Medicare 101

Basics of Medicare

Medicare is offered to Americans 65 and older. If you’re eligible for Medicare, here are some things you should know.

1: Medicare is not free. There are monthly premiums and cost-sharing for things like deductibles and coinsurance.

2: There are over 56 million people on Medicare

3: There are over 800,000 providers who accept Medicare in the US.

4: In some cases, people under the age of 65 can qualify based on health conditions or disability.

5: Your initial enrollment period is 7 months long and begins 3 months before your turn 65.

6: There are some penalties if you miss the enrollment period and don’t have any other credible health 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?

AEP

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? 

Talk with someone about the following:

• If you have a qualifying chronic condition
• If you have a low income subsidy or Medicaid
• If you’ve moved to a new zip code  
• Changing to a plan with a 5 star rating
• Change in extra help or Medicaid 
• Leaving group coverage or retirement coverage
• If you have VA benefits
• If you move into or out of a Long-term care facility or skilled nursing facility.

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 premium 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 premium, but have copays for most services and feature a cap on your maximum out-of-pocket expenses. Medicare Advantage plans also typically include additional benefits at no extra cost that are not included with traditional Medicare coverage (Part A & B).

What are the Parts (A) and (B) referenced in Medicare?

PART A: HOSPITAL INSURANCE

• Inpatient care including skilled nursing facilities
• Hospice care

PART B: MEDICAL INSURANCE

• Doctor Services (Not Routine Physicals)
• Outpatient Surgeries
• Diagnostic Tests
• ER Visits
• Ambulatory Services
• Durable Medicare Equipment (like wheelchairs, walkers, hospital beds)
• Outpatient Mental Health
• Outpatient Physical and Occupational Therapy
• Speech/Language Therapy

Benefits for Medicare recipients

Most Medicare Advantage Plans offer both Medical and Prescription Drug Coverage. They also include many additonal benefits such as dental, hearing, and vision. Plan benefts will vary by plans and zip codes.

What is Medigap?

Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

• Copayments
• Coinsurance
• Deductibles

Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here’s what happens:

• Medicare will pay its share of the Medicare-Approved Amount for covered health care costs.
• Then, your Medigap insurance company pays its share.

Medigap policies don’t cover everything

Medigap policies generally don’t cover: 

• • Long-term care (like non-skilled care you get in a nursing home)
  • Vision or dental services
  • Hearing aids
  • Eyeglasses
  • Private-duty nursing

Who qualifies for a Medigap plan?

Anyone that is eligible for Medicare parts A&B could qualify for a Medicare Supplement plan as long as they are not under contract with a Medicare Advantage plan and they can pass underwriting!

Some people may qualify for a Medicare Supplement without underwriting

Open Enrollment:

• Open Enrollment (OE) is a 6 month period that begins the first month someone is enrolled in Part B
• During OE there is no underwriting to qualify for a Medicare Supplement plan
  • This means there is no disqualification for pre-existing conditions!
• Can change policy as many times as necessary during this 6 month window

Guaranteed Issue:

• Guaranteed Issue (GI) is for those that have involuntarily lost creditable coverage
• This window allows 60 days before and 63 days after the end of coverage to qualify for certain Medicare Supplement plans without underwriting
• Can change policy as many times as necessary during this window
• Generally occurs after moving to a new service area or changes to standing coverage

Most Common Medigap Plans

Plan N:

• Typically lower premiums than Plan G or Plan F
• Covers most Part B copayments and coinsurance
  • Up to $50 ER visits
  • Up to $20 doctor visits
  • Does not cover Part B Excess Charges – could be responsible for up to 15% above what Medicare allows for billing in certain states
    • Not very common, but can be seen from specialists, surgeons, etc. 
    • Not allowed in CT, MA, MN, NY, OH, PA, RI, VT

What states are Apollo licensed for Medicare?

Apollo is licensed in 35 states to help find a medicare plan that meets your needs and is able to aid in the enrollment process. These states include: AL, AR, AZ, CA, CO, FL, GA, IA, IL, IN, KS, KY, LA , MD, MI, MN, MO, MS, MT, NC, NE, NJ, NM, NV, OH, OK, PA, SC, TN, TX, UT, VA, WA, WI, WY.

FAQ on Medicare

I’m about to turn 65—WHAT DO I DO?

If you are currently collecting Social Security Income (SSI) congratulations you will be automatically enrolled in Original Medicare—parts A & B.

If not then you will need to actively sign up by the following:

• Calling the social security office
• Going to www.socialsecurity.gov and applying online
• Visiting your local social security office in person

I received my Medicare card. Is it important?

Yes!  Your medicare number is what allows someone to determine your current plan and enroll you into any additional plans.  Up until 2018 it was your social security number.  If you are looking at one with your social security number on it then that number has changed…you will want to find one that is a combination of letters and numbers.

Why should I talk to a sales agent?

First and foremost the services of the sales agents are ABSOLUTELY FREE. Your sales agent will have access to dozens of top rated carriers to find that plan that suits you.  This can all be done over the phone in the convenience of your house.  There will be no need to spend hours filling out paperwork and everything you need to get started can be sent right to your doorstep.

Apollo Fights For You

HOW WE HELP

Contact Apollo Today!

After breaking down all your Medicare questions, we would love to help you out in any way possible. If you are looking for help with your health insurance needs or Medicare needs, give us a call!