Medicare

Medicare is a government-provided health insurance program catering to individuals aged 65 years or older, those with qualifying disabilities, and people with end-stage renal disease. The program mainly consists of Original Medicare, directly administered by Medicare, which encompasses:

Part A Hospital Insurance – Most individuals do not have to pay a Part A premium, as it covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Part B Medical Insurance – Most beneficiaries pay a monthly premium for Part B, which covers doctor’s services, outpatient care, medical supplies, and numerous preventative services.

You can access the “Medicare and You” handbook by downloading it here:

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You have several options for receiving your Medicare benefits:

• Original Medicare
• Original Medicare + Supplement OR Cost Plan
• Medicare Advantage Plan
• Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare. These plans are bundled and typically include Part A, Part B, and Part D.

If you decide to enroll in a Medicare Advantage Plan, you will still be covered by Medicare and will continue to pay your Part B premium. However, your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) coverage will be provided by the Medicare Advantage Plan instead of Original Medicare.

Medicare Supplements

Medicare Supplements, also referred to as Medigap, are insurance plans offered by private insurance companies to complement Original Medicare Parts A and B. These policies are designed to cover the gaps in Medicare, including co-payments, coinsurances, and deductibles that you would normally be responsible for paying. Unlike some other insurance plans, most Medicare Supplements do not restrict you to a specific network of healthcare providers, allowing you the flexibility to choose your preferred doctors and specialists.

It’s important to note that Medicare Supplement premiums are typically based on your age at the time of enrollment, and they may increase as you get older. However, despite having a Medicare Supplement, you will still be required to pay your regular Part B premium to maintain your Medicare coverage.

Medicare Advantage

Medicare Advantage Plans, also known as “Part C” or “MA Plans,” present an alternative way to receive your Medicare benefits. These plans are offered by Medicare-approved private insurance companies that adhere to Medicare’s guidelines. Although you’ll still have Medicare coverage, a Medicare Advantage Plan will provide most of your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) benefits, rather than relying on Original Medicare.

One of the advantages of Medicare Advantage Plans is the additional benefits they often offer beyond Original Medicare. These can include dental, vision, hearing, and gym memberships, among others. Unlike some other insurance plans, Medicare Advantage Plan premiums are not determined by the age of the insured.

In our area, the two primary plan types are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO).

Medicare Advantage plans can be particularly suitable for Veterans. While Original Medicare Parts A & B still leave Veterans with financial exposure for services outside the VA system, Medicare Advantage Plans cap the out-of-pocket risk and provide additional benefits like dental, vision, and hearing services. Some plans may even offer a reduction in the Part B premium.

Annual Enrollment Period

The Annual Enrollment Period (AEP) for Medicare Advantage (Part C) occurs from October 15 to December 7 each year, during which you have the opportunity to select or modify your insurance plan for the following year. Additionally, there are Special Election Periods (SEPs) available under limited circumstances, allowing for changes outside the regular enrollment period.

The Medicare Advantage Open Enrollment Period (OEP) takes place from January 1 to March 31:

If you currently have a Medicare Advantage Plan, with or without drug coverage, you have the option to switch to another Medicare Advantage Plan, with or without drug coverage.

During this period, you also have the choice to drop your Medicare Advantage Plan and revert to Original Medicare. Additionally, you will be eligible to join a Medicare drug plan.

It’s essential to note that you can only make one change during this period, and any adjustments you request will become effective on the first day of the following month after the plan receives your request.