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Original Medicare (Traditional Medicare), is health insurance coverage, provided through the federal government. Original Medicare includes Part A and Part B.
PART A - Hospital Insurance - This helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
PART B - Medical Insurance - This helps cover services from doctors and other health care providers, outpatient care, and home health care.
PART C - also known as a Medicare Advantage Plan - This plan replaces Original Medicare
PART D - Drug Coverage - It is a federal-government program to subsidize prescription drug costs for Medicare beneficiaries. It is sold by private insurance companies
When you turn 65, or retire, you get on Medicare part A and B. You must also get on a drug plan (part D) or else you will have a penalty. There are 2 main ways to receive your Medicare benefits: Original Medicare & Medicare Advantage. We are here to help you review your options and make the best choice for YOU that suits your needs and budget.
Most people become eligible for Medicare when they turn 65. Your Initial Enrollment Period begins three months before your 65th birthday, includes the month of your birthday, and continues for three months after—giving you a 7-month window to enroll.
You may also qualify for Medicare before 65 if you’ve been receiving Social Security Disability benefits for 24 months, or if you have certain conditions.
If you’re still working and have employer coverage, or if your spouse’s plan covers you, you might be able to delay certain parts of Medicare without penalty. We’re happy to help you review your options based on your specific situation.
Medicare Advantage (Part C) is a Medicare approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. In most cases, you can only use doctors who are in the plan’s network. You may also need to get approval from your plan before it covers certain drugs or services. Plans often have different out-of-pocket costs than Original Medicare or Medigap coverage.
A Medicare Supplement policy is basically a policy that pays the “gaps” in Original Medicare. Original Medicare doesn’t pay all of the cost for covered health care services and supplies. Medicare Supplement (Medigap) policies sold by private insurance companies can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles. Medigap policies are “standardized” plans, which are named in most states by letters A–D, F, G, and K–N. All plans with the same letter offer the same basic benefits, no matter where you live or which insurance company you buy the policy from.
Medicare Supplement (Medigap) insurance is a policy, issued by a private insurer, that fills in the “gaps” of traditional medicare. With a supplement, you can still go to any physician that accepts Medicare.
Medicare Advantage (Part C) is a policy, also issued by a private insurer, that replaces Medicare. You can only see physicians in their network, which is generally smaller than the number of providers who take Medicare.
If you choose to receive your Medicare benefits through a Medicare Advantage plan, you cannot buy a Medicare Supplement or Medigap plan.
You can enroll in Medicare online at: www.SocialSecurity.gov or by calling the Social Security office at: 1-800-772-1213, Monday – Friday, from 7am to 7 pm.
The Open Enrollment period is a 6 month window that begins on the first day of the month during which you are both 65 or older and enrolled in Part B.
A Guarantee Issue Period is a certain time period when you can buy a Medicare Supplement (Medigap Policy) without answering any health questions or going through underwriting. This time period is called Medigap Open Enrollment Period. During this time you are guaranteed acceptance. You cannot be denied coverage in any Medigap policy in your state. There are some other times and reasons you might qualify for “Guarantee Issue”, such as if you are retiring and losing group health insurance, or if your previous health insurance plan is being terminated, or if you move out of state or out of your plans service area, etc.
You can join, switch, or drop a Medicare drug plan or a Medicare Advantage Plan with drug coverage during these times:
1 - Initial Enrollment Period. When you first become eligible for Medicare, you can join a plan.
2 - Open Enrollment Period. From October 15 – December 7 each year, you can join, switch, or drop a plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7)
3 - Medicare Advantage Open Enrollment Period (only if you're already in a Medicare Advantage Plan). From January 1 – March 31 each year, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time.
4 - Special Enrollment Period - When certain events happen in your life, like if you move or lose other insurance coverage, you may qualify for a Special Enrollment Period. You may be able to make changes to your plan mid-year if you qualify.
You can join or switch your Medigap policy anytime you want to, but there are better times to buy a Medigap policy than others. The best time to purchase a Medigap policy is during your one-time Open Enrollment period which is during the 6 month period of which you are 65 or older and covered by Medicare Part B. During this 6 month window, you are “guaranteed” coverage regardless of your health conditions. You can’t be denied coverage.
You can buy a Medigap plan at any time, but you will most likely have to go through underwriting and could be turned down for coverage. However, there are some exceptions to this. Never cancel your current Medicare Supplement plan, until you have been approved for coverage by the new company. We generally shop for our customers every two years to make sure they are not paying more for their plan than they have to.
No, the annual Open Enrollment period (AEP) which takes place every year from October 15 – December 7 is only for people who want to change their Part D Prescription Drug plan or their Medicare Advantage to a different plan or company. Medicare Supplement plans can be changed anytime of the year, as long as you qualify.
No. If you have a Medicare Supplement plan, that means Original Medicare is your primary coverage, so you can see any doctor or provider that takes Original Medicare; which is about 93% of the providers.
No. Since a Medigap policy is designed to cover the “gaps” in Original Medicare, you cannot add a Medigap policy to a Medicare Advantage plan, because the Medicare Advantage plan has replaced Original Medicare.
No. It is against the law for someone to sell you a second Medigap policy unless you tell the insurance company in writing that you intend to replace your existing Medigap policy.
No, a Medicare Supplement policy is designed to fill the “gaps” in Medicare Parts A & B, like copayments, coinsurance, deductibles and more.
For Part D, you would select a separate plan that offers prescription drug coverage. This allows you the freedom to change your prescription drug plan every year during the annual Open Enrollment Period without having to change your Medicare Supplement plan.
Yes, the late enrollment penalty is an amount that’s permanently added to your Medicare drug coverage (Part D) premium. You may have to pay a late enrollment penalty if you enroll at any time after your Initial Enrollment Period is over and there’s a period of 63 or more days in a row when you don’t have Medicare drug coverage or other creditable prescription drug coverage. You’ll generally have to pay the penalty for as long as you have Medicare drug coverage.
Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but always check to make sure that yours do.
An appeal is the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan.
Creditable coverage normally is referring to prescription drug coverage. Basically the Medicare Modernization Act (MMA), requires an entity that offers you drug coverage to notify you whether that prescription drug coverage is “creditable coverage” which means that it will pay, on an average, as much as a standard Medicare Prescription drug plan.
Original Medicare does not usually cover routine vision services, such as eyeglasses and eye exams. It will pay for some eye care services if you have a chronic eye condition, like cataracts or glaucoma. If you are a diabetic, or a high risk for glaucoma, Medicare will cover some preventive and diagnostic routine eye care also.
The right insurance broker, can literally save you time, money, and greatly reduce the frustration of making sense of all the Medicare regulations. First of all, you need to know that you don’t pay the insurance broker…the broker is paid directly by the insurance company. There is no negotiation with an insurance company to get a lower rate by going direct. Premiums are the same regardless if you buy direct with an employee of the insurance company, or a broker.
It is important to know that different insurance companies charge different rates for the exact same Medigap policy and not all insurance companies offer all Medigap plans. This is why our customers refer so many friends and relatives to us…we make it easy to understand Medicare and your options. We are contracted with most of the companies in all areas to be able to give you the best rates in a matter of minutes, without you having to go through the labor intensive process of calling each company and talking to dozens of sales people to find the rates. We are able to help you with a Medicare Supplement plan, Medicare Advantage plan, and prescription drug plans. We will help you choose which plan fits your needs as well as your pocket book. You will have the assurance of knowing we will review your plan and the competition each year, to make sure you never overpay for your coverage. Our goal is always, to represent your best interest.
There is no negotiation with an insurance company to get a lower rate by going direct. Premiums are the same regardless of whether you buy direct with an employee of the insurance company, or a broker.
Yes, our service is completely FREE to our customers. We are paid directly by the insurance companies. Your premium is the same, whether you buy from a broker or direct from the insurance company. The only thing you get is “personalized” service that is absolutely FREE.