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What is Medicare?
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.
Your Trusted Health Advisor
How Does Medicare Work?
Medicare is a federal health insurance program that provides coverage for eligible individuals, primarily those aged 65 and older, as well as certain younger individuals with disabilities or specific medical conditions.
It is divided into different parts, including Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage). Medicare enrollment occurs during specific periods, and there are costs involved such as deductibles and co-payments.
To choose the right coverage, individuals can consider options like Original Medicare, Medicare Advantage, or supplemental coverage like Medigap plans.
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.
Medicare Basics
Medicare is not free
There are over 56 million
people on Medicare.
There are over 800,000
providers who accept
Medicare in the US.
In some cases, people
under the age of 65
can qualify based on
health conditions or
disability.
Your initial enrollment
period is 7 months long
and begins 3 months
before your turn 65.
There are some penalties
if you miss the enrollment
period and don’t have
any other credible health
coverage.
Enrollment Opportunities
Initial Election
Period for
Part C & D:
When you first turn 65 (or become eligible for Medicare prior to age 65 through special circumstance) and have enrolled in Part A & B of Medicare, you will have a 7-month window to enroll in a Medicare Advantage Plan (Part C) or Prescription Drug Plan (Part D).
This 7-month window is the 3 months prior to your Part A & B starting, the month they take effect, and the 3 months following that effective month.
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.
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?
AEP: Annual Enrollment Period
The Medicare Annual Enrollment Period (AEP) is October 15th-December 7th and all plans will take effect January 1st. Medicare recipients can add, switch, or drop a plan. You are also allowed to enroll in as many plans as you want and typically the last enrollment completed during the enrollment period will be the one that goes into effect January 1st of the following year.
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?
Low Income Subsidy or Medicaid
If you qualify for a low income subsidy or Medicaid, you may have opportunities to enroll in Medicare outside the regular enrollment periods.
Qualifying Chronic Condition:
If you have a chronic condition that meets the eligibility criteria, you may be able to enroll outside the enrollment periods.
Change of Residence
If you have moved to a new zip code, you may be eligible for a special enrollment period to enroll in or change your Medicare plan.
5-Star Rated Plans:
You may be able to enroll in a plan with a 5-star rating outside the enrollment periods, as these plans offer exceptional quality and performance.
Changes in Extra Help or Medicaid:
If you experience changes in your eligibility for extra help or Medicaid, you may have options to enroll or make changes to your Medicare coverage.
Leaving Group Coverage or Retirement Coverage
If you are leaving a group health insurance plan or retirement coverage, you may be eligible for a special enrollment period to enroll in Medicare.
Veterans Affairs (VA)
If you have VA, you may have flexibility in enrolling in or changing your Medicare coverage.
Moving into or out of Long-Term Care Facility
If you are moving into or out of a long-term care facility or skilled nursing facility, there may be opportunities to enroll or make changes to your Medicare plan.
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
Supplement
VS.
Medicare
Advantage
Medicare Supplement Insurance Plans are also called Medigap Plans. These types of policies can help with the cost of your deductibles, copayments, coinsurance and excess charges depending on the coverage you choose, as there are several different Medigap options.
Medicare Supplements are more “pay up front” with a higher monthly paymet and very little cost as you use them.
Medicare Supplements follow the coverage and freedoms of Medicare, meaning they work the same everywhere in the US and are not a network-based type of coverage.
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:
- Medicare Coverage: Medicare will first pay its portion of the Medicare-approved amount for the covered healthcare services you receive.
- 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.