by Lynnell Wold, Broker/Owner Health Insurance Options LLC
This article is intended to provide a basic understanding of the election periods available to Medicare Beneficiaries in addition to provide an overview of the types of Medicare Plans available to you. It is recommended that Medicare beneficiaries discuss plan options with an independent Medicare agent to make sure an informed decision is made.
UNDERSTANDING MEDICARE TIMELINES
Initial Enrollment Period (IEP)
Your Initial Enrollment Period is when you first become eligible for Part A & Part B. This may be when you turn 65, retire, or you have been receiving Social Security Disability payments for 24 months. If you or your spouse have worked 40 quarters and paid into Medicare, your Part A will not have a premium. Part B does have a premium based on your income. Those still working and have “Creditable Coverage” may wish to delay taking Part B. These individuals will not incur a Part B penalty if their employer’s coverage is considered creditable. Your employer is required to inform you if your policy is considered “Creditable Coverage”.
Medicare Annual Enrollment Period (AEP)
October 15th – December 7th each year. You may add, drop or switch a Medicare Advantage Plan, Part D Plan or apply for a Supplement Plan. All policies will begin Jan 1st of the following year.
Open Enrollment Period (OEP)
Jan. 1st – March 31st each year. If you enroll into an Medicare advantage Plan during AEP but change your mind. You are given one opportunity to move to another Advantage Plan or switch back to Original Medicare and purchase a Supplement and Part D policy. To begin the first of the following month
Special Enrollment Period (SEP)
You are allowed to change plans during the year due to special circumstances such as moving out of your service area, losing employer coverage, becoming disabled, receiving or losing extra help on your prescription cost, or if you qualify for Medicaid. It is important to note that each SEP has a limited time frame in which you must use your election or lose it. Contact Social Security or Medicare to learn your enrollment limitations.
UNDERSTANDING MEDICARE OPTIONS
To help us understand Original Medicare better, let’s think of Medicare as having “Parts” and “Plans”. Original Medicare consists of 2 “Parts”, Part A and Part B. You then have the option of adding “Plans”.
The 2 Parts of “Original Medicare”
Part A helps pay for hospital, skilled nursing facility, home healthcare and hospice care. There are deductibles and co insurances when you use Part A.
Part B think “outpatient”. Part B helps pay physicians services, outpatient services, durable medical equipment, lab work and ambulance. After an annual deductible, Medicare will pay 80% of approved procedures. You are required to have BOTH Part A and Part B in order to purchase a Medicare Supplement Plan or a Medicare Advantage Plan.
The 3 types of Plans
1) Medicare Advantage Plans are primary to Original Medicare and are referred to as Part C.
2) Medicare Supplements, are secondary to Original Medicare.
3) Prescription Drug Plans also referred to as Part D.
Medicare Advantage Plans usually incorporate A, B and D into one policy. Medicare pays a private insurance company to provide your health coverage. Part C must cover the same benefits as Original Medicare and may have a monthly premium in additions to your Part B premium. These are pay-as-you-go plans; you will have co-pays, co-insurances and a maximum out of pocket limit. Some plans have networks that you work within (HMO), while others offer out of network options (PPO & POS). Medicare Advantage Plans may include extra benefits not offered by Original Medicare like vision, dental, hearing and a fitness program.
Private insurance companies provide Medicare Supplement Plans; also known as Medi-gap Plans. They are secondary to Original Medicare, Medicare pays for Medicare eligible benefits then the Medi-gap Plan pays some or all of the client’s remaining portion. Medi-gap’s do not include a Part D Plan. Because Medicare is primary, you do not work with a network but must see providers that take Medicare. Some plans provide limited coverage outside of the US.
Refers to a Medicare Prescription Drug Plan. If you chose to keep Original Medicare primary, you can purchase a Part D Plan. If you have the VA for medications, the VA is considered “Creditable Coverage” and you will not need a Part D Plan. If you have chosen to purchase a Medicare Advantage Plan, in most cases, you cannot purchase a separate Part D Plan. You should note if you choose not to sign up for a Part D Plan, a penalty may be assessed.
Health Insurance Options LLC is a local grown team handpicked right here in Spokane. We bring over 60 years of experience specializing in Medicare related insurance products and more. We truly believe in working for our clients. We work with as many carriers as possible to give you multiple options when choosing your plan, helping to meet your specific needs when it comes to your healthcare. To reach a licensed insurance agent please call 509-353-0476 or read more at www.MedicareinSpokane.com.