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MEDICARE
101
Navigating Medicare can be complex at times. Below we gathered some important information to help fill knowledge gaps, and or highlight certain areas sometimes overlooked with Medicare.
Medicare Decisions
When Turning 65
As you approach age 65, its very important that you get familiar with Medicare coverage choices and make several important decisions about enrollment. There can be financial penalties if you do not enroll in specific coverages on time, so its best to get familiarized with Medicare topics and expectations at least 3 months before you turn 65. This list below is not all exclusive, but it is a start to get you going in the right direction. ​​ ​​​​​​​​​​​​
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1. What is Medicare
Medicare is health insurance for people 65 or older, people under 65 with certain disabilities, and people of any age with End- Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).​
2. Know the Different parts of Medicare:
Medicare Part A (Hospital Insurance)
Medicare Part B (Medical Insurance)
Medicare Part C (also called “Medicare Advantage”)
Medicare Part D (Medicare prescription drug coverage)
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3. Determine your Initial Enrollment Period
When turning 65, your time/period for Enrollment into Medicare is called the Initial Enrollment Period.
The Initial Enrollment Period is a 7-month period. This period begins 3 months before the month you turn 65, the month of your birthday, and 3 months after your birthday month.
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4. Choose Coverage
**You can decide to enroll in Original Medicare (Medicare A & B, with or without a supplemental Plan).
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**You can decide to enroll in Medicare Part C (some plans include prescription drug coverage).
​​​And / Or
** You can decide to enroll in Medicare Part D.
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​​5. Signing Up for Coverage
** If you have questions and wanted to see options for Medicare coverage, it is highly suggested that you speak with a Licensed Insurance Agent to help you navigate the options to ensure that you select the best health care coverage that will fit your needs. Once you have that narrowed down you should be able to confidently make the right decision about your coverage needs.
** Remember when turning 65 the Initial Enrollment Period is the time you want to enroll into Medicare, so if you can start looking into available options before that window options you will be all set and ready to enroll as soon as your Enrollment period begins.
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65
Medicare Part A
In Patient
Hospital Coverage
Medicare Part B Medical Coverage
(doctors visit, outpatient, etc)
Medicare Part C (Medicare Advantage)
This is an "all in one" alternative to Original Medicare. It bundles Medicare Part A &B, and usually Part D.
Medicare Part D (Prescription Drug Coverage)
This coverage is optional but if you choose to not join a Medicare drug plan when your first eligible, (or have creditable drug coverage elsewhere) you may have to pay a late enrollment penalty if you join later.
Supplemental Coverage
Can help pay some
health care cost.
What is Special Needs Plans (SNP)?
​Special Needs Plans are Managed Care Plans (Part C) that provides benefits and services to people with specific diseases, certain health care needs, who have both Medicare and Medicaid coverage.
Special Needs Plans allows you to keep your Medicaid benefits while providing additional support to help manage your health care needs. This is done by The Managed Care plan coordinating benefits on your behalf to help fill the gaps in your care to help improve the quality of your life as well as provide a more streamlined, hassle-free experience.
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Some additional benefits may include:
Dental Coverage
Gym Memberships
Eye glasses and Hearing aids
Care Coordinator, and more.
There are 3 groups of Special Needs Plans (D-SNP, C-SNP & I-SNP) available for those who qualify.
1. Dual Eligible Special Needs Plans (D-SNP): Helps to coordinate your Medicare and Medicaid benefits, while providing additional support to deal with your health care needs.
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2. Chronic Condition Special Needs Plan (C-SNP) are for people who have specific severe or disabling chronic conditions like (e.g., diabetes, heart failure). C-SNP members have access to a network of providers who specialize in their condition to allow for better coverage and access to prescription drugs used to treat their condition.
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3. Institutional Special Needs Plan (I-SNP) Are for people who live in certain institutions (like nursing homes) or who live in the community but require nursing care at home. It is designed to enhance coordinated care. Some of the benefits that my be offered are:
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On-site care management services.
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Follow up care to achieve medical goals.
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Medication Review
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Coordination of Care with Primary Care Physician & Facility care team.
ENROLLMENT ELIGIBILITY
Annual Enrollment Period (AEP)
When:
Every year from Oct.15 - Dec. 7th.
Who is it for?
Anyone enrolled in Medicare A and/ or B, Medicare Advantage, or Part D. plan.
What can you do?
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Change from original Medicare to a private Medicare Advantage Plan.
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Change from Medicare Advantage to Original Medicare.
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Join, drop, or switch Part D drug coverage.
Medigap Enrollment Period
When:
Six month window after you enroll into Medicare Part B.
Who is it for?
People turning 65, newly eligible for Medicare, and enrolled in Parts A & B.
What can you do?
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Purchase a Medigap
(a.k.a supplemental Medicare)
Initial Enrollment Period (IEP)
When:
The 7th Month window around your 65th birthday, or those under 65 and found to have a disability, generally the month after a 24-month waiting period.
Who is it for?
People newly eligible for Medicare, both those turning 65 and those under 65 who are found to have a disability by Social Security and have met their Medicare "waiting period" (received SSDI benefits for 24 months).
What can you do?
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Join Medicare Parts A and/or B, and also enroll in part D.
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Also, the month of entitlement of Medicare Part A and B through to the 7th month of your initial enrollment period you can Enroll in a Medicare Advantage Plan, with or without Part D.
**Please note to enroll into a Medicare Advantage plan you must first have Medicare Part a & B prior to enrolling, that is why you are eligible to enroll in such plans after the initial enrollment into Medicare).
Special Enrollment Period (SEP)
When:
Ongoing, (SEPs exist for people to enroll in/switch Medicare Advantage and Part D)
Who is it for?
There are many SEPs for both Medicare Part D, and Medicare Advantage plans. SEPs
can apply to those who:
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Lose active employee/spousal coverage ( and didn't sign up for original Medicare when first eligible).
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Move out of plan service area.
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Enter or leave an institution (nursing home, jail).
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Qualify for Part D Low- Income Subsidy (Extra Help).
What can you do?
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Change/ enroll into a Medicare Advantage plan.
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Move back to Medicare Part A and B.
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Change / enroll into a Part D Plan.
**Please note specific rules and timing apply to SEPs and its based on a person's individual circumstances​. **
If you have any questions or would like to review your eligibility options regarding Medicare options, please feel free to request a free consultation, and any of our licensed agents will be happy to assist you.