals can opt for Medicare Supplement Insurance (Medi-Gap) plans offered by private insurance companies.
Medicare Advantage plans, or Part C plans, combine the benefits of Parts A, B, and D. These plans are provided by private insurers and can offer additional benefits, such as dental and vision coverage. Enrollment periods for different plans occur annually from October 15 to December 7.
For the Korean community, many individuals are enrolled in HMO plans, but some insurance companies are introducing PPO plans, which provide more flexibility in choosing healthcare providers. United Healthcare, for example, offers a new PPO plan that allows individuals to see any doctor without referrals.
Sunny Kwon, representative of Uni & Good Friend Insurance, advises that Medicare Advantage plans have varying coverage and limitations based on insurers and plans. Therefore, seeking guidance from specialized agents is crucial in selecting the most suitable plan.