Original Medicare is made up of two parts:
Part A provides your hospital insurance
Part B provides medical insurance for things like doctor visits and check-ups
You’re at least 65 years old, or you’re under 65 and qualify on the basis of a disability or other special situation
You’re a U.S. citizen or a legal resident who lived in the U.S. for at least five consecutive years.
Initial Enrollment Period
When you turn 65 or otherwise become eligible for Medicare, you’ll have your Initial Enrollment Period (IEP) Your IEP begins three months before and ends three months after the month of your 65th birthday ( a seven month window). If you have employer or plan-sponsored coverage when you first become eligible, you won’t need to enroll until you retire or otherwise lose the coverage. Prescription drug (Part D) coverage must be creditable or you may be subject to a Late Enrollment Penalty when you enroll in a plan with Part D benefits.
If you’re still working at age 65 and covered by your employer’s health insurance, then in most cases you don’t need to sign up for Part B yet. Once you stop working, you’ll have a special enrollment period of eight months after your employment ends in which to sign up for Part B.
During Open Enrollment you can add, drop or switch your Medicare plan coverage. The annual open enrollment period for Medicare is October 15 through December 7. This is the time each year when you can switch from original Medicare to a Medicare Advantage plan; change from your Medicare Advantage plan back to original Medicare; or switch from one Medicare Advantage plan to another.
Some individuals may also qualify for a SEP depending on certain circumstance. You may qualify for a Special Election Period if you:
Retire and lose your employer coverage
Move out of the plan’s service area
Receive assistance for the State
Have been diagnosed with certain qualifying disabilities or chronic health conditions
When choosing a health plan, it’s important to select one that best meets your needs and budget. Here are some important questions to think about as you focus on the “Big Picture” of your health coverage for the coming year.
How’s your current health? Some plans are designed for specific conditions.
Do you take any prescription drugs?
Are you looking for a preferred doctor, hospital or clinic?
Do you expect changes to your finances in the coming year?
Are benefits like vision, hearing or dental important to you?
Is worldwide emergency coverage important?
Do you have any wellness goals you want to achieve?
How you answer the above questions can help determine which type of Medicare plan may be best for you.
Enrolled in Original Medicare
Live in the plan’s service area
Do not have end-stage renal disease (ESRD)
Medicare Plan Options
Medicare Advantage plans, typically HMO or PPO products, are insurance plans that combine the benefits of Part A and B and, in most cases, includes prescription drug coverage and may include extra benefits and services for an additional cost.
What is the advantage of a Medicare Advantage plan?
The payments the company receives from Medicare help with the cost of the plan. Most of the plans have provider networks that provide services at discounted rates. The plan features also give the ability to manage costs and offer the coverage of Medicare A and B at a lower cost than Original Medicare. Some of the extra benefits you could get with a Medicare Advantage plan include:
Prescription drug coverage
Access to wellness programs
Gym membership discounts
Routine hearing, vision and dental coverage and more
Some people who are covered by original Medicare purchase a separate Medi-gap plan, also known as a Medicare Supplement plan. These plans help “fill the gap” by partially or fully covering the portion of approved healthcare expenses that original Medicare doesn’t pay.
What is the advantage of a Medicare Supplement plan?
A Medicare Supplement or Medi-gap plan offers the beneficiary more flexibility, but at a higher premium. Available plans range from letters A to F, and each type of plan offers a different level of benefits or coverage. So you can choose the plan that best fits your needs and budget.
The Medicare Supplement works hand-in-hand with Medicare, which only pays the first 80% of Medicare-approved healthcare costs. Depending on which plan you choose, the Supplement will pay all or part of the remaining 20%. These plans have little to no copayments and no required network of health care facilities, doctors, and other healthcare professionals. You have access to any hospital or physician that accepts Medicare in any state.
Medicare Supplements do not include prescription drug coverage, so Part D needs to be picked up in a separate plan. Part D refers to the stand-alone prescription drug plan. These plans are based on different formularies (lists of covered medications) and have different premiums and copayments. Some plans have deductibles and some don’t. Medications are broken up into different tiers or levels including preferred and non-preferred generic and brand-name drugs. All plans are based on CMS (Medicare) guidelines and have the same initial coverage stage. There is a penalty for not having a creditable prescription drug plan during the correct time frame.
It’s complicated! Let Relion Insurance Solutions help you navigate through all of the literature you are receiving and narrow down the perfect Medicare plan for you.