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WHY MEDICARE

ADVANTAGE

SPENDING TOO MUCH ON MEDICARE?

Watch the video and learn why we believe Medicare Advantage is the best choice for most of our patients.

WHO IS ELIGIBLE

I am going to be turning 65

To become enrolled in Medicare Part A and Medicare Part B (Original Medicare):

  • Must be 65 years old and retired.
    • Starts 3 months before your birthday and lasts for three months after (Initial Enrollment Period (IEP)).
  • While you are automatically enrolled in Part A and Part B you can also apply for an additional plan that offers you extra coverage. Plans such as:
    • Medicare Advantage
    • Supplemental Insurance (Medigap)
    • Medicare Part D (prescription drug plan).

*Part A of Original Medicare is covered if you or a spouse have worked for 10 years. If you have worked less than 10 years, you may have to pay a partial premium.*

I currently have Medicare

For our patients, we typically recommend Medicare Advantage. This plan allows you to receive comprehensive care while also being monetarily more manageable. Overall, the choice comes down to what best fits your lifestyle

I am 65 and still working

  • Working past the age of 65
    • If you are still working and are receiving comprehensive insurance coverage through your employer, Medicare Part A & B can be delayed.
  • Quit working or retired after delaying Medicare:You will begin your Special Enrollment Period (SEP).
    • You will have eight months from the time your current insurance plan ends to enroll in Medicare.
ENROLLMENT PERIOD

Annual Enrollment Period

Annual Enrollment Period (October 15 – December 7)

            What can you do during this time?

  • Enroll in a plan that will give you additional coverage on top of Original Medicare
  • Disenroll from your current additional coverage plan
  • Switch your additional coverage
  • Keep your plan exactly the same

Any enrollments or changes made during this period are effective on January 1 of the following year.

Disenrollment Period

Disenrollment Period (January 1 – February 14)

            What can you do during this time?

  • You can choose to leave Medicare Advantage and return to Original Medicare (Part A & B alone – meaning no additional coverage)
  • You can enroll in a prescription drug plan
    • You can only enroll if you return to Original Medicare (Part A & B)
  • There is no switching between different Medicare Advantage plans or prescription drug plans during this time.

Lock-in Period

Lock-In Period (February 15 – October 14)

            What you do during this period?

  • You will not be able to change your Medicare plan at all, unless you qualify for a Special Enrollment Period (SEP).
    • You will have to wait for the next Annual Enrollment Period (AEP) between the months of October and December.

Special Enrollment Period (SEP)

Special Enrollment Period (SEP)

            What can you do during this time?

  • You can only qualify if you have one of the circumstances listed below. If you do qualify, then you are allowed to make changes to your coverage
    • Loss of employer coverage of health insurance.
    • Three months before or after your 65thbirthday when you become eligible for Medicare
    • If you become eligible for Medicaid (low income based health insurance)
    • Making a permanent move
      • Out of state
      • Entering a nursing home
    • Qualify due to low income
    • Loss of Part D (prescription drug plan) coverage unwillingly
4 PARTS OF MEDICARE ADVANTAGE

Received if:

  • Legal Resident
  • Over 65
  • You or spouse paid FICA (Medicare) taxes for 10 years
    • Receive part A at no cost
    • Paid taxes under 10 years
      • May be subject to monthly premium

Part A provides coverage for:

  • Inpatient hospital care
  • Inpatient stays:
    • Skilled nursing
    • Hospice
    • Home Health services

Part A does NOT fully provide coverage for:

  • Potential hospital costs
  • We recommend a Medicare Advantage planto reduce your over-all out of pocket costs.

Part Bprovides coverage for medical insurance:

  • Doctor visits
  • Emergency ambulance
  • Labs and X-rays
  • Mental health service
  • Medical equipment
  • Preventative tests
    • Pap smears
    • Flu shots
    • Screenings
  • Rehabilitation
    • Physical therapy
    • Occupational therapy
    • Speech/language pathology

What do you pay?

  • Monthly premium
    • The average is $134.00 (varies per person)
  • Yearly deductible
    • $183.00 (varies per person)

Part C (Medicare Advantage) provides coverage for:

  • Part A
  • Part B (continue to pay separate monthly premium)
  • Includes prescription drug coverage
  • Some plans even include extra coverage for:
    • Vision
    • Hearing
    • Dental

What do you pay?

  • Not all Part C (Medicare Advantage) plans have a monthly premium
    • You may pay a $0.00 premium
  • If you do pay a premium it is most likely to cover a wider range of services
    • Vision
    • Hearing
    • Dental
  • Each plan comes with a maximum out-of-pocket limit.
    • Once you spend the maximum amount, you do not have to pay anything for covered services
      • The max out-of-pocket limit will vary per each Medicare Advantage plan.

Part D provides coverage for:

  • Prescription drugs
    • Cost for each drug varies per plan.
    • Most part D plans charge a monthly premium

Who is eligible?

  • You have Part A and Part B coverage
  • The area you live in an area that offers Part D plans.

What if I don’t need a prescription drug plan right away?

  • A Part D plan is not required
  • If you choose to enroll at a later time:
    • May pay a late-enrollment penalty
    • Unless you can prove you had credible coverage

What is the Medicare Part D coverage gap (Donut Hole)?

  • Once you reach your initial coverage limit:
    • You pay higher portions of your drug costs until you reach the next phase: “catastrophic coverage phase”
WHAT PLAN IS BEST FOR ME?
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Don’t stress. we have you covered

One of our trusted brokers, A&B Insurance Services is an experienced team representing a variety of Medicare Insurance plans. Their services are at ZERO cost to you. A&B Insurance treats you as an individual with unique needs and understands not every plan is right for everyone.  As your agent, they will be your patient advocates.

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