Medicare Annual Enrollment Period (AEP)

Medicare Annual Enrollment Period (AEP)

by | Jul 23, 2022 | Blog

Medicare Enrollment Breakdown: How and When to Get Signed Up

Getting signed up for the right health insurance plan for you can be a little confusing. When it comes to Medicare enrollment, you can only sign up or make changes to your coverage during certain times of the year, and you have to make sure you qualify.

Here’s the breakdown on Medicare eligibility, how you can sign up if you’re eligible, and when Medicare open enrollment is.

 

Who Qualifies for Medicare?

In general, people who are age 65 and older, have permanent kidney disease that requires dialysis or a transplant, or are younger than 65 but have disabilities are eligible for Medicare, according to the Department of Health & Human Services.

Additionally, you don’t have to pay a premium for Part A, which is hospital insurance, if you are at least 65 and you or your spouse worked and paid Medicare taxes for at least 10 years.

The following conditions also entitle someone who is over 65 to Part A without having to pay a premium:

  • Those receiving Social Security or Railroad Retirement Board benefits.
  • Being eligible for those benefits but have not yet filed to receive them.
  • You or your spouse were employed by a government department that was covered by Medicare.

If you aren’t 65 yet, you may still qualify for Part A without paying premiums if you have qualified for Social Security or Railroad Retirement Board disability benefits for 24 months or if you are a kidney dialysis or transplant patient.

Everyone who qualifies for Medicare also has access to prescription drug coverage.

Puede acceder a Medicare cualquier persona mayor de 65 años que padece alguna enfermedad renal con tratamiento de diálisis o un trasplante.

How to Sign Up

Some people are automatically enrolled for Medicare coverage, and others will have to sign up.

People over 65 or who will turn 65 in the next three months and aren’t already getting Social Security benefits will need to apply for Medicare, which you can do online or by getting in touch with Social Security.

If you are already receiving Social Security benefits you will be automatically enrolled in Part A and Part B as soon as you’re eligible. You will get an introductory packet in the mail three months before you turn 65.

Some people are automatically enrolled for Medicare coverage, and others will have to sign up.

Medicare Enrollment Periods

There are a few different times you need to pay attention so you can get signed up for the coverage you want.

There are a few different times you need to pay attention so you can get signed up for the coverage you want.

Initial Enrollment Period

This period runs for seven months. It begins three months before the month you turn 65, includes the month of your birthday, and continues for three months after your birth month.

During that time, you can sign up for a Medicare Advantage plan (Part C) or Medicare Drug Plan (Part D).

For Medicare Advantage Plans, there are a few timeframes to keep in mind.

General Enrollment Period

During this time, if you have Part A and get Part B you’re also allowed to join a Medicare Advantage or Medicare drug plan.

The drawback is your coverage may not start until July 1.

 

Annual Enrollment Period

This runs from October 15 – December 7. During this timeframe, you can change from Original Medicare to Medicare Advantage (or vice versa), join or change a prescription drug plan, or drop your coverage entirely.

Open Enrollment Period

The Medicare Open Enrollment period runs from January 1 – March 31. This period allows people who already have a Medicare Advantage Plan to change to another Medicare Advantage Plan or change back to Original Medicare.

The Medicare Open Enrollment Period does not allow for beneficiaries to switch from Original Medicare to Medicare Advantage or add or change a drug plan if they’re on Original Medicare.

Algunas personas están inscritas automáticamente en la cobertura de Medicare, y otras tendrán que hacer la inscripción.

Special Enrollment Period

If you move to a new location or lose your insurance coverage, you may be eligible for a Special Enrollment Period. The rules for this will vary from case to case.

The government’s Medicare website addresses each situation and what changes you are allowed to make.

The Parts of Medicare Explained: Medicare Part A, B, C & D

The Parts of Medicare Explained: Medicare Part A, B, C & D

by | Jul 23, 2022 | Blog

Medicare is a federal health insurance program that affects millions of seniors every year. It makes healthcare coverage possible for adults 65 and older as well as younger individuals with disabilities.

And although 62 million Americans are currently enrolled in Medicare, very few actually truly understand it and all its layers. Medicare on its own can be confusing, but once you start talking about its different parts – A, B, C, and D – it’s enough to overwhelm even those who are insurance savvy.

Breaking Down Medicare

Selecting the right benefits to cover services you specifically need is crucial in keeping your costs low. Not taking the time to fully understand what you’re signing up for can result in higher premiums, out-of-pocket drug costs, and even paying more in taxes.

Original Medicare and Medicare Advantage are terms used when discussing the healthcare program. Simply put, Original Medicare includes Part A and Part B. Medicare Advantage is an “all in one” alternative known as Part C. There’s also Part D that you can add to Original Medicare as a type of supplemental coverage.

Let’s take a closer look at each individual part and what it covers.

 

What is Part A?

Part A is what’s considered hospital insurance. In a nutshell, it covers hospital visits, skilled nursing facility care, nursing home care, hospice care, and home health care.

So, for example, if you were admitted into the hospital, Part A would help cover the cost of common expenses, such as a semi-private room, meals, and nurse care.

If you have turned 65 and you or your spouse worked and paid Medicare taxes for at least 10 years, you are eligible for Medicare Part A. Most eligible individuals do not have to pay premiums for Part A; however, there is a deductible and a coinsurance responsibility for beneficiaries.

Even though Part A is “hospital coverage,” not everything that happens at the hospital falls under that umbrella. For example, some hospital care and procedures ordered by physicians fall under Part B.

 

Part A - Medicare

What is Part B?

Part B can be compared to what we know as basic health insurance. It covers outpatient services that are medically necessary, such as doctor visits, lab work, diagnostic testing, surgeries, chemotherapy, preventive treatment, and most other ambulatory services.

Part B does have a premium that beneficiaries are responsible for. But just like with other types of insurance, prices vary depending on several factors, including income and marital status.

You don’t have to purchase Part B, but together, Part A and Part B make up Original Medicare. Most individuals sign up for parts A and B when applying for social security.

 

Part B - Medicare

What is Part C?

Part C is what’s referred to as Medicare Advantage. It’s different from Part A and B in that it’s an actual comprehensive Medicare-approved health plan that you purchase from a private insurance company. Coverage includes Part A and B benefits, along with some Part D (more on that later). In addition, other preventive services such as vision, dental, and hearing are also included. It’s basically all the parts rolled into one convenient plan.

With Part C, you have a network of physicians within your service area that you can select from for services. This helps to lower premiums and limit your out-of-pocket expenses. In addition, most Part C plans help keep you from having to run all over the place for treatment because you must stay in-network.

Unlike Original Medicare, where you get what you get, Medicare Advantage allows you to pick a specific insurance plan from a provider that caters to your particular needs.

 

Part C - Medicare

What is Part D?

Part D is entirely optional and must be purchased separately from a private insurance carrier. It is a federal program that provides prescription drug coverage to individuals who receive Original Medicare.

With Part D, you will have a monthly premium, and in return, you will receive significantly lower copays on medicine and prescription drugs. If you receive Part A and Part B, Part D is a separate plan; however, Medicare Advantage plans have a built-in drug plan so Part D is not necessary.

 

Part D - Medicare

What Medicare Parts Do I Need?

When it comes to what coverage you need, it’s entirely personal and varies from person to person. There is no one-plan-fits-all, and there are pros and cons to each part.

One thing to note, however, is Medicare enrollment eligibility for the various parts and plans changes depending on your age, what you are currently enrolled in, and whether you have moved or had a life change. There are only certain times during the year when you can change/add plans or switch from Original Medicare to Medicare Advantage.

Need Help? Contact SaludVIP Today!

If you’re still confused about Medicare and what parts you need, contact us at SaludVIP, and we’ll be happy to answer all your questions and discuss your options.

When it comes to what coverage you need, it’s entirely personal and varies from person to person.
What is a Medicare Advantage Plan? How It’s Different Than Original Medicare

What is a Medicare Advantage Plan? How It’s Different Than Original Medicare

by | Jul 23, 2022 | Blog

For older adults, health care costs account for about 9% – 14% of household spending. Medicare, the government’s health care program for people age 65 and older, is a way to manage those costs. It can get confusing, though. What is a Medicare Advantage plan? Is it different from Original Medicare? What do the plans cover?

It can be a lot to digest. Let’s break it down to the basics so you’ve got a good foundation to decide if this is a good route for you to take.

What is Medicare

Medicare is the government-run health insurance program that covers people age 65 and older, some younger people with disabilities, and people with End-Stage Renal Disease.

The two main options for coverage are Original Medicare and Medicare Advantage. In this section, we’re talking about Original Medicare, which includes Part A and Part B.

What Part A Covers

Medicare Part A is basically your hospital insurance. It covers hospital visits, skilled nursing facility care, nursing home care, hospice care, and home health care.

There is a deductible for Part A, as well as a coinsurance you’ll have to pay. That coinsurance doesn’t kick in until after a 60-day stay at an inpatient facility.

 

Parte A - Medicare

What Part B Covers

Part B is more like your traditional medical insurance. It covers your doctor visits, mental health visits, ambulance services, services and supplies used to diagnose or treat a medical condition, and preventive services.

You’ll pay a monthly premium for Medicare Part B. That price varies based on things like your marital status and income.

 

Parte B - Medicare

What Part A and Part B Don’t Cover

While Original Medicare might cover the majority of your healthcare needs, it’s important to factor in what it won’t cover before you enroll. Those things include:

  • Long-term care
  • Most dental services
  • Dentures
  • Eye exams for getting prescription eyeglasses
  • Cosmetic Surgery
  • Hearing aids

If you would like prescription drug coverage, there’s an additional plan called Part D that you’ll need to join.

If there’s a specific test, item, or service you’re wondering about, the Medicare website has a search feature to help you find out.

Aunque el Medicare Original puede cubrir la mayoría de sus necesidades, es importante tener en cuenta lo que no cubre antes de inscribirse.

What is a Medicare Advantage Plan

Los planes Medicare Advantage son una alternativa al Medicare Original y son proporcionados por compañías de seguros privadas.

Also called Part C, Medicare Advantage Plans are an alternative to Original Medicare. These plans are provided by private insurance companies that are approved by Medicare. Think of them as an all-in-one option.

Essentially, these are bundled plans that will include benefits like Part A, Part B, oftentimes Part D, and other things like vision, hearing, and dental coverage.

The packages can have some other perks that you might not usually think about, like assistance for fitness programs, over-the-counter drugs, and even transportation to and from doctor visits.

The cost of Medicare Advantage Plans will vary depending on which insurance provider you go with. There will also be certain stipulations based on what providers are in the plan’s network and the service area.

Pros and Cons of Medicare Advantage Plans

While Medicare Advantage Plans are a great option for some people, others may not need the amount of coverage provided.

Here are some things to consider.

Pros

Medicare Advantage plans can offer more personalized benefits based on your situation. With Original Medicare, the extent of your coverage is already laid out. Going the Advantage route will give you some more flexibility to cater your plan to fit your needs.

In that same vein, you’ll also get more convenient options for your coverage. You can wrap everything up into one plan. If you take the Original Medicare route, you would have to add Part D coverage if you want a prescription drug plan, for example.

There is potential to save money with Advantage plans, too. Some of this type of plan will come along with lower premiums and set limits on the maximum amount you will have to pay out of pocket during the year.

Cons

You are likely to be more limited in healthcare providers you can choose from with an Advantage plan. Since this is run through private insurance companies, you are probably going to face the old in-network versus out-of-network provider dilemma. That’s dependent on the plan you choose, but it’s still important to keep in mind.

Speaking of the plans, there are a lot of them to choose from. The number of available options can make it more complex to choose a plan. It can get overwhelming trying to narrow them down.

Finally, Medicare Advantage Plans may only offer coverage in specific areas. That means if you end up moving you may also have to change your plan. By contrast, Original Medicare has the same coverage no matter where you are in the country.

 

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