Medicare in a Nutshell

Medicare in a nutshell

Medicare in a nutshell, it is a federal health insurance program that gives you access to specific coverage and benefits. Medicare is different from health insurance you may have had before. It offers you a variety of coverage options — and it has key enrollment dates and guidelines you need to follow. We’re here to help you make sense of it all.

1) Open Enrollment Dates

The annual election period for Medicare products is fast approaching:

Annual election period (October 15 – December 7)

Medicare Advantage Open Enrollment Period (January 1 – March 31)

Special Enrollment Periods are available when special circumstances arise.

Just a reminder; Open enrollment applies to Medicare Advantage & Prescription Drug Plans.

Medicare Supplements are secondary to Medicare and can be applied for at any time.

2) Confusion about when a current Medicare Enrollee can make plan changes

Medicare eligible consumers have many carriers, plans and plan types to choose from. It may seem overwhelming. Using an experienced, licensed agent can assist consumers to understand their options so they can elect the carrier, plan and plan type that would offer the most benefits.

Just a reminder: I represent many Advantage plans in Arizona as wellas Prescription drug plans.

3) Medicare eligible but still working

Many Medicare eligible people remain in the work force even after becoming eligible for Medicare benefits. Understanding how this affects those benefits is necessary so they can make decisions that will maximize their benefits. Group benefits can offer better prescription coverage than Medicare drug coverage, so staying on your group plan may be a good idea. But can that cause negative issues when the employee retires? Not necessarily. Working with a qualified agent to evaluate that employee’s situation, can create an advantageous plan to find the correct coverage as you transition from retiring from the work force and moving to full retirement.

Be sure to know all your options before leaving a group plan.

4) What do all the Parts and Plans mean? 

Original Medicare is made up of Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare eligible consumers enrolled in Part A and B can enroll in a Medicare Supplement and/or a Part D plan (Prescription Drug Insurance)

Part C is known as Medicare Advantage which is an “all in one” alternative to Original Medicare. These plans include Part A and B and can include Part D (Prescription Drug Insurance)

Part D is the prescription drug coverage available to qualified Medicare eligible consumers.

Plans normally refer to the different Medicare Supplement plans available to purchase with your original Medicare Part A and B. The plans associated with each letter offer different benefits. But each plan’s benefits will be identical between the different insurance carriers. Example: Plan G will have the exact same benefits regardless of which carrier you purchase the plan from. Plan G is the richest plan available while plan A offers the lowest amount of coverage.

Plan F & C are no longer available to new enrollees, but you may currently have f or c if you eligible prior to Jan 1,2020.

5) When can you enroll in Medicare?

When you are first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.

For example, if you are eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

• Begins 3 months before the month you turn 65.
• Includes the month you turn 65.
• Ends 3 months after the month you turn 65.

If you are not automatically enrolled, you can sign up for free Part A (if you are eligible) any time during or after your Initial Enrollment Period starts. Your coverage start date will depend on when you sign up. If you must buy Part A and/or Part B, you can only sign up during a valid enrollment period.

If you wait until the month, you turn 65 (or the 3 months after you turn 65) to enroll, your Part B coverage will be delayed. This could cause a gap in your coverage.

In most cases, if you don’t sign up for Medicare Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll have to pay this penalty for as long as you have Part B and could have a gap in your health coverage. Your monthly premium for Part B may go up 10% of the standard premium for each full 12-month period that you could have had Part B but didn’t sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Coverage will start July 1 of that year.

Usually, you don’t pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period (Example: covered under an employer group health plan).

It is extremely important to make sure that you don’t miss your enrollment period.

6) What is not covered by Part A and Part B?

• Deductible, coinsurance, and co-payment
• Long-term care (also called custodial care)
• Most dental care
• Eye exams related to prescription glasses.
• Dentures
• Cosmetic surgery
• Acupuncture
• Hearing aids and exams for fitting them.
• Routine foot care

Most of these benefits are available through separate policies. Let me know if you would like a quote on any of them.

Also, Medicare Advantage plans may cover many of these benefits.