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Medicare FAQ

What Is Medicare?

Medicare is the federal government program that provides health care coverage if you are 65+, under 65 and receiving Social Security Disability Insurance for a certain period of time, under 65 with End Stage Renal Disease.

The four parts of Medicare are:

Medicare Part A - Inpatient Hospital, Skilled Nursing, Home Health Care, Hospice

Medicare Part B - Doctor Services, Outpatient Hospital, Durable Medical Equipment

Medicare Part C - Medicare Advantage Plans, Combines Part A, Part B and Part D    
Medicare Part D - Prescription Drug Plans, Provided by Private Insurance Companies

When Are You Eligible? Guide to Enrollment Periods

     If you're approaching Medicare eligibility, it is important to know the various times to sign up for this important milestone.  Here are the enrollmentperiods that might help you determine what your eligibility is and whether you need to sign up for Medicare at all. 

Initial Enrollment Period - Period three months before your 65th birthday month, your birthday month, and three months following your birthday month.  You are guaranteed issue (no underwriting) for the plan you select. 

Annual Enrollment Period - Period every year between October 15 and December 7 when you can change your Medicare Advantage Plan or Prescription Drug Plan.

Open Enrollment Period - Additional period of time from January 1 through March 31 when you can change your Medicare Advantage Plan.  You can also return to Original Medicare with or without a drug plan.

Retirement/Loss of Group Health Insurance - Period of time once you retire or lose creditable group coverage to sign up for Medicare and a Supplemental, Advantage  Plan and/or Part D Drug plan.

Supplemental Plan Birthday Rule - Period that allows you to change your Supplemental plan that begins 30 days before your birthday up to 30 days after your birthday.

Special Enrollment Period - Period of time to change your Medicare Advantage plan or Part D drug plan because of a life event, i.e., moving out of service area, qualifying for Low Income Subsidy.

     If you are still actively working and have a creditable (as good as Medicare) employee group plan, you may be able to postpone enrolling in Medicare until you retire without incurring any penalties.

What Are The Gaps In Medicare and How Can You Cover Them?

     While most peoples' health insurance costs go down when they sign up for Medicare, many are surprised that Medicare doesn't pay 100% of their medical expenses.  There are deductibles, co-pays, and coinsurance which can add up to hundreds, if not thousands, of dollars per year of out-of-pocket costs if you have Medicare alone.  
     So how can you bridge the gap and keep more money in your pocket?  There are basically two ways you can go.  Below is an explanation of each:

Medicare Supplemental Plans - You remain in Original Medicare and can go to any doctor who takes Medicare throughout the United States.  Your plan travels with you, and you do not have to get a new plan if you move out of State or get referrals to see a specialist.  If you want prescription drug coverage, you would have to purchase a stand-alone Part D plan to go with your Supplemental Plan.

Medicare Advantage Plans - You opt out of Original Medicare and go with a private company that combines Parts A, B and D into once plan (which is also called Medicare Part C).  Most plans require you to see Network Doctors and get referrals to see a specialist.  Some plans exclude Part D if you have other drug coverage such as VA benefits.  Advantage Plans include Special Needs Plans for people with certain chronic conditions and Medi-Medi plans for those who qualify for both Medicare and Medical.