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Original Medicare FAQs

Medicare is a federal health insurance program for individuals 65 or older and certain younger individuals with disabilities, and people with End-Stage Renal disease (ESRD).

  • If receiving Social Security benefits prior to turning 65, individuals will be enrolled in Medicare Part A and Part B automatically based on working the Medicare required amount to receive benefits. Typically, you should receive your Medicare information, including Medicare card in the mail 3 months prior to you turning 65.
  • However, not everyone is enrolled automatically, in which case you would need to contact the Social Security. You may do so three months before, the month of and three months after turning 65
  • Certain individuals that are 65 and still have group insurance will still receive Medicare Part A benefits, but can delay Medicare Part B benefits due to still having credible coverage through an employer.

  • It depends, is your group coverage comparable or better than traditional Medicare options?
  • Our licensed agents will compare pricing, coverage, deductibles, co-payment, coinsurance and flexibility of choosing your own doctors.
  • We also take into consideration if there are any other members on the current group policy, as this could affect premiums for other individuals on your current plan.
  • Depending on the company – in some cases, once an individual goes off the group coverage, they may never return to that coverage.

Medigap

Medicare Supplement Insurance Plans (also referred to as Medigap Plans) are offered through private health insurance carriers such as AARP (United HealthCare), Mutual of Omaha, Aetna and Humana to name a few. These plans are designed to supplement Original Medicare. This means it helps pay some and sometimes all of the health care costs (“gaps”) that Original Medicare doesn’t cover such as: co-payments, coinsurance, and deductibles.

Each standardized Medicare Supplement policy must offer the same basic benefits, no matter which insurance company sells it. Cost and rating is usually the only difference between Medicare Supplement Insurance policies with the same letter sold by different insurance companies.

In most cases, insurance companies use these common factors to determine Medicare Supplement Insurance Rates:

  • Age
  • Gender
  • Location
  • Health
  • Tobacco Use

There are also other parameters that insurance companies and/or states require the use of, such as:

  • Community Rating (also referred to as "no-age" rating)
  • Issue Age Rating (also referred to as "entry-age" rating)
  • Attained Age Rating

Medicare Advantage FAQs

The most common difference between an HMO and PPO plan is that by having an HMO plan, one must use the network provided by the insurance company. If the HMO enrollee decides to seek care outside of the plans network, he/she will pay out of pocket costs to the maximum Medicare allowed amount.

Having a PPO will allow you to seek care at any provider that accepts Medicare. However, you may pay more out of pocket for not using the plans “preferred” network.

Medicare Advantage plans typically have little, to no premium. In most cases, clients of a Medicare Advantage plan are limited to a “network” of doctors and hospitals they must attend for their plan to work accordingly and minimize out-of-pocket expenses. If a client of a Medicare Advantage plan travels outside the network, there is coverage for urgently needed and emergency care.

A Medicare Supplement Plan does NOT replace original Medicare and is designed to pay for cost (or fill “gaps”) not covered by traditional Medicare. Medicare Supplement Insurance Plans typically have a monthly premium that can vary depending on age, gender, location and health to name a few. Medicare Supplement clients are NOT restricted to a network of doctors and in most cases will experience very little to zero out-of-pocket expenses after the monthly premium has been paid, depending on the plan.

If you don’t enroll while eligible for Part D and don’t hold credible drug coverage, Medicare will charge a 1% late enrollment penalty each month until you do enroll. This would be applied to the future plan chosen and would be applicable to the average monthly premium for that year. Monthly premium can also vary based on household income.

As with any insurance we purchase, we have it for the "what if" reasons. Furthermore, Medicare will charge a penalty for not enrolling in a prescription drug plan; so long you are eligible to enroll.

Depending on the plan you choose, you may have to pay a deductible, co-pay and/or con-insurance. Some plans offer $0 deductibles and $0 co-pays on most generics. Each company has a formulary of covered drugs that are listed into different “tiers”. The level tier of the drug will determine the cost; the lower the tier of the drug, the lower the cost. To compare Medicare plans in your area, call one of our licensed advisers today. We take the time to review your needs for healthcare and use that information to find the plan in your area that best fits your needs and budget.