You may be interested in signing up for Medicare or finding out alternatives to your existing coverage. Understandably, insurance can be a difficult topic to try to grasp and the complications are compounded by so many separate options. With Medicare, the important thing to get you started is your eligibility. Finding out if you’re a candidate for Medicare is important and you’ll find that there’s only a few criteria you’ll need to review. The Health Exchange Agency is skilled at determining eligibility and answering questions for you if you do have a unique situation.
When it comes to the Annual Election Period or “AEP,” being on schedule is very important. For 2020 coverage the timeline began on October 15th and ran through December 7th. For those interested in taking on the coverage for Medicare Advantage, the enrollment time-frame is available from January 1st to March 31st, 2020. This is the Medicare Advantage Open Enrollment, otherwise known as “MA OEP.” It’s important to remember that this is available to those already enrolled in Medicare Advantage plans. This is also the timeframe in which one can adjust from Medicare Advantage to the Original Medicare plan. In addition, there is the option for those are near the inception of their Medicare eligibility who can take advantage of the Initial Coverage Election Period, or “ICEP.” This time is designated for those who are newly eligible for Medicare to begin enrolling in the Medicare Advantage Plan for the first time. This happens at a different time of year than the Medicare Advantage Open Enrollment (MA OEP). It’s important to identify when the right time is for you to enroll as there are very few exceptions that fall into the Special Election Period. These exceptions, are limited to specific life events such as marriage or losing other health coverage elsewhere.
The principal criteria for determining eligibility with Medicare is age. In order to qualify you must be 65 years of age. If you are not yet 65 there are some specific conditions that would make you eligible like Lou Gehrig’s disease or End-Stage Renal Disease (ESRD). If you have one of these conditions or have additional questions about your eligibility, contact The Health Exchange Agency directly to discuss your specific options. Specified conditions are important to disclose in order to properly qualify an individual for coverage during an ongoing health concern. Qualifying may be easier than you imagine.
After you’ve checked off the “65 years” bucket, you’ll need to evaluate a few other things. It’s important that you’ve had Medicare-covered Employment for a minimum of 10 years leading up to your enrollment. This means having at least 40 quarters of employment that has paid out Medicare taxes. If you (or your spouse) did not pay these Medicare taxes, you still may be eligible. There is additional criteria that would be the determining factor for your qualification.
In addition to the aforementioned criteria, another important qualifier is the citizenship or permanent residency status that you currently have. You must have either the US Citizenship or Permanent Residency for a minimum of 5 years in order to move forward in your enrollment process. If this sounds like you, you’re ready to enroll. Taking the next step and signing up for Medicare may lead you to some new questions, be sure to gain clarity on questions you may have surrounding the process.
While Medicare has three major criteria for the enrollment of it’s clientele, it’s important to note that the individual circumstances of each person can make a difference in eligibility. If you’re unsure based on your current status, we have answers to your questions. While you may still be working part-time or full-time or carry insurance privately, Medicare still may be an important option for you to consider. The benefits of having a supplementary plan assist in ensuring that you don’t end up paying out of pocket for costs that could otherwise be covered. The Health Exchange Agency specializes in assisting men and women like you each day with their Medicare enrollment, you don’t have to do this alone. We’re here to help and know that with the right personalization of the process, you’ll get the exact coverage you want and need. You are at or nearing the age of Retirement (65) and you may still be covered by your own Health Insurance or by your Employer or through the VA. You have heard about Medicare for years but you also know Medicare has Part A, Part B, Part C and Part D. Family members and friends may have mentioned Medicare Supplement Plans and Medigap Plans, Medicare Advantage Plans and probably Prescription Drug Plans. All of these questions and things to consider probably seem a bot overwhelming at times but we have tried to break things down and make it a little bit easier to decipher and understand.
The 4 PARTS Of ORIGINAL MEDICARE
Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement or a Medigap Insurance policy help pay for additional things such as:
As of January 1, 2020, Medigap plans sold to new people with Medicare aren't allowed to cover the Part B deductible. Because of this, Plans C and F are not available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) prior to January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.
Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care if/when you travel outside of the United States. If you have Original Medicare and you buy a Medigap policy, here's what happens:
Are the most desired Medicare Plans and they have the most flexibility, you can see any Doctor Nationwide who accepts Medicare patients. There are well over 800,000 Doctors who accept Medicare that equals out to over 90% of all physicians! All of these doctors will accept any Medigap Policy that you enroll in, regardless of the Insurance Company you choose to partner with. All of the Medicare Supplement Plans are identified by a Alphabetic Letter such as Plan A, B, C, D, F, G, K, L, M, N, S, T.
Medicare Advantage Plans must cover all of the services that Original Medicare covers. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies. In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care.
The plan can choose not to cover the costs of services that aren't medically necessary under Medicare. If you're not sure whether a service is covered, check with your provider before you get the service.
Most Medicare Advantage Plans offer coverage for things that aren't covered by Original Medicare, like vision, hearing, dental, and wellness programs (like gym memberships). Plans can also cover more extra benefits than they have in the past, including services like transportation to doctor visits, over-the-counter drugs, adult day-care services, and other health-related services that promote your health and wellness. Plans can also tailor their benefit packages to offer these new benefits to certain chronically ill enrollees. These packages will provide benefits customized to treat those conditions. Check with the plan to see what benefits are offered and if you qualify. Most include Medicare Prescription Drug Coverage or Medicare Part D. In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan. In 2020, the standard Part B premium amount is $144.60 (or higher depending on your income).
If you need a service that the plan says isn't medically necessary, you may have to pay all the costs of the service. But, you have the right to appeal the decision.
You (or a provider acting on your behalf) can request to see if an item or service will be covered by the plan in advance. Sometimes you must do this for the service to be covered. This is called an “organization determination.” If your plan denies coverage, the plan must tell you in writing.
You don’t have to pay more than the plan’s usual cost-sharing for a service or supply if a network provider didn’t get an organization determination and either of these is true:
Medicare Part D is prescription drug coverage. Medicare Part D is optional, and it’s available only through private insurance companies that contract with Medicare.
Medicare Part D prescription drug coverage was created by the Medicare Modernization Act (MMA) of 2003 and implemented in 2006. The goal of Medicare Part D is to help make prescription drugs available and affordable for Medicare beneficiaries.
Anyone with Medicare coverage—either Medicare Part A (hospital insurance) or Part B (medical insurance) or both parts—may be eligible for a stand-alone Medicare Part D prescription drug coverage. You can’t be turned down because of your health status or income.
You can get your Medicare Part D coverage from either of these types of plans:
If you enroll in a Medicare Advantage plan, note that you continue to pay your monthly Medicare Part B premium. You also pay any premium the plan might charge.
You can change Medicare Supplement/Medigap Plans anytime but you need to remember that after your IEP (Initial Enrollment Period) there is no guarantee that you will be accepted by an Insurance Company and you may be subject to Underwriting depending on your current state of health.
You are limited to when you can change your Medicare Advantage Plan. The Annual Enrollment Period (AEP) Period is in the Fall from October - December. There are other times you may make a change such as moving out of a coverage area or to another state.
We are always available to answer your calls and to give you the best, straightforward answers to all of your healthcare questions. If you would like to engage us to represent you and your interests please know that we get paid by the various Insurance companies and that we would never charge our clients for any services.
The best form of knowing that we helped you is by you referring us to family and friends who need help understanding the fundamentals of Medicare and you have our promise that we will treat them with the same level of care and respect that we have given to you and to each of our nearly 800 Clients.