SPECIALIZING IN MEDIGAP MEDICARE ADVANTAGE, & PRESCRIPTION DRUG PLANS
As you get started with Medicare, you have a choice in how you get your Medicare coverage. And, there are some important decisions for you to make. Follow these 3 steps to help you get started:
If you're over 65 (or turning 65 in the next 3 months) and not already getting benefits from Social Security, you need to sign up to get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). You won't get Medicare automatically.
Medicare is health insurance for people 65 or older, certain people under 65 with disabilities, and people of any age with End-Stage Renal Disease (ESRD). Learn how to get started with Medicare if you have a disability or if you have ESRD.
Your first chance to get Medicare usually starts 3 months before you turn 65 and ends 3 months after you turn 65. Find out when you're eligible for Medicare.
You can only enroll in Medicare at certain times, and the cost can go up the longer you wait to sign up. Getting Medicare late can mean lifetime premium penalties and delays in when your coverage can start.
Deciding to enroll in Part B is an important decision. It depends on the type of coverage you have now, and whether you can sign up later (without a penalty). Not all other health coverage is the same as Part B. Find out if you should get Part B.
If you're getting benefits from the Railroad Retirement Board (RRB), you'll get Medicare Part A and Part B automatically when you're first eligible. Contact your local RRB office for more information about enrolling in Medicare.
You'll get your Medicare card in the mail about 2 weeks after you sign up. Your card is included in your official "Welcome to Medicare" packet.
If you already get benefits from Social Security, you'll get Medicare Part A and Part B automatically when you're first eligible and don't need to sign up. Medicare will send you a "Welcome to Medicare" packet 3 months before you turn 65. You'll still have other important deadlines and actions to take, so read all of the materials in the packet. (If you live in Puerto Rico, you'll only get Part A. If you want Part B, you need to sign up for it.)
People get Medicare coverage in different ways. You'll get lots of information to help you make a decision about how to get your Medicare coverage:
There are 2 main ways to get Medicare coverage:
Original Medicare – Includes Part A and Part B. You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
If you don't get Part D or a Medigap policy when you're first eligible, you may have to pay more to get this coverage later. For Part D, this could mean a lifetime premium penalty.
Medicare Advantage – An "all in one" alternative to Original Medicare. These "bundled" plans include Part A, Part B, and usually Part D. Most plans offer extra benefits that Original Medicare doesn't cover – like vision, hearing, dental, and more.
If you have Medicare and other health insurance or coverage, each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" to pay. In some cases, there may also be a third payer.
If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should've made.
If your questions about who pays first, or if your coverage changes, call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY: 1-855-797-2627). Tell your doctor and other health care provider about any changes in your insurance or coverage when you get care.
Medicare is very strict about when you can and need to enroll in or change your Medicare Coverage. If you have Employer Coverage for example you're fine as it is considered Credible Coverage.
Most Medicare beneficiaries who are still working have group coverage through an employer or an employers union plan. This allows you to delay enrollment in Part A and/or B without penalties. When you retire, you can sign up for those Parts during a Special Enrollment Period (SEP). Medicare credits you for having employer group coverage at any large employer (20+ employees.)
Later when you retire, you will be eligible for a 63-day Special Enrollment period to sign up for Parts A and/or B with no late enrollment penalties.
The Medicare Special Enrollment Period is an eight-month period that begins either the month you or your spouse quits working or the month your group coverage ends, whichever comes first.
If for some reason you missed or forgot to enroll in your Initial Enrollment Period (IEP) you will have to wait to enroll in the General Enrollment Period (GEP). This runs from January 1 through March 31 each year.
Even though you can enroll in Original Medicare during this time, you are still subject to the late enrollment penalties. However, in most cases your new Medicare coverage will not go into effect until July 1st, meaning you might have an extended period with no Insurance.
Keep in mind that the General Enrollment Period only applies to Original Medicare. If you want a Medicare Advantage plan or Medicare Part D coverage for prescription drugs, you’ll have to wait for the Annual Enrollment Period. From October 15 through December 7th.
Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:
Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here's what happens:
8 things to know about Medigap policies
Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Some types of insurance aren't Medigap plans, they include:
You may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage). Or, you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.
If you decide to drop your entire Medigap policy, you need to be careful about the timing. When you join a new Medicare drug plan, you pay a late enrollment penalty if one of these applies:
Medicare doesn't pay any of the costs for you to get a Medigap policy. You have to pay the premiums for a Medigap policy.
In most Medigap policies, the Medigap insurance company will get your Part B claim information directly from Medicare. Then, they pay the doctor directly. Some Medigap insurance companies also provide this service for Part A claims.
If your Medigap insurance company doesn't provide this service, ask your doctors if they "participate" in Medicare. This means that they "accept assignment" for all Medicare patients. If your doctor participates, the Medigap insurance company is required to pay the doctor directly if you request it.
Insurance companies may charge different premiums for the same exact policy. As you shop for a policy, be sure you're comparing the same policy. For example, compare Plan A from one company with Plan A from another company.
In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. If you buy a Medicare SELECT policy, you have the right to change your mind within 12 months and switch to a standard Medigap policy.The Medicare Advantage Open Enrollment Period
Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Your Medicare services aren’t paid for by Original Medicare. Below are the most common types of Medicare Advantage Plans.
The late enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:
1. Join a Medicare drug plan when you're first eligible.
You won't have to pay a Part D late enrollment penalty, even if you've never had prescription drug coverage before.
2. Don't go 63 days or more in a row without Medicare prescription drug coverage or other creditable drug coverage.
Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, CHAMPVA, or health insurance coverage. Your prescription drug plan must tell you each year if your drug coverage is creditable coverage. They may send you this information in a letter, or draw your attention to it in a newsletter or other piece of correspondence. Keep this information because you may need it if you join a Medicare drug plan later and want to avoid the Part D late enrollment penalty.
3. Keep records showing when you had creditable drug coverage, and tell your plan about it.
When you join a Medicare drug plan, the plan will check to see if you had creditable drug coverage for 63 days or more in a row. If the plan believes you didn't, it will send you a letter with a form asking about any drug coverage you had. To avoid a Part D penalty, complete the form and return it to your drug plan by the deadline in the letter. If you don't tell the plan about your creditable drug coverage, you may have to pay a Medicare Part D late enrollment penalty.