As a United States citizen who has reached the age of 65 or above, you have the opportunity to enroll in Medicare, the federally provided healthcare program. Medicare consists of Parts A and B, commonly known as Original Medicare, which provide coverage for fundamental hospital and doctor expenses.

However, Original Medicare leaves certain expenses uncovered, resulting in potential out-of-pocket expenses. To safeguard against these gaps in coverage, Medicare supplements or Medicare Advantage plans are available, offering additional protection. Our team has extensive experience assisting clients in comprehending the coverage provided by Original Medicare and identifying plan options that align with their individual circumstances. We are dedicated to helping individuals make informed decisions about their healthcare coverage.

Enrollment Opportunities

Annual Enrollment
Period (AEP) for
Part C & D

For Medicare Recipients that have Medicare Part A and/or Part B they are eligible to enroll into or change their Medicare Prescription Drug Plan (Part D) between October 15th and December 7th and all those enrollments will take effect on January 1st.
For Medicare Recipients that have Medicare Part A and Part B they are eligible to enroll into or change their Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan (Part C) between October 15th and December 7th and all those enrollments will take effect on January 1st.

When are the Enrollment Periods?

Open Enrollment
for Medigap:

If someone would like to purchase a Medigap Plan (Medicare Supplement) instead of a Medicare Advantage Plan, they have a 6 month “Open Enrollment window” starting the day their Part B takes effect where they can do so without being subjected to medical underwriting by an insurance carrier. Medigap Plans can also be purchased at any time throughout the year, but they would be subject to underwriting if outside of the Open Enrollment.

Are There Times I May Be
Able to Enroll Outside the
Enrollment Periods?

It is essential to consult with a representative who can provide personalized guidance based on your specific circumstances and help you understand the options available for enrolling in or changing your Medicare coverage outside the regular enrollment periods.

Medicare
Advantage

Medicare Advantage Plans will minimize your overall risk, while keeping your monthly costs at a minimum due to being a network-based type of coverage.
Medicare Advantage plans are more “pay as you go” with little to no monthly payments, but have copays for most services and feature a cap on your maximum out-of-pocket expenses.

Certain Medigap policies provide coverage for services that are not covered by Original Medicare, such as medical care received when traveling outside of the United States. If you have Original Medicare and you choose to purchase a Medigap policy, the following occurs:

1. Medicare Coverage: Medicare will first pay its portion of the Medicare-approved amount for the covered healthcare services you receive.
2. Medigap Coverage: After Medicare has paid its share, your Medigap insurance company will then pay its portion of the remaining costs. This helps fill the gaps in coverage left by Original Medicare.

By combining Original Medicare with a Medigap policy, you can have more comprehensive coverage and potentially lower out-of-pocket expenses for healthcare services. The Medigap policy works alongside Original Medicare to provide additional financial protection and peace of mind.

What is Medigap?

Medigap, also known as Medicare Supplement Insurance, is a private insurance coverage that assists in filling the gaps left by Original Medicare. While Original Medicare covers a substantial portion of the expenses for healthcare services and supplies, it does not cover everything. By obtaining a Medigap policy, you can alleviate some of the remaining healthcare costs, such as copayments, coinsurance, and deductibles. Moreover, certain Medigap policies provide coverage for services that are not included in Original Medicare, such as medical care during international travel. If you have Original Medicare and decide to purchase a Medigap policy, the following process occurs:

Medicare will cover its portion of the Medicare-Approved Amount for the healthcare costs that are eligible.
Afterward, your Medigap insurance company will cover its portion of the expenses.

Medigap Policies Don’t Cover Everything

Typically, Medigap policies do not provide coverage for the following:

Long-term care: This refers to non-skilled care received in a nursing home or assisted living facility.

Vision or dental services: Medigap does not cover routine vision or dental care, such as eye exams, eyeglasses, or dental procedures.

Hearing aids: The cost of hearing aids is generally not covered by Medigap policies.

Eyeglasses: Medigap does not cover the expenses related to purchasing or replacing eyeglasses.

Private-duty nursing: Medigap policies do not typically cover the costs associated with private-duty nursing services, which involve hiring a nurse for in-home care.

It’s important to note that while Medigap policies do not cover these services, you may be able to obtain separate insurance or coverage for them, such as standalone dental or vision insurance plans.

Who Qualifies for a Medigap Plan?

Individuals who are eligible for Medicare Parts A and B can qualify for a Medicare Supplement plan,
provided they are not enrolled in a Medicare Advantage plan and can pass underwriting.

However, there are circumstances where individuals may qualify for a Medicare Supplement plan
without undergoing underwriting:

It’s important to note that these eligibility criteria and enrollment periods may vary, so it’s advisable to consult with a Medicare representative or insurance provider for specific details and guidance based on individual circumstances.

Most Common Medigap Plans

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