You have three basic options for your Medicare:

• Original Medicare (the coverage from the government via the red-white-and blue card)
• Medicare Supplement – this works along with original Medicare, and picks up most of the ‘gaps’, or out-of-pocket expenses of it; although it has a fairly high monthly premium, and it goes up almost every year.
• Medicare Advantage – this option takes the place of original Medicare, and a Medicare Supplement in the event someone has that as well. Many of these plans have a $0 monthly premium, and that’s because when someone enrolls in an Advantage plan, the enrolling company takes over the bulk of responsibility from the federal government for an individual enrollee’s expenses, and in turn starts receiving a monthly subsidy for doing so.  That monthly subsidy enables them to still be profitable, though not charging a monthly premium, and they offer relatively small, predictable copays to the enrollee.

Most people sign up for both Part A (Hospital Insurance) and Part B (Medical Insurance)

 when they’re first eligible (usually when they turn 65), starting 3 months before you turn 65 and ending 3 months after the month you turn 65 (this 7-month window is known as your Initial Enrollment Period, or IEP).  

You will be automatically enrolled in Medicare Parts A and B effective the month you turn 65 if you are already receiving Social Security Retirement benefits. If you are not already receiving Social Security Retirement benefits, then you will need to sign up for Medicare yourself (Part A and B). 

Generally, there are risks to signing up later, like a gap in your coverage or having to pay a penalty. However, in some cases, it might make sense to sign up later.  And, you are not ‘locked-in’ to your plan forever, whether a Medicare Supplement or Advantage plan.

This is one of the many things our licensed team is here to hand-walk you through: help secure your Part A and Part B coverage, and assist with your enrollment.

Just click the button below and  schedule a FREE Initial Consultation with one of our licensed, independent advisors.

If you or your spouse are still working, you can wait until you (or your spouse) stop working (or lose your health insurance, if that happens first) to sign up for Part B (Medical Insurance), and you won’t pay a late enrollment penalty.

Once you stop working (or lose your health insurance, if that happens first) you have an 8-month Special Enrollment Period (SEP) when you can sign up for Medicare (or add Part B to existing Part A coverage). The SEP starts when you stop working (or lose insurance), even if you choose COBRA or other coverage that’s not Medicare.

https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65

A Medicare Supplement works with original Medicare (red, white and blue card), and if you have a Med Supp, you cannot have a Medicare Advantage plan at the same time.  Regarding networks, you can see any doctor or provider who accepts original Medicare, so the issue of a doctor being in or out of a plan’s network becomes virtually a non-issue.

While you definitely have a higher monthly premium with a Med Supp plan, and those premiums will go up, if not every year, every other year, the benefit of that is that you have much less out-of-pocket copays than the alternative.  And lastly, ancillary benefits, such as dental, vision, hearing, fitness, and over-the-counter (OTC), are not built in to a Med Supp plan, so you must pay an extra monthly premium to get those benefits.

Medicare Advantage plans, however, replace original Medicare, and if you have an Advantage plan, you cannot have a Medicare Supplement plan at the same time.  With Advantage plans, you do have networks to deal with: with an HMO, your current providers must be in network; with a PPO, they could be out of network, and as long as they accept the plan, you could still see them, you’ll just typically pay a higher copay.

You have more out-of-pocket copays with Advantage plans, though they are generally small, predictable copays, and the copays are offset by the plans mostly having a $0 monthly premium.  And they pretty much stay at a $0 monthly premium from year to year, and that’s because when a person enrolls with an Advantage plan, that company starts receiving a monthly subsidy between $1,000-1,500 per month in return for managing their claims and services going forward.  And, most Advantage plans have ancillary benefits built into their plans at no extra cost, again such as: dental, vision, hearing, fitness and OTC benefits.

You can certainly try and figure it out yourself, or let our team do the heavy lifting for you.  Just schedule your FREE Initial Consultation, and during that time we will collect the information that is needed for us to properly guide you.

As far as networks go, there are two basic types of Medicare Advantage plans: HMO and PPO.  With HMO’s, you generally must get care from in-network providers (although HMO-POS plans offer some out-of-network services), whereas PPO plans allow you to go to out-of-network providers, though you generally will pay a higher copay for doing so.

Beyond that, there are other types of Advantage plans, such as: Give-back plans (the plan will ‘give-back’ a certain amount of money each month to your social security check to offset the monthly Part B premium that’s being deducted); and Special Needs plans, for those with certain chronic conditions (i.e., diabetes and/or heart-related conditions), and those with limited financial resources (i.e., whether LIS-eligible, or even Medicaid eligible).

If you’d like to determine which plan is more suitable for you, without having to figure it all out by yourself, just reach out to our team by scheduling your initial FREE consultation, and we’ll get the information that’s needed to determine which plan is right for you.

Medicare drug coverage helps pay for prescription drugs you need. It’s optional and offered to everyone with Medicare. However, even if you don’t take prescription drugs now, you should consider getting Medicare drug coverage, because if you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare drug coverage.  To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered. 

The coverage gap, or ‘donut hole’, occurs when the combined out-of-pocket drug costs for an individual beneficiary (along with what the insurance company has paid out), reaches a certain annual threshold, at which time their total out-of-pocket drug costs increase considerably for the remainer of that calendar year, unless and until they reach the end of the coverage gap.

If you have spoken with another licensed, independent agent or agency like us, that’s fine.

But, what’s the harm in getting a ‘second opinion’ as they say?  It doesn’t cost you anything, and it will either give you peace of mind/confirmation that the other agent or group has done a good job, or show you that they may have missed some key pieces.  We cannot tell you how many times we’ve talked with someone who was starting on Medicare soon, and we were the second or third group that they’d talked with, but there were several things that we shared with them, that they’d never heard such things from any of the other groups before, for which they were very appreciative.

We’ll cover ALL the bases of what you need to know and do to get properly set up with Medicare, and you won’t have to do any of that without our direction and guidance…both initially, and every year going forward!  In other words, we’re with you for the long haul, committed to building a personal relationship, and being there for you.

Is a zoom meeting any less face-to-face than a meeting in person? With the internet and social media becoming more commonplace each day, business practices have been transformed, to where more and more companies do virtually everything right over the phone & computer.  And think about this, what about your mortgage/rent company, as well as all your utility companies: most likely, you got set up with them without ever having physically met with anyone, right?  Truth is, things can just be done much more EFFICIENTLY today by phone and computer.  Besides, by scheduling an initial FREE consultation with us, we will meet via Zoom, where we will see each other virtually face-to-face, and we believe you’ll feel very comfortable with us after having done that.