1 – There are two ways to get Medicare
Original Medicare (Parts A & B). Part A is hospital coverage and Part B is medical coverage. Original Medicare is provided by the federal government. Benefits and coverage are the same across the country. With Original Medicare, you can also add a stand-alone Part D prescription drug plan and/or a Medicare supplement insurance plan (Medigap). Medicare Advantage (Part C). These plans combine your Part A and Part B coverage, and many also include Part D prescription drug coverage and other benefits such as hearing, vision, dental or fitness. Plans are offered by private insurance companies.
2 – There are two ways to get drug coverage
You may add a stand-alone prescription drug plan (Part D) to Original Medicare. Or you may enroll in a Medicare Advantage plan that includes prescription drug coverage.
3 – Original Medicare doesn’t cover everything
Original Medicare (Parts A & B) doesn’t cover everything that you may need for your health. It doesn’t include prescription drug coverage, hearing health, dental, vision, wellness services or financial protection. If you want additional coverage, explore plans provided by private insurance companies.
4 – Location impacts your coverage choices
Medicare Advantage plans and prescription drug plans vary in terms of coverage and cost. Insurance companies may offer several plans where you live. Medicare supplement insurance (Medigap) plans are standardized and are the same nationwide, except in Minnesota, Wisconsin and Massachusetts.
5 – Calculate all your Medicare costs
- You are responsible for monthly premiums plus additional out-of-pocket costs such as deductibles, copays and coinsurance.
- Your costs will vary based on the Medicare coverage you choose, the health services you use during the year and if you have any financial assistance for Medicare costs.
6 – Protection from high out-of-pocket costs is available
- Medicare Advantage plans put a cap on your out-ofpocket costs for Part A and Part B services covered by the plan. It’s called the “annual out-of-pocket maximum” and it provides built-in financial protection. There is no out-of-pocket cap with Original Medicare. Total out-of-pocket costs and financial protections may vary for in-network vs. out-of-network costs.
- Medicare supplement insurance plans help pay some out-of-pocket costs not paid by Original Medicare, like deductibles and coinsurance. A variety of plans are available that offer different levels of financial protection. Medigap plans are organized by letters, such as “Plan A” or “Plan G.”
- Both Medicare Advantage and Medicare supplement insurance plans are offered by private insurance companies. You can have either a Medicare Advantage or Medicare supplement insurance plan, but not both together.
7 – Timing matters when you first enroll
- Your Initial Enrollment Period (IEP) is your first chance to enroll in Medicare. It is 7 months long – it includes your birthday month or the 25th month of getting disability benefits plus the 3 months before and 3 months after.
- You may qualify to delay Medicare enrollment if you have creditable coverage through your employer or your spouse’s employer. If you can delay, you’ll have an 8-month Special Enrollment Period (SEP) that begins either when you lose the employer coverage or leave your job, whichever occurs first.
- If you enroll after your Initial Enrollment Period or Special Enrollment Period, you could face late penalties for Medicare Part A, Part B or Part D.
8 – You may be able to enroll or make changes at other times
- Medicare offers a General Enrollment Period (GEP) every year January 1 – March 31 for those who have missed their Initial Enrollment Period.
- Medicare provides Special Enrollment Periods (SEP) for qualifying life events. Examples include moving your primary residence or leaving an employer health plan. Visit Medicare.gov for a complete list of qualifying events.
- The Medicare Advantage Open Enrollment Period (MAOEP) is January 1 – March 31 each year. You may switch to a different Medicare Advantage plan or drop a plan and go back to Original Medicare at this time.
- The Medicare Annual Enrollment Period (AEP) happens every year from October 15 to December 7. You may change your coverage during this time if you decide to.
Medicare Quick Tips provided by Daniel Gomez, owner of Good Life Insurance, NC. He can be reached at 336-546-7956.