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Medicare and You Understanding Coverages

Medicare and You: Understanding Coverages

June 20, 2019


Are you wondering where the years have gone? They certainly go by fast, but the golden years are ahead of you! Believe it or not, it is time to start thinking about Medicare. Where do you start? Great question! It can be overwhelming and confusing. The amount of phone calls and mailings just add to the mess. Let’s cover the basics of Medicare and You!

Enrollment in Original Medicare

Original Medicare is offered by the Federal Government. It is comprised of Part A and Part B.

  • Part A is hospital insurance.
  • Part B is medical insurance.

There are eligibility requirements and once you meet them, you cannot be turned down. The easiest way to enroll in Original Medicare is to contact your local Social Security Office. Then wait for your red, white and blue card to arrive in the mail. This card will allow access to more Medicare coverage, which we will cover next.

Medicare Supplement

Medicare Supplement is also referred to as Med Supp or Medigap. This insurance helps to pay for healthcare costs that Original Medicare does not cover. It “supplements” Original Medicare, just like the name suggests.

All Medicare Supplement plans are named with a letter. The coverage has to be the same for that named plan across all insurance companies that offer it. For example, all Med Supp Plan G plans have the same exact coverage. What’s the difference then? Monthly premiums can be different.

You do not have to worry about a network of doctors with Medicare Supplement plans. If the provider accepts Medicare, they will accept your Med Supp plan.

Prescription drug coverage is not included with a Medicare Supplement plan. It is definitely something to consider as a add on, especially if you take medications. Let’s review that next.

Prescription Drug Coverage

Prescription Drug Coverage is also referred to as Part D. It is a good idea to enroll in a Part D plan if you take any prescription medications. There is a monthly premium associated with this coverage.

Keep in mind there is a penalty if you do not enroll in a Part D plan when you are first eligible. This penalty can be waived if you have credible drug coverage provided by another entity, such as the VA.

Each insurance company has a drug formulary, which lists how individual medications are covered. Comparing this with your current list of medications will help determine the best plan for you. It is also a good idea to review your Part D plan yearly, as formularies can change from one year to the next.

Medicare Advantage

A Medicare Advantage (MA or MAPD) plan manages all your benefits! Essentially, it covers everything Original Medicare, a Med Supp and a Part D plan would provide. Sometimes there are even additional benefits, such as vision or hearing coverage.

Here are two important difference you will want to note! Medicare Advantage plans have a specific network of doctors and hospitals! Pay careful attention so you can continue to be cared for by your doctor of choice. These plans also typically have co-pays and co-insurance, which may weigh in to your decision.

When Can I Enroll?

After you have your red, white and blue Medicare card, you can enroll in additional coverage.

  • Enrolling at 65
    • This is called your Initial Enrollment Period (IEP)
    • Starts 3 months prior to your birthday and ends 3 months after your birthday.
      • For example, if your birthday is April 30, 1954. You can enroll from January 1, 2019 until July 31, 2019.
        • If enrollment is completed in the 3 months prior, coverage will begin at the beginning of the birthday month. In this example, if you enrolled from January to March, coverage would start on April 1, 2019.
        • If enrollment is completed in the birth month or after, coverage would start on the 1st of the following month. In this example, if you enrolled in April, your coverage would start May 1, 2019.
  • Enrolling after Retirement
    • Some people choose to continue to work and retire later than age 65. No worries!
    • Enrollment would start for you after your employment ends or your group health insurance ends. You only have 8 months though.

There are several factors to consider when choosing coverage that works best for you. Hopefully, this brief overview of Medicare and You has been helpful. Contact us if you are approaching your 65th birthday. Our trusted, insurance professionals are available to be your personal guide through the process. Start by filling out this quick form and we will be in touch!