Medicare 101: Anita's Story

Medicare can be a complex topic. Follow along as we recount how Marsha, a financial professional, assisted Anita and her daughter as they navigated the basics of Medicare coverage and enrollment.

Anita's story is told from the perspective of Carlo Cordasco, Director of the Insights and Field Solutions team within the Nationwide Retirement Institute®. Carlo regularly interacts with and supports financial professionals in the field.

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Listen in as specialists from the Nationwide Retirement Institute and the Advanced Consulting Group discuss Medicare:

Medicare 101: Facts and common questions: A conversation about Medicare basics plus the concerns and misconceptions among clients who are on the cusp of enrolling.

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Anita's Story

Anita is on the cusp of turning 65 and plans to retire that same month — which means she would lose her employer-provided health care. She is speaking to her financial professional, Marsha, about enrolling in Medicare and wants to ensure there are no gaps in coverage.

Marsha explains that Medicare enrollment is permitted in the three months preceding Anita's 65th birthday, her birthday month, and for three months following her birthday month. This seven-month window is called the Initial Enrollment Period.

Because Anita is planning to retire in June (the month of her birthday), Marsha suggests she enroll in April to ensure that coverage begins in time. If you enroll in advance of your birthday, coverage begins on the first day of your birthday month.

A disappointing revelation

Next, the two discuss Medicare costs. Anita is surprised to learn that Medicare is not free. There are monthly premiums, plus potential deductibles and co-pays.

Marsha explains the two principal choices Anita has when enrolling: Original Medicare or a Medicare Advantage plan. Original Medicare is a national program that would allow Anita the ability to see any doctor who accepts Medicare. It is often supplemented with an optional Medigap policy, which helps cover deductibles and co-pays. Original Medicare is often considered to offer more flexibility and choice.

Medicare Advantage plans, on the other hand, may offer more convenience. Although they are often limited to local networks of doctors, they may cover services that Original Medicare does not, such as hearing, dental and vision care.

Anita is alert to the difference between Original Medicare being a national program and Medicare Advantage plans being localized. She has two sons on the West Coast and a sister in Puerto Rico, all of whom she travels to visit. As a U.S. territory, Puerto Rico is included in the national network of Original Medicare.

Together, Marsha and Anita conclude that Original Medicare, plus a Medigap policy, is the best solution.

Two separate timelines

One other interesting point comes up in their conversation: A friend of Anita’s had told her that she has to be receiving Social Security benefits to enroll in Medicare. Marsha quickly clarifies that this is not true. Enrolling in these two programs are independent tasks; Medicare enrollment usually happens right at age 65, while drawing Social Security benefits can begin anytime between ages 62 and 70.

The meeting ends with Marsha referring Anita to additional resources, such as her State Health Insurance Assistance Program, Medicare.gov, and the National Council on Aging.

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Nationwide has a paid sponsorship agreement in place with the National Council on Aging (NCOA) to help promote financial wellness concepts for older consumers.

The information in the linked documents is sourced from medicare.gov, cms.gov, hhs.gov and some state-level sources.

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