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 live human please feel free to call (866) 374-0002.
Medicare turns 55 (1965), it was designed to provide seniors with medical treatments and a peace of mind. Please be
aware that Medicare has limitations and deductibles. Please refer to the Medicare & You 2020 the official U.S.
Government Medicare Handbook. Things to be aware of, Coverages and costs change yearly, Open Enrollment Period is
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 insurance plan
pays the deductibles and coinsurance. Premiums are usually paid on a monthly basis for Medicare Part B.
2. Medicare Prescription Drug Plan (Part D): These plans are offered by private companies that are approved by
Medicare.
3. Medicare Part A & B 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 does your 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. Does your plan have a Coverage Gap aka "Donut Hole" like Original Medicare? 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? Will your plan cover you if you travel out of state or out of the U.S.?
Prescription drugs -
Do you need to join a Medicare drug plan (part D)? 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. A licensed qualified representative should have the 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.?
Your other coverage -
Do you have, or are you eligible for, other types of health or prescription drug coverage from a previous or current
employer, union or medicaid? 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 Advantage
or Medigap - Medicare Supplement Insurance plan. If you are confused please feel free to contact us or call us
866/374-0002) to help you get better informed. Medicare Advantage (click here), Medicare Supplements (click here),
Original Medicare has substantial deductibles and copays (click here).
Medicare Information -
When can you sign up for Part A & Part B? When can 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 ave 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 31st each year. In that case 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 may not be 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 automatically If you are already
getting benefits from Social Security or RRB (Railroad Retirement Board. Under 65 years old with a disability, if 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 anniversary of your disability. A Medigap - Medicare Supplement Insurance policy is
different from a Medicare Advantage Plan. Advantage Plans (click here) are ways to get Medicare benefits, while a
Medigap - Medicare Supplement Insurance policy supplements your Original Medicare benefits. (click here).
Pre-existing health care condition covered under Medicare
1. Understand that under national laws Medigap -Medicare Supplement Insurance policies can refuse to cover prior
medical conditions for the first six months. That apply's if you did not enrol during the "Guaranteed Issue" period(s).
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 - Medicare Supplement or Medicare Advantage plan 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 - Medicare Supplement and Medicare
Advantage plan Insurance 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 coverage of pre-existing conditions if you have a guaranteed issue right.
Due to many Insurance Companies selling Medigap - Medicare Supplement Insurance and Advantage
policies we are unable to advise until we are aware of your needs and permission.