Medicare

Medicare has become one of the most frequently asked about lines of coverage in our business. With all the options available and Medicare Advantage plans becoming more popular, we find that our clients appreciate the local and personalized service we are able to provide.

Medicare Facts

• Enroll in Original Medicare when you become eligible
  You’re eligible for Original Medicare when you’re at least 65 years old, or you’re under 65 and qualify on the basis of a disability or other special situation.

• Initial Enrollment Period (IEP)
  When you turn 65 or otherwise become eligible for Medicare, you’ll have your Initial Enrollment Period. This 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 that coverage. Prescription drugs (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.

• Annual Enrollment Period (AEP) October 15 – December 7
  During this period you can add, drop or switch your Medicare plan and/or prescription drug coverage for a January 1^st effective date.

• Open Enrollment Period (OEP) January 1 – March 31
  Medicare Advantage (MA) plan members can make a one-time election annually to switch MA plans or to disenroll from an MA plan and obtain coverage through Original Medicare, with or without a stand-alone prescription drug plan.  In addition, newly eligible MA individuals who enroll in an MA plan can use the OEP, but only during the first three months in which they have both Part A and Part B. Members enrolled in stand-alone prescription drug plans are not eligible for the OEP election because the OEP is only available to those enrolled in an MA plan.

Special Election Period

Some individuals may also qualify for a Special Election Period. Depending on certain circumstances, you may be able to enroll in a Medicare plan outside of the Initial Enrollment Period or Open Enrollment time frames.

You may qualify for a Special Election Period (SEP) if you:

• Retire and lose your employer coverage
• Move out of the plan’s service area
• Receive assistance from the state
• Have been diagnosed with certain qualifying disabilities or chronic health conditions
• Special Needs Plans have other eligibility requirements

Medicare Part A
Covers hospital stays and is paid by the government

Medicare Part B
Covers doctor and outpatient visits

Medicare Part D / Offered by private companies
Covers prescription drugs

Medicare Advantage (Part C) / Offered by private companies
Part C: combines Parts A (hospital) and B (doctor)
Plus, Provides additional benefits such as routine eye care, eye glasses, hearing, dental, and health club membership.
Note: Most plans cover prescription drugs