Medicare Coverages
We are here to help you get better informed and make educated choices to fit your needs. Whether you are healthy or
an individual with pre existing medical conditions the information and links below were chosen to better inform you. If
you prefer to speak to a person please feel free to call (866) 374-0002.
Medicare turns 55 (1965) it was designed to provide seniors with a peace of mind. Please be awarethat Medicare has
limitations and deductibles. Please refer to the Medicare & You 2016 the official U.S. Government Medicare Handbook.
Things to be aware of Coverage and costs change yearly. Medicare & You Coverage-Outline 2020-2021
Open Enrollment Period October 15, to December 7th. If you find a plan that better suits your needs or budget this is
your window of opportunity to make a change. New coverage if you make a change begins January 1, of the following
year.
Medicare coverage's:
1. Original Medicare includes Part A (Hospital Insurance) and or Part B (Medical Insurance) You or your supplement plan
pays the decuctibles and coinsurance. Premiums are ususlly paid on a monthy basis for Medicare Part B.
2. Medicare Prescription Drug Plan (Part D): These plans are un by private companies that are approved by Medicare.
3. Deductibles and cost (click here)
What you should consider before choosing or changing coverage
Convenience -
Where are my doctors’ offices? Are they accepted? Are the pharmacies you use in the plan? If it is in the network does
you pharmacy offer preferred cost sharing?
Cost -
How much are your premiums, deductibles, and other costs? How much do you pay for services; hospital stays or doctor
visits? Is there a yearly limit on what you pay out-of-pocket? Costs may vary and may be different if you don’t follow the
coverage guidelines. Coverage, how well does the plan cover the services you need?
Doctor and hospital choice
Do your doctors and health care providers accept the type of coverage you have? Do you need to get referrals? Do you
have to choose your hospital and health care providers from a network? Is your doctor in the network? Can you go
outside of the network?
Prescription drugs
Do you need to join a Medicare drug plan? Are your drugs covered under the plan?Are there any coverage rules that
apply to your prescriptions (prior authorization, step therapy, quantity limits, etc.).
Quality of care -
Are you satisfied with your medical care? The quality of care and services offered by plans and other health care
providers may vary. Medicare has information to help you compare how well plans and providers work to give you
the best care possible.
Travel
Will you have coverage in another state or outside the U.S.?
Other coverages -
Do you have, or are you eligible for, other types of health or prescription drug coverage from a previous or current
employer or union? If so, read the materials from your insurer or plan, or call them to find out how the coverage
works with Medicare. If you have coverage talk to your benefits administrator, insurer, plan before making any
changes to your coverage. If you cancel your coverage, you may not be able to get it back.
If you have a Pre Existing Condition? (click here)
As you will learn Medicare has its limits. It is important to determine your needs before choosing a Medicare Supplement
(Medigap) insurance plan. If you are confused please feel free to contact or call us (866/374-0002) to help you get
better informed. See Medicare Supplements (click here)
Medicare Information
When can you sign up for Part A & Part B?
When you first get Medicare
When you're first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.
If you're eligible for Medicare when you turn 65, you can sign up during a 7-month period. It begins begins 90 days
(3 months) before the month you turn 65, includes the month you turn 65, and ends 90 days (3 months) after the
month you turn 65.If you are eligible for Medicare you can sign up for free Part A any time during or after your Initial
Enrollment Period starts. Your coverage start date depends on when you enroll.
If you have to buy Part A and/or Part B, you can only sign up during a valid enrollment period. In most cases, if you
don’t sign up for Medicare Part B when you’re first eligible, you’ll have to pay a late enrollment penalty and could have
a gap in your health coverage.
If you didn't sign up for Medicare Part A and/or Part B (for which you must pay premiums) when you were first eligible,
and you aren’t eligible for Special Enrollment Period, you can sign up during the General Enrollment Period between
January 1–March 31 each year. Your coverage will start July 1. You may have to pay a higher premium for late
enrollment in Part A and/or a higher premium for late enrollment in Part B.Once your Initial Enrollment Period ends,
you may have the chance to sign up for Medicare during a Special Enrollment Period.
If you're covered under a group health plan based on current employment, you have a Special Enrollment Period to sign
up for Part A and/or Part B any time as long as you or your spouse (or family member if you're disabled) is working, and
you're covered by a group health plan through the employer or union based on that work.You also have an 8-month
Special Enrollment Period to sign up for Part A and/or Part B that starts the month after the employment ends or the
group health plan insurance based on current employment ends, whichever happens first. Usually,you don't pay a late
enrollment penalty if you sign up during a Special Enrollment Period.
* COBRA and retiree health plans aren't considered coverage based on current employment. You're not eligible for a
Special Enrollment Period when that coverage ends. This Special Enrollment Period also doesn't apply to people with
End-Stage Renal Disease (ESRD). You may also qualify for a Special Enrollment Period for Part A and Part B if you're a
volunteer, serving in a foreign country.
Some people get Part A & Part B automaticallyIf you are alrerady getting benefits from Social Security or RRB (Railroad
Retirement Board. Under 65 years old with a disabilityIf you are enrolled in Medicare automatically you'll get a red,
white & blue Medicare card in the mail 3 months before your 65th birthday or the 25th month anniverary of your
disability.
A Medigap - Medicare Supplement policy is different from a Medicare Advantage Plan. Advantage Plans are ways
to get Medicare benefits, while a Medicare Supplement (Medigap) policy supplements your Original Medicare benefits.
Pre-existing health care condition covered under Medicare
1. Understand that under national laws Medicare supplement policies can refuse to cover prior medical conditions for the
first six months.
2. The wait time for coverage to start is called a pre-existing condition waiting period. You can avoid waiting periods if
you buy your policy when you have a guaranteed issue right. If you buy your policy when you have guaranteed issue
rights, insurers can never refuse to cover prior medical conditions coverage for any period of time.
a. Make sure you buy a Medigap in advance of enrolling in Medicare so you do not have any gaps in coverage. If you
already had Part B when you turned 65, your open enrollment period to buy a Medicare Supplement (Medigap)
policy begins the month of your 65th birthday.
b. If you miss your open enrollment period, you can also buy a Medigap when you have a guaranteed issue right. If
you are age 65 or older, you have a guaranteed issue right within 63 days of when you lose or end certain kinds
of health coverage. This includes:• If you had group health insurance (through either current or previous
employment) that paid after Medicare and lost it through no fault of your own, you have the right to buy most
Medigap policies.
• If you joined a Medicare Advantage plan when you first became eligible for Medicare and disenrolled within 12
months, you have the right to buy any Medigap policy offered in your state by any insurance company.
• If your previous Medigap policy, Medicare Advantage plan, PACE program ends its coverage or commits fraud,
you have the right to buy most Medigap policies.
c. If you have a Medicare Advantage plan, Medicare SELECT policy or PACE program and you move out of the plan's
service area, you have the right to buy most Medigap policies.
When you have a guaranteed-issue right, companies are required to sell you a policy at the best available rate,
regardless of your health status, an insurance company cannot deny you coverage. The best available rate may depend
on number of factors, including your age, gender, whether you smoke and where you live. Companies cannot make you
wait for coverageof pre-existing conditions if you have a guaranteed issue right.
Open enrollment (click here)
Due to Governmental regulations and the many different opportunities we are unable to advise
until we are aware of your needs and get your permission.