Medicare Insurance

Everything You Need
to Learn About Medicare

Medicare

Welcome to Medicare! If you are new to Medicare, take a few moments, and read these few paragraphs so that you may know what to expect.

To be eligible for Medicare, you have to either have worked for at least 40 quarters and paid taxes in this country; or you may purchase it, and Social Security can tell you what the cost would be. You may enroll at the local Security office, or if you are already collecting Social Security, you will be automatically enrolled. This window of opportunity to do this begins 3 months before your birthday month and ends 3 months after your birthday month. It is important to note here that if you miss the window of opportunity to enroll in part B, that you could possibly be charged a 10% penalty for every 12 months that you could have part B but didn’t. The next time that you will have the opportunity to enroll in part B will be during the General Election which runs from January to March and your effective date will be July 1 of the year you enroll.

There are two parts to Original Medicare. They are as follows:

  • Part A, which covers about 80% of your in-patient hospital costs
  • Part B, which covers about 80% of your out-patient Physician costs

You may be eligible for Medicare if you are 65 years old, or under 65 and have been collecting Disability for 24 months. Or at any age, if you have end-stage renal disease.

This 7-month window of opportunity is also the opportunity to enroll in your PDP program or a Medicare Advantage Plan. In order to have an effective date for the first day of your birthday month, you will need to contact me at least two weeks prior to that date.

Call me at (707) 324-9994 for assistance.

California Medicare Advantage (Part C)

Part C or as it is usually referred to: the Medicare Advantage program is where private health care companies offer health plans that cover all Medicare part A and B benefits. Most of the plans available are HMO plans; Health Maintenance Organizations. Some also include a drug plan, which can save a beneficiary having to enroll in a standalone part D plan and pay a monthly premium.

HMO plans generally require the members to use a specific network of doctors and hospitals, and if a member goes outside the network, the plan will not pay for the services, unless they went outside the Network due to an emergency situation and felt their life may be in jeopardy. All MA plans have a maximum out of pocket limit. Most HMO MA/PD plans are an inexpensive way to obtain good health coverage. If your Primary Care Physician is on the network and you are okay with the Hospital then this could be a good cost-effective way to cover your health care needs.

Call me at (707) 324-9994 for assistance.

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Medicare Part D

While Part D plans are an option; there is a penalty if you don’t enroll in one when eligible, if you should need to enroll in one in the future. The penalty at this time is 1% of the National average cost of a health plan for each month that you could have had one but did not. At this time, it is $.32. Not too bad, but how it plays out is that the penalty is added to the cost of whatever plan you choose for the rest of your life. Like the Medicare Advantage plan; you enroll in a Part D during your 7-month window of opportunity. Your next opportunity would be the Annual Enrollment Period.

With both Part D and Part C, there are special times that occur in your life that may qualify as a Special Enrollment Period, SEP, and allow you to change plans in the middle of the year in what we refer to as Lock downtime. This would be allowed, if you moved from one region to another, and your plan was not available in the area you moved to. Another SEP may occur if you lost your Group coverage.

If you are struggling to pay for a Drug plan or keep up with the co-pays, you may qualify for Extra Help.

Call me at (707) 324-9994 for assistance.

California Medicare Supplement (Medigap)

Medigap plans or as they are sometimes called, Medicare Supplement plans work with Original Medicare to cover the 20% cost share in part or in full; that is yours to pay. Medigap plans only cover procedures that Medicare covers. Medigap plans are preferred by people who want to choose their own Doctors, and hospitals should they get ill. Turning 65 triggers a 6-month open enrollment period when Medigap plans must be issued, regardless of any pre-existing conditions.

The amount of coverage that you have with a Medigap plan depends on which plan you purchase. They are available in standardized benefit plans and are differentiated by a letter of the alphabet. A through N. The only thing that changes from one carrier to the next is the premium, and the underwriting once the 6-month open enrollment period ends.

People that travel a lot prefer to have Medigap plans.

For help in finding the right Medigap plan or prescription drug plan and finding Medicare providers in your area, give Early and Associates Insurance Services a call at (707) 324-9994. I’ll help you understand your options so you can make an informed decision.