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Medicare Overview

With over 60 million individuals enrolled in Medicare nationwide, it’s highly likely that either you or someone you know is currently benefiting from Medicare. If you or a loved one is approaching Medicare eligibility and has questions, rest assured that we have the information you need.
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Medicare Part A & B

✔ Original Medicare has two parts: Medicare Part A and Medicare Part B .
✔ Part A and Part B  provide hospital and medical coverage for individuals 65 years of age and older.
✔ Medicare customers can see any doctor in the country that accepts Medicare.
✔ You have a seven-month window when you turn 65 called your Initial Enrollment Period (IEP) to enroll in Original Medicare — the month of your birthday plus three months before and after your birthday month. If you miss your IEP, you’ll need to wait for the Annual Enrollment Period.

Medicare Advantage (Part C)

Medicare Advantage (Part C) represents a type of private health insurance that strictly adheres to the guidelines set by Medicare. This comprehensive plan combines the coverage provided by both Part A and B, while also offering additional health and wellness benefits, often incorporating a Part D prescription drug plan.

Medicare Part D

Medicare Part D is a prescription drug insurance program overseen by private insurance companies under federal regulations. Put simply, it functions as insurance for your prescription medication requirements. You have the choice to enroll in a standalone Part D plan to supplement your Part A and Part B benefits. Alternatively, you can select a Medicare Advantage (Part C) plan, which consolidates Parts A, B, and D.

To obtain a Part D plan, you can procure it from a private insurance company. This plan provides access to the company’s pharmacy network, and you will usually make co-payments for your prescriptions.

Enrolling in Medicare for the First Time

Beneficiaries of Original Medicare (Part A and Part B) are still accountable for co-payments, deductibles, and coinsurance. Medicare Supplement Insurance, also referred to as Medigap policies, steps in to help cover some of the costs that Original Medicare does not. Without adequate coverage, frequent hospital or doctor visits can result in significant expenses.

 Medicare Supplement plans address expenses that fall outside the scope of Original Medicare coverage. For example, a Medigap plan could help offset a 20% coinsurance bill related to a doctor visit. All Medicare Supplemental insurance plans are required to cover standard services, and certain plans may provide additional benefits.

Enrolling in Medicare for the First Time

It’s referred to as your Initial Enrollment Period, covering the month of your 65th birthday, the three months before, and the three months after your birthday month. If your birthday falls on the first of the month, the period extends to the month of your 65th birthday, the four months before, and the two months after your birthday month.

Understanding that life events can affect timing, both you and Medicare are aware. In case you miss the opportunity to enroll during your Initial Enrollment Period, there’s a General Enrollment Period from January 1 to March 31, allowing for enrollment with coverage starting on July 1.

LET US ANSWER YOUR QUESTIONS

Frequently Asked Questions

The Medicare Annual Enrollment Period (AEP) typically begins on October 15th and ends on December 7th each year.

During this period, Medicare beneficiaries can review and make changes to their Medicare Advantage (Part C) and Medicare Prescription Drug Plans (Part D). It’s an opportunity for individuals to switch plans, enroll in a new plan, or make other changes to their existing coverage. Keep in mind that these dates may be subject to change, so it’s always a good idea to check for the most current information.

Medicare eligibility is primarily based on age and certain qualifying conditions. Here are the general eligibility criteria:

  1. Age 65 or Older: You are typically eligible for Medicare when you turn 65. You can apply for Medicare during the Initial Enrollment Period (IEP), which includes the three months before your 65th birthday, the month of your birthday, and the three months after.
  2. Disability: If you are under 65 but have been receiving Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) disability benefits for at least 24 months, you may also qualify for Medicare.
  3. Certain Medical Conditions: Individuals with certain medical conditions, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), may be eligible for Medicare regardless of age.

It’s important to note that even if you’re eligible, you may need to actively enroll in Medicare. If you’re already receiving Social Security benefits, you may be automatically enrolled. If not, you’ll need to sign up during the Initial Enrollment Period.

You can apply for Medicare online through the Social Security Administration’s website or by visiting your local Social Security office. If you have questions about your specific situation, it’s advisable to contact the Social Security Administration or visit their official website for the most accurate and up-to-date information.

:Enrolling in Medicare Advantage and Prescription Drug Plans is a separate process:

– Medicare Advantage (Part C): You can enroll during your Initial Enrollment Period, Special Enrollment Period, or the Annual Enrollment Period (October 15 to December 7 each year).

– Medicare Prescription Drug Plans (Part D): You can enroll during your Initial Enrollment Period or the Annual Enrollment Period.

Additional Information:
‍– For those eligible due to disability, enrollment usually happens automatically after 24 months of receiving Social Security Disability Insurance (SSDI) benefits.
– If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), contact Social Security for guidance on enrollment.

Always check with the Social Security Administration or visit their official website for the most accurate and up-to-date information, as processes and timelines can be subject to change.

No, Medicare Advantage plans (also known as Medicare Part C) are not all the same. While they must provide at least the same level of coverage as Original Medicare (Part A and Part B), Medicare Advantage plans are offered by private insurance companies, and they can vary in terms of cost, coverage, and additional benefits.

When considering a Medicare Advantage plan, it’s important to carefully review the plan’s details, including the coverage, costs, network, and any additional benefits. You can compare plans in your area using the Medicare Plan Finder tool on the official Medicare website or consult with a Medicare advisor for personalized assistance. Keep in mind that plans can change annually, so it’s a good idea to review your coverage during the Annual Enrollment Period (AEP) if you’re considering making changes.