Medicare

Medicare is a government health insurance program with a complex set of rules and regulations.

In order to sign up for a Medicare Supplement plan or a Medicare Advantage plan, you need to have both parts A and B issued.

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MedicareAEP

October 15

The first day of AEP. You can now make changes to your Medicare Health coverage for 2022.

December 7

Last day of AEP. December 7 is the day to make changes to your Medicare coverage for 2022.

January 1

If you enroll in a different Medicare plan during AEP, your new coverage will go into effect on Jan 1.

The different parts of Medicare coverage

Type of Insurance

What it covers

Prescription drug coverage

Enrollment

Part A

Hospitalization

Includes inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, and home health care

No

Usually automatic if you receive Social Security benefits

Part B

Medical

Includes doctor and other providers' services and outpatient care, preventitve care, durable medical equipment, hospital outpatient services, laboratory tests, X-rays, mental healthcare, and some home health and ambulance services

Typically physician adminstered drugs only

You must enroll

Part C | Medicare Advantage Plans

Not a seperate insurance benefit: a coverage option for Medicare Parts A & B

Allows private health insurance companies tp provide your medicare benefits through what are called Medicare Advantage (MA) plans

Most of Medicare Advantage plans include prescription coverage. Known as MAPD

Optional. You can either enrroll in MA plan or Medigap plan. see differences below

Part D | Prescription Drug Coverage

A seperate coverage option that you can add to Medicare Parts A & B

Prescription Medication

Yes typically oral and self-adminstered drugs

You must enroll. Late penalty may be applied.

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Who is eligible for Medicare?

Individuals who are:

65 years of age or older

Disabled

End-Stage Renal Disease (ESRD)

Medicare Advantage Plans

You can sign up for a Medicare Advantage Plan with or without prescription coverage. You need to have Parts A and B ready before signing up.

Medicare Supplement Plans

You can sign up for Medicare Supplement Plan at any time during the year. Your coverage will start the first day of the following month.

Prescription Drug Plans (Part D)

You can enroll in a prescription coverage along with a Medicare Supplement plan. Part D plans have a separate premium.

How do I Compare Medigap (Supplement) Plans?

Schedule a Medicare Consultation CallFree

Eligibility and Enrollment

Learn about Medicare enrollment periods and find out when you are eligible to make changes to your coverage.

Choosing the Right Coverage

There isn’t a one-size-fits-all solution for every Medicare recipient. Choose coverage tailored to your needs, preference and budget.

Making Changes

Review your coverage every year to make sure your current Medicare Insurance plan meets your evolving needs.

How it Works?

We simplified the Medicare Sign Up process. We untied all the knots hindering you from getting the coverage you deserve

Find A Plan

Decide on Medicare Supplement or Advantage

Review and Compare

Cost, Coverage, and Network are all important factors to make your mind about a plan.

Enroll in a Plan

If you are enrolling in a Medicare Supplement plan, your coverage will start the 1st day of the following month

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What are the Part A and Part B sign up periods?



Initial Enrollment Period

You can first sign up for Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you sign up for Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage begins the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month. If you enroll in and are paying for Part A and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Part B coverage will be delayed.



Special Enrollment Period

After your Initial Enrollment Period is over, you may have a chance to sign up for Medicare during a Special Enrollment Period. If you didn’t sign up for Part B (or Part A if you have to buy it) when you were first eligible because you have group health plan coverage based on current employment your own, a spouse’s, or a family member’s-if you have a disability), you can sign up for Part and or Part B:

Anytime you are still covered by the group health plan
During the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first.



General Enrollment Period

If you did not sign up for Part A (if you have to buy it) and/or Part B (for which you must pay premiums) during your initial Enrollment Period, and you don’t qualify for a Special Enrollment Period between January 1-March 31 each year. Your coverage won’t start until July 1 of that year, and you may have to pay a higher Part A and/or Part B premium for late enrollment. If you are not sure if you qualify for a special enrollment period contact us to learn more.

What are the parts of Medicare?

Part A (Hospital Insurance)

Inpatient care in hospitals

Skilled Nursing Facility Care

Hospice Care

Home Health Care

Part B (Medical Insurance)

Services from doctors and other health care providers

Outpatient care

Home health care

Durable Medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)

Many preventative services (like screenings, shots, or vaccines, and yearly “Wellness” visits).

Part D (Drug Coverage)

Helps cover the cost of prescription drugs (including many recommended shorts or vaccines).

Plans that offer Medicare Drug coverage (part D) are run by private insurance companies that follow rules set by Medicare.

Read more about Pat D plans and coverage here.

More about Medicare?

How Much Does Part A Coverage Cost?

You usually do not pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working for a certain amount of time.

This is sometimes called premium -free part A. if you are not eligible for premium-free Part A, you may be able to buy Part A. For more information on how to pay your part A premium contact us. If you buy Part A, you will pay a premium of either $259 or up to $471 each month in 2021 depending on how long you or your spouse worked and paid Medicare taxes. To get the most up-to-date cost information, contact us or visit Medicare.gov. In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you choose NOT to buy Part A, you can still buy Part B if you are eligible.

What is the Part A late enrollment penalty?

If you are not eligible for premium-free Part A, and you don’t buy it when you are first eligible, your monthly premium may go up 10%. You will have to pay the higher premium for twice the number of years you could have had Part A but did not enroll.

Example: if you were eligible for Part A for 2 years but did not enroll, you will have to pay a 10% higher premium for 4 years.

How much does Part B coverage cost?

The standard Part B premium in 2022 is $170.10. Most people pay the standard Part B premium.

If your modified adjusted gross income is above a certain amount, you may pay an income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

To determine if you will pay the IRMAA, Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago.

Note: you may also pay an extra amount for your Medicare drug coverage (Part D) premium if your modified adjusted gross income is above a certain amount.

What is Part B late enrollment penalty?

If you do not sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty for as long as you have Part B.

Your monthly Part B premium may go up 10% for each full 12 months in the period that you could’ve had part B, but did not enroll. If you are allowed to sign up for Part B during a Special Enrollment Period, you usually do not pay a late enrollment penalty.

Example: Mr. Smith’s initial Enrollment Period ended December 2019. He waited to enroll in Part B until March 2022 during the General Enrollment Period. His coverage begins July 1, 2022. His Part B premium penalty is 20% and he will have to pay this penalty for as long as he has Part B. (Even though Mr. Smith was not covered a total of 27 months, this included only 2 full 12-month periods.)

What if I need help paying for my Medicare health care costs?

Medicare Savings Programs

If you have limited income and resources, you may be able to get help from your state to pay your Medicare costs if you meet certain conditions. There are 4 kinds of Medicare Savings Programs:

1. Qualified Medicare Beneficiary (QMB) Program:

If you are eligible, the QMB Program helps pay for Part A and/or Part B premiums. In addition, Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments. If you get a bill for these charges, tell your provider or the debt collected that you are in the QMB program and can not be charged for Medicare deductibles, coinsurance, and copayments. If you have already made payments on bill for services and items Medicare covers, you have the right to a refund. If you are enrolled in Medicare Advantage Plan, you should also contact the plan to ask them to stop the charges. In some cases, you may be billed a small copayment through Medicaid, if one applies.

Note: To make suer your provider knows your are in the QMB Program, show both your Medicare and Medicaid or QMB card each time you get care. If you have Original Medicare, you can also give your provider a copy of your “Medicare Summary Notice” (MSN. Your MSN will shou you are in the QMB Program and should not be billed.

2. Specified Low-Income Medicare Beneficiary (SLMB) Program

Helps pay Part B premiums only

3. Qualifying Individual (QI) Program:

Helps pay Part B premiums only. Applications are granted on first come, first served basis.

4. Qualified Disabled and Working Individuals (QDWI) Program:

Helps pay Part A premiums only. You may qualify for this program if you have a disability, you are working, and you lost your Social Security disability.

Medicare Diabetes Prevention Program

Medicare covers a once-per-lifetime health behavior change program to help you prevent type 2 diabetes. The program begins with weekly core sessions offered in a group setting over a 6-month period. IN these sessions, you will get:

Training to make realistic, lasting behavior changes around diet and exercise.
Tips on how to get more exercise.
Strategies for controlling your weight.
A specially trained coach to help keep you motivated.
Support from people with similar goals and challenges.

Once you complete the core sessions, you will get:

6 months follow-up sessions to help maintain healthy habits.
12 additional months of ongoing maintenance sessions if you meet certain weight loss and attendance goals.

To be eligible, all of these conditions must apply to you:

You have Part B.
You have a hemoglobin A1c test result between 5.7 and 6.4%, a fasting plasma glucose of 110-125mg/dl, or a 2-hour plasma glucose of 140-199 mg/dl (oral glucose tolerant test) within 12 months prior to attending the first core session.
You have a body mass index (BMI) of 25 or more (BMI of 23 or more if you are Asian).
You have never been diagnosed with type 1 or Type 2 diabetes, or END-Stage Renal Disease (ESRD).
You have never participated in the Medicare Diabetes Prevention Program.

What is NOT covered by Part A and Part B?

Some of the items and services that Original Medicare does not cover include:

Most Dental Care
Eye Exams (for prescription glasses).
Dentures
Cosmetic Surgery
Massage therapy
Routine physical exam
Hearing Aids and exams for fitting them
Long-term care
Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)
Covered items or services you get from an opt out doctor or other provider (except in the case of emergency or urgent need).

To get coverage for the services mention above you need to enroll in a Medicare Supplement Plan, Medicare Advantage Plan or Dental and Vision Plan.

If you enroll in a Medicare Advantage Plan with Drug Coverage (MAPD) you may have Dental, Vision, and hearing services covered. Check available MAPD plans in your area to learn more about the plan details. If you need help finding the covered services under your Medicare Advantage (MAPD) plan, contact us.

If you enroll in a Medicare Supplement plan you will still have to enroll in a Prescription Part D plan to get drug coverage. Be careful or speak to your agent about Part D penalty.

You can enroll in a separate Dental and Vision plan at any time during the year. There are different Dental and Vision plans available for you with difference carriers. Our Dental and Vision page allows you to explore the different plan benefits and coverages.

Medicare Supplement Guaranteed Issue Rights

This table describes the situations where you have the right to buy a policy without any pre-existing condition exclusions, the kind of policy you can buy, and when you can or must apply for it:

You are in a Medicare Advantage Plan (HMO or PPO), and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area

You have Original Medicare and employer group health plan (including retireee or COBRA coverage) or union coverage that pays after Medicare pays and that plan ceaseses to provide all such supplemental benefits

You have Original Medicare and a Medicare Select policy. You move out of the Medicare Select policy's service area.

You joined a Medicare Advantage Plan (like HMO or PPO) when you were first eligible for Medicare Part A at or after age 65 and enroll in part B, and you decide you want to switch to Original Medicare within the first year of joining.

You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare Select policy) for the first time, you have been in the plan less than a year, and you want to switch back.

Your Medigap insurance company goes bankrupt and you lose coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

You have a Medicare Advantage Plan or drop a Medigap policy because the company has not followed the rules, or it misled you.

You Have the Right to Buy:

Any Medigap policy from any insurance company. You only have this right if you switch to Original Medicare rather than join another Medicare Advantage Plan.

AnyMedigap plan that is sold in your state by any insurance company. If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends

Any Medigap Plan sold by any insurance company in your state or the state you are moving to.

Any Medigap policy that is sold in your state by any insurance company.

The Medigap policy you had before you joinded the Medicare Advantage Plan or Medicare Select policy, if the same insurnace company you had before still sells it.

Any Medigap Plan sold by any insurance company in your state

You are in a Medicare Advantage Plan (HMO or PPO), and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area

You have Original Medicare and employer group health plan (including retireee or COBRA coverage) or union coverage that pays after Medicare pays and that plan ceaseses to provide all such supplemental benefits

You have Original Medicare and a Medicare Select policy. You move out of the Medicare Select policy's service area.

You joined a Medicare Advantage Plan (like HMO or PPO) when you were first eligible for Medicare Part A at or after age 65 and enroll in part B, and you decide you want to switch to Original Medicare within the first year of joining.

You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare Select policy) for the first time, you have been in the plan less than a year, and you want to switch back.

Your Medigap insurance company goes bankrupt and you lose coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

You have a Medicare Advantage Plan or drop a Medigap policy because the company has not followed the rules, or it misled you.

You can/Must Apply for a Medigap Policy:

As early as 60 calendar days before the date your health care coverage will end, but no later than 63 calendar days after your health care coverage ends. Medigap coverage can’t start until your Medicare Advantage Plan coverage ends

No later than 63 calendar days after the latest of these 3 dates: 1. Date the coverage ends. 2. Date on the notice you get telling you tha ct coverage is ending. 3. Date on a claim denial, if this is the only way you know that your coverage ended.

As early as 60 calendar days before the date your Medicare Select coverage will end, but no later than 63 days after your Medicare select ends.

As early as 60 calendar days before the date your coverage will end, but no later than 63 days after your coverage ends.

No later than 63 calendar days from the date your coverage ends.

No later than 63 calendar days from the date your coverage ends

Overview of Medicare Advantage Plan Choices

Here are the different types of Medicare Advantage Plans. Insurance companies may offer difference plan choices that changes the type of network and access to providers. Note that not all plan types may be offered by the same insurance companies in all states.

HMO

HMO-POS

PPO

PFFS

SNP

Accessibility of Restrictions

Most Restrictive. Must use in-network prviders. Referrals needed for specialists.

Restrictive, but with some added flexibility. May have limited out-of-network service options.

More flexibility. Can see in-network or out-of-network providers. Local and Regional PPO service area may be available.

Least restrictive. Can go to any doctor that accepts Medicare plan.

Provides focused care management, special expertise plan providers, and benefits tailored to the enrollees' condition.

Monthly Premiums and Other Costs

Generally lowest cost option

May have higher costs than regular HMO

Usually higher cost than HMMOs. Have specific in-network and out of network costs for services. Out of network costs will be higher. Regional PPO service area may cost more tha a local PPO.

Usually a higher cost MA plan

Costs will vary

Frequently asked questions

What does Medicare Part A cover?

Medicare Part A covers Hospital services. Medicare pays 80% of the hospital covered services.

What is Medicare Part B?

Medicare Part B pays for outpatient services and doctor visits. Read a step by step guide on how to apply for Part B.

What is Medicare Part D?

Prescription Drug plans cover prescription needs, but offer no medical coverage. Part D have a separate Premium than Part B.

What is the Medicare Supplement Plan?

Medicare Supplement Plans cover gaps in Original Medicare Part A and B. Medicare Supplement Plans help pay some of the health care costs that the Original Medicare Plan doesn’t cover. Medicare Supplement Plans are not the same as Medicare Advantage Plans and can only be combined with Original Medicare. You may choose to also enroll in a stand-alone Prescription Drug Plan.

When is the Annual Enrollment Period?

AEP runs from October 15th to December 7th. New coverage starts on January 1st.

When is the Medicare Advantage Open Enrollment Period?

Each year there is a Medicare advantage open enrollment period from January 1 – March 31.

What is Medicare Advantage Plan (Part C)?

Medicare Advantage (Part C) plans work in place of your Part A and Part B Medicare coverage. Benefits include medical expenses, but not prescriptions.

What is Medicare Advantage Prescription Drug (C + D)?

Medicare Advantage Prescription Drug plans combine the benefits of a Medicare Advantage plan and a Prescription Drug plan. Benefits include medical expenses and prescription drug coverage..

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