The Basics of Medicare

Enrollment period

IEP

IEP stands for Initial Enrollment Period. This is the time when you are soon to be 65 years old or when you first enroll in Part A and/or Part B of Medicare. You can join a plan when you first become eligible for Medicare. You can enroll beginning three months before the month you turn 65, the month you turn 65, or three months after you turn 65.

If you are receiving Social Security Benefits you will be automatically enrolled in Medicare Parts A and B.

If you are not receiving Social Security Benefits, you must contact Social Security to enroll in Medicare in the following ways:

• Online at www.SocialSecurity.gov
• By calling Social Security at 1-800-772-1213
  (TTY users 1-800-325-0778)
• In person at your local Social Security Office

costs

Standard Premiums

For most people enrolling in Medicare, Part A is FREE. But, Part B has a monthly premium. The standard Part B premium amount in 2022 is $170.10. Most people will pay the standard Part B premium amount. (See charts below. Tab over a Premium to find the associated level of income or Benefit and its description.)

Plan options

Advantage Plans

Medicare Advantage Plans, sometimes called Part C, are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through the Medicare Advantage Plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

• Medicare Health Maintenance Organization (HMO)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

Medicare Advantage Plans are designed and centered around populated areas. In most cases, plans can differ from county to county. The more rural you are, the less plans are available – this is what makes Medicare Supplement Policies very popular in rural counties.

Medicare Advantage Plans differ from provider to provider. They do not have to offer the same thing like Medicare Supplement Coverage.

Once you enroll in a Medicare Advantage Plan, you are IN the plan. There is an Annual Enrollment Period (AEP) each year (October 15th through December 7th) when you can switch or drop your plan or return to Original Medicare. In any case, your coverage is a calendar year contract from Jan 1 to Dec 31. You cannot change plans any time you want to unless you qualify for a Special Election Period.

Prescriptions

Drug Plans

You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday. It’s important to do this on time because there’s a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don’t have equivalent drug coverage from another source, such as a retiree plan.

What is the Penalty?

The definition of the Part D Prescription Drug Plan penalty is 1% of the National Average Premium multiplied by the number of months you did not have a drug plan.

Choosing a prescription drug plan is simply choosing the Right Drug Plan for YOUR MEDICATIONS. Nothing else. It’s not about the flyer you received in the mail with the beautiful pictures that made you feel so good, you decided that plan must be the best one. It’s about the meds! So, what meds are you taking? What are the dosages? How many times per day do you take them? And…What Pharmacies do you like to use? Or, Do you like mail order?

The answers to these questions will be what decides the right plan for you.

This information was obtained from www.medicare.gov

Annual Enrollment

Medicare offers an Annual Enrollment Period (AEP) each year from October 15th through December 7th. If you have a Medicare Advantage or a Prescription Drug Plan, you can select and enroll in a different plan with coverage beginning January 1st. This is a benefit as your Doctors may not be in your network or your medications may have changed.

medigap

Supplement Insurance

A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like co-payments, coinsurance, and deductibles.

If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Your Medigap policy pays its share.

A Medigap policy is different from a Medicae Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

What you need to know about Medicare Supplement policies:

• You must have Medicare Part A and Part B.
• If you have a Medicare Advantage Plan, you can switch to a Medicare Supplement insurance policy, but make sure you can leave the Medicare Advantage Plan before your Medicare Supplement insurance policy begins.
• You pay the private insurance company a monthly premium for your Medicare Supplement insurance policy in addition to the monthly Part B premium that you pay to Medicare.
• A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you will each have to buy separate policies.
• You can buy a Medicare Supplement insurance policy from any insurance company that is licensed in your state to sell one.
• Any standardized Medicare Supplement insurance policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medicare Supplement insurance policy as long as you pay the premium.
• Medicare Supplement insurance policies sold after January 1, 2006 are not allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
• It is illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you are switching back to Original Medicare.

Information obtained from www.medicare.gov