Do You Have Questions About Medicare?

By Roni Bell

You are NOT alone! I have seen much change so I stay current and informed so I can give you a choice, convenience and counsel is important to me.   Choosing insurance plans can be difficult. I have listed several of the most frequently asked questions below.

WHAT AGE DO I NEED TO BE TO SIGN UP FOR MEDICARE?

  1. Original Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS) for those who are:
  2. 65 and older
  3. Any age and disabled (after 25 months)
  4. Diagnosed with End Stage Renal Disease (Kidney disease requiring dialysis)
  5. IF I RECEIVE SOCIAL SECURITY, AM I AUTOMATICALLY ENROLLED IN MEDICARE?
  • If you are collecting social security, you will automatically be signed up for Original Medicare and receive your Medicare card in the mail 3 to 4 months before you turn 65.
  • Otherwise, you need to go to www.medicare.gov and formally enroll in Medicare Parts A & B in order to be signed up and get your Medicare Card. You may also call or visit your local Social Security office for help or to sign up for Medicare.
  • If you are covered under your (or your spouse’s) CURRENT employer group health plan, you may delay enrollment into Medicare Part B.

WHAT IS THE DIFFERENCE BETWEEN THE MEDICARE ADVANTAGE PLAN vs. THE MEDICARE SUPPLEMENT PLAN?

  1. Original Medicare never intended to pay 100% of health care costs. You have two options in Medicare if you want additional coverage, either a Medicare Supplement or an Advantage plan.

Medicare Supplement Insurance plans (Medigap) help with the coverage gaps in Original Medicare. (You will need to add a separate prescription drug plan – Part D.) Original Medicare is still the primary payer of claims; you choose an insurance company that helps fill in some/all of the costs that Original Medicare does not cover. (deductible, co-insurance)

With a Medicare Supplement Plan or Medigap, you pay little or NO out of pocket cost when used (for medical). These plans have NO network. They are accepted nationwide by all doctors/hospitals who accept Original Medicare.

Medicare Advantage plan:

You still pay your Part B premium. You choose a plan with a private health insurance company, and they will pay your doctors and hospitals. You will be charged out-of-pocket costs when the plan is used. That means you will pay copays at the doctor, hospital, outpatient surgery, labs, etc.

You will need to be willing to use network providers, as these plans can be HMOs or PPOs. They have a maximum out-of-pocket cost for medical (prescriptions not included). Most Medicare Advantage Plans include prescription drug coverage. They may also offer some added benefits such as vision, dental, hearing, fitness, etc. These plans can have a lower cost or no additional cost to you, in addition to your Part B premium.

HOW DO I SELECT THE BEST PLAN TO FIT OUR NEEDS?

  1. I highly recommend meeting with a licensed insurance agent. HealthMarkets and my team are here to help, and there is no charge or fee to meet with an agent. You will pay the same rate that you would if you trudge through it on your own.   There are many things to take into consideration in choosing the most appropriate plan for you. There is no BEST plan in Medicare; it is really determining the plan that fits with your lifestyle, your medications, and your individual situation.

I do like to make sure that clients know that they are eligible to purchase a Medicare supplement with no health questions asked, in your guarantee issue period. (This is 6 months beginning with turning 65 or enrolling in Part B, whichever is later.) There are some other special circumstances, typically 63 days after loss of coverage.   After your guaranteed enrollment period ends, you will be asked medical questions to determine if you are eligible for a Medicare Supplement. They can either decline or charge a higher rate based on health.

Please reach out if you have questions. We will work to find the plan that best fits you and your family. ~Roni

Health Markets- Brunswick 
www.HealthMarkets.com/Roni.Bell