Understanding Medicare & Supplement Insurance Plans

What's Medicare?
Medicare is the federal health insurance program for:

  • People who are 65 and older
  • Younger people with disabilities
  • People with the End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)

Medicare provides only basic health insurance coverage. It does not cover 100% of all hospital and medical expenses you might have. It also has large deductibles for hospitalizations, etc. That comes out-of-pocket before it kicks in. Due to these reasons, most people on Medicare will procure additional supplementary health care like Medicare Supplemental Insurance to cover any additional expenses.

The different parts of Medicare with their specific services:

Keep in mind that each of these parts of your Medicare coverage and supplements will be paid for separately.

Medicare Part A (Hospital Insurance)

Keep in mind that each of these parts of your Medicare coverage and supplements will be paid for separately.

Part A covers inpatient hospital stays, care in a skilled nursing facility, blood services, hospice care, and some home health care.

Skilled nursing facility (SNF) care is for recovery from a sickness, injury, or a surgery, and is NOT long-term care like many people commonly confuse. Skilled nursing care is only for short-term care (max 100 days), and currently, Medicare stipulates that you must be showing continuous improvement in the SNF every day or else they will terminate that benefit.

Medicare Part B (Medical Insurance)

Medicare Advantage Plans include:

  • Health Maintenance Organizations
  • Preferred Provider Organizations
  • Private Fee-for-Service Plans
  • Special Needs Plans
  • Medicare Medical Savings Account Plans

If you’re enrolled in a Medicare Advantage Plan:

  • Most Medicare services are covered through the plan
  • Medicare services aren’t paid for by Original Medicare
  • Most Medicare Advantage Plans offer prescription drug coverage.

Bear in mind that Medicare Advantage also has these policies:

  • Require you to only use certain doctors and hospitals
  • Pre-certifications & referrals are usually needed to see specialists
  • Not guaranteed policy for life and can be canceled at any time (not renewable contract)
  • Funding cuts from Medicare will likely hurt plan benefits and increase plan costs
  • Locked into a contract for 12 months
  • High co-pays and deductibles
  • Lack of choices and decisions to be made by the policyholder
Medicare Part D (prescription drug coverage)

These plans will generally pay a portion of each medication that you are taking. Part D adds prescription drug coverage to:

  • Original Medicare
  • Some Medicare Cost Plans
  • Some Medicare Private-Fee-for-Service Plans
  • Medicare Medical Savings Account Plans

These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Medicare Supplement Insurance (Medigap)

Medicare Supplement Insurance supplements the “gaps” left by the Original Medicare. There are 10 policies that you can choose from varying in coverage. All companies will offer the same benefits for each policy but will only differ on the price they charge.

Enrollment Periods
  • Initial Enrollment Period (IEP)
  • Annual Election Period (AEP)
  • Open Enrollment Period (OEP)
  • Medicare Advantage Dis-enrollment Period (MADP)
Initial Enrollment Period (IEP)

The Initial Enrollment Period for Medicare Parts A and B lasts 7 months. It starts at the month of your 65th birthday, or, if due to a disability, the 25th month of receiving Social Security Disability Insurance (SSDI).

Annual Election Period (AEP)

This refers to the yearly period when people can choose to drop, switch, or enroll in a health insurance plan for the following year without restrictions. Every year, Medicare’s open enrollment period is October 15 - December 7. The new plan you will be choosing will come in effect on January 1st of the coming year.

Those with Medigap policies, on the other hand, can switch their policies anytime.

Open Enrollment Period (OEP)

This is a period of time in which a person new to Medicare will be guaranteed a Medicare Supplement Insurance plan without restrictions. This starts when you are both age 65 and enrolled in Medicare Part B for the first time.

Medicare Advantage Dis-enrollment Period (MADP)

This is for people currently holding a Medicare Advantage Plan thinking to terminate their coverage and switch back to Original Medicare. It also has option of purchasing a Medicare Supplement Insurance Policy. This lasts from January 1st to February 14th.

If you are still confused with all of these we have expert Medicare Specialists standing by ready to answer all your questions. Please call us now at (855) 230-0801.

How to Enroll in Medicare?

You can enroll in Medicare Part A and/or Medicare Part B in the following ways:

  • You can apply online at www.SocialSecurity.gov.
  • By phone - Call us at 1-800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday. If you are deaf or hard of hearing, you can call TTY 1-800-325-0778.
  • In person – Visit your local Social Security office. (Call first to make an appointment.)

If you do not live in the U.S. or one of its territories you can also contact the nearest U.S. Social Security office, U.S. Embassy or consulate.

If you worked at a railroad, contact the Railroad Retirement Board (RRB) at 1-877-772-5772 (TTY users 1-312-751-4701) Monday through Friday, 9AM to 3:30PM


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