Medicare is government insurance for people turning 65, people under 65 with certain disabilities, and people of all ages with ESRD (Permanent Kidney Failure).
Medicare consists of 4 parts. Part A (Hospital Insurance) and Part B (Medical Insurance). Part C (Medicare Advantage Plans) and Part D (Prescription Drug Plans).
Medicare Supplement Plans are plans that supplement Original Medicare. These plans pay second after Medicare has paid first. Each Medicare Supplement is standardized and lettered A-N. This means that no matter where you get your plan, each lettered plan will be identical. In other words, no matter the price, a Plan A is a Plan A, is a Plan A. These plans can be purchased from private insurance companies. Prices vary by company.
Recent News for Medicare Supplement Plans
As of 2020, the Plan F & C will no longer be available for purchase. Medicare is eliminating these two plans. People who currently have these plans will be allowed to keep them. Plan F is the most popular Medicare Supplement. On average, the premium for these plans continue to rise. What that leaves everyone with is the next closest plan to F & C, and that is Plan G.
Plan G makes sense financially. I will use an example: Plan F & C both cover the Medicare Part B deductible of $183.00. With Plan G, you would be responsible for that amount. Besides your premium, that is your total out of pocket for the year with a plan G. You pay the first $183 and you are covered at 100% after that.
Here is the value in Plan G. One company’s plan F next year will run about $184 a month. Annually, that is $2,208. A Plan G will run about $128.00 a month, which is $1536.00, a savings of $672. a year. With the Medicare Plan G, you are only paying $183 a year out of pocket. This savings is more than the annual deductible of $183.
MEDICARE ADVANTAGE PLANS
Medicare Advantage Plans (Part C) are another way to get your Medicare Insurance coverage. These plans (HMO’s, PPO’s, PFFS, etc. ) are offered by private insurance companies with a Medicare contract. Some come with prescription drug coverage included, but all must include all the benefits of Medicare Parts A and B. Some plans offer additional benefits such as vision, hearing, and dental. These plans are lower in cost than Medicare Supplement plans. Not all plans are offered in every area.
Recent News for Advantage Plans
Medicare has eased a lot of restrictions on Medicare Advantage Plans. They have eliminated the cap on paying for physical, occupational, and speech therapy. They have also eased the restrictions on Home Health Services. In some plans, Medicare is allowing the plans to offer additional home health services; such as eating, dressing, and personal care. This is a big change. Prior to this, home heath care was mostly restricted to heath related services only.
PRESCRIPTION DRUG PLANS
Also known as Medicare Part D, prescription drug coverage is also offered by private insurance companies with a Medicare contract. Prescription drug plans can be offered as a stand-alone plan, or included in a Medicare Advantage plan.
Recent News for Prescription Drug Plans
Technically known as the “Coverage Gap” the "donut hole in all Prescription Drug Plans, will go away in 2019. The gap was scheduled to go away in 2020 under the Affordable Care Act of 2010. Instead, it is going away early. In 2019, there will no longer be a donut hole in the prescription drug plans.
The way the Prescription Drug Plan model has always worked is that people on a standard PDP (basic Medicare drug plan) pay the annual deductible first, then pay 25% of their drug cost until they reach the donut hole. Cost in the donut hole used to be full cost, but the ACA has been bringing it down gradually each year. In 2019, when you reach the donut hole, you will pay 25% of your drug cost.
Employer and/or Union group Medicare coverage is another way to receive your Medicare coverage. Employer group coverage varies from company to company. This type of coverage requires coordination with employer benefits personnel. It is always wise to check with your benefit coordinator before making a change.
There are many ways to get your Medicare coverage. We secialize in all areas. Please call 800-920-6805 or email us at firstname.lastname@example.org for more details.
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Enrollment Periods For Medicare
There are very specific enrollment periods for Medicare Advantage and Prescription Drug Plans. Medicare Supplement Plans do not have annual enrollment periods. you can enroll in a Medicare Supplement all year long, as long as you are eligible.
Medicare Supplements do have what is classified as "Open Enrollment". This period is the first 6 months of turning 65. During this period, you can purchase a Medicare Supplement without answering any health questions. This period is called "Guarantee Issue". You cannot be denied during this period. After this period, you must go through a health underwriting, and based on your health, you may or may not be approved for the plan.
There are however special circumstances where you may be able to get a guarantee issue outside of this period. Contact us for details.
Medicare Advantage and Prescription Drug plans however do have specific times of the year when you can enroll, or dis-enroll. The first is called your initial enrollment period.
This period is for when you are first eligible for Medicare parts A and/or B. If you are turning 65, it is 3 months before your birth date, the month of, and 3 months after. If you are under 65 and disabled, it is the 25th month after receiving Social Security benefits.
After your initial enrollment, you are subject to the Annual Enrollment Period. This Period is October 15th through December 7th of every year. However, next year Medicare has brought back the Open Enrollment Period. (OEP). This enrollment period is for people with Medicare Advantage plans (MA & MAPD) only. If you have a stand-alone Prescription Drug plan (PDP), you are not eligible to use this enrollment period.
From January 1st through March 31, 2019, people with Medicare Advantage plans will have the opportunity to change their plan if they are not happy with the plan they chose during AEP, (October 15-Dec 7). This Open Enrollment period also gives people with Medicare Advantage plans a chance to still make a choice if they missed out during the AEP. Again, this is only for MA & MAPD plans. You cannot use this period to change a prescription only plan. For instance, if you miss out on the AEP for whatever reason, you can use the Open Enrollment Period to make a change.
Important! You can only use this enrollment period if you already have a plan or chose one during the AEP. You cannot use this to enroll in a plan, if you don’t already have one. If you make a choice in January, your plan will start Feb 1. A choice in Feb will give you a start date of March 1st, etc.