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Medicare 101

YOUR MEDICARE OPTIONS

Medicare enrollment can be confusing & overwhelming, but it doesn’t have to be.

Original Medicare is a federal health insurance program for people 65 & older and others with disabilities; while invaluable, the program alone may not suffice. Gaps in coverage, such as deductibles, copayments and prescription drugs, are not included under Original Medicare. To address these gaps and enhance coverage, Seniors often opt for additional plans, such as Part D, Medicare Advantage or Medigap...and that's where we can assist! 

Our agency is independent and we use selected, reputable carriers to bring you the best coverage that suits both your needs and budget.

Your plan choices don’t have to be permanent; health, lifestyle and even budgets often change. Let us review your current coverage to make sure you have the best plan for you.

It’s important to know when & how you can enroll to avoid penalty and missed opportunity.

ANNUAL ENROLLMENT PERIOD

This is the designated time for anyone Medicare eligible, regardless of plan type, to enroll or change 

Oct 15 – Dec 7

OPEN ENROLLMENT PERIOD

This is the designated time for anyone who is specifically on Medicare Advantage to change plans or disenroll 

Jan 1 - Mar 31

INITIAL ELECTION PERIOD

This timeframe depends on when you turn 65 - your enrollment window starts 3 months before, continues the month of and up to 3 months after your Birthday month

SPECIAL ELECTION PERIODS 

There are various exceptions to the standard enrollment periods, known as SEP

- Leaving employer coverage

- Losing/Gaining Medicaid eligibility

- You change where you live

Original Medicare is provided by the federal government offering:

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Hospital and Skilled Nursing

This is called Part A - generally premium free for most - there is a large deductible for inpatient stays and a daily copay for skilled nursing longer than 20 days 

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Doctor Visits and Other Medical Care
This is called Part B - you pay a monthly premium for it - there is a 20% coinsurance and an annual deductible

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Original Medicare does NOT include prescription drug coverage.

Depending on your needs you may want to add more coverage.

Additional coverage is offered by private insurance companies.

You have a couple of different options to choose from:

Option 1: Enroll in a Medicare Advantage plan
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Also called Part C - These plans combine Part A & Part B. Most Medicare Advantage plans also include Part D, so your hospital, medical & prescription drug insurance is all in one plan. Many Part C plans also include dental, vision and hearing benefits

Option 2: Add to Original Medicare
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Medicare Supplement - Helps pay for most of the costs not covered by Original Medicare.

Medicare Part D plan - Helps pay for prescription drugs & helps you avoid the late enrollment penalty (you are required to have Part D even if you're not on any medication)

Medicare FAQs

Do I need to sign up for Medicare if I'm still working past 65? 

It depends on how you get your health insurance now and the number of employees that are in the company where you (or your spouse) work.

-If you're self employed and don't have 'group health coverage' (as defined by the IRS) then you will need to enroll in Medicare when you turn 65 to avoid a monthly Part B late enrollment penalty

-If your employer has less than 20 employees you will need to sign up for Medicare when you turn 65

-If you have COBRA you will need to sign up for Medicare when you turn 65 to avoid a monthly part B late enrollment penalty

Do I need to get Medicare drug coverage (Part D) if I'm not taking any prescriptions? 

YES! Even if you are not utilizing the benefits, you must maintain creditable drug coverage to avoid the Part D late enrollment penalty

How much does Medicare Cost?

Part A - is "premium free" for most people (who paid Medicare taxes at least 10 years) but there is a deductible of $1,600 for each time you are admitted to the hospital and a daily copayment if you are confined beyond 60 days and a daily copayment for skilled nursing facilities beyond 20 days
 

Part B - has a standard premium of $174.70 each month (higher income earners will also pay an Income Related Monthly Adjustment Amount (IRMAA) in addition to the standard premium); you might pay a penalty if you don't sign up for Part B when you're first eligible.  The deductible is $240 each year before Medicare starts to pay plus you'll usually pay 20% of the cost for each covered service thereafter


Parts C, D and Medigap - Monthly premiums vary based on which policy you buy, where you live, and other factors. The amount can change each year. It is very important to talk to a qualified professional to help you navigate these choices, you can CHECK HERE for an idea of costs in your area but it’s highly recommended you do not enroll on your own without guidance

How does Medicare enrollment work?

You only need to sign up for Part A and Part B once. Each year, you can choose which way you get additional coverage (and add or switch drug plans).  Medicare is different from private insurance — it doesn’t offer plans for couples or families. You don’t have to make the same choice as your spouse, either. It is recommended you review your Medicare options annually at the allotted time (Oct 15 - Dec 7)

In addition to the Annual Enrollment Period (AEP) there are also other qualifying election periods, known as Special Enrollment Periods (SEP) that are based on specific circumstances and the plans available in your area 

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