Medicare

Medicare is a health insurance program provided by the government for those age 65 years or older, individuals with qualifying disabilities, and people with end-stage renal disease. Original Medicare is provided directly through Medicare and typically includes:

• Part A Hospital Insurance – most people don’t have to pay a Part A premium, which helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care

• Part B Medical Insurance – most people pay a monthly premium for Part B, which helps cover doctor’s services, outpatient care, medical supplies, and many preventative services

Download your “Medicare and You” handbook here (right-click PDF select “Save link as”):

English PDF | Spanish PDF | Chinese PDF | Korean PDF | Vietnamese PDF

You can choose to receive your Medicare benefits in various ways:

• Original Medicare

• Original Medicare + Supplement OR Cost Plan

• Medicare Advantage Plan

• An “all in one” alternative to Original Medicare is Medicare Advantage (Part C). These “bundled” plans include Part A, Part B, and usually Part D.

• If you join a Medicare Advantage Plan, you’ll still have Medicare and still pay your Part B premium. However, you’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare.

Medicare Supplements (Medigap)

Medicare supplement insurance, also known as Medigap, is sold by private insurance companies and supplements Original Medicare Parts A and B. These policies cover gaps in Original Medicare Parts A and Part B such as co-payments, coinsurances, and deductibles you would otherwise pay yourself. Most Medicare Supplements do not have a network and you will continue to pay your Part B premium. Premiums are typically based on age and can increase as the insured gets older.

Medicare Advantage Plans

A Medicare Advantage Plan is another way to obtain your Medicare benefits. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private insurance companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you’ll still have Medicare, but you’ll get most of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) benefits from the plan, not Original Medicare. Many Medicare Advantage Plans offer additional benefits not available through Original Medicare such as dental, vision, hearing, and gym memberships. Premiums are not based on the age of the insured.

The two predominant plan types in our area are:

• Health Maintenance Organization (HMO)

• Preferred Provider Organization (PPO)

Veterans – Medicare Advantage plans can be a great fit for Veterans. With Original Medicare Parts A & B, Veterans still have financial exposure when receiving services outside the VA system.

Medicare Advantage Plans cap your out-of-pocket risk and add benefits Original Medicare or the VA may not offer such as dental, vision, and hearing services. Some plans also offer a Part B premium reduction.

Annual Enrollment Period

The Annual Enrollment Period (AEP) for Medicare Advantage (Part C) is October 15-December 7 of each year, with Special Election Periods (SEP) available under limited circumstances. This is the time of year to select or change your insurance for the following year.

Medicare Advantage Open Enrollment Period (OEP) is January 1 – March 31:

• If you’re in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage).

• You can drop your Medicare Advantage Plan and return to Original Medicare. You’ll also be able to join a Medicare drug plan.

You can only make one change during this period, and any changes you make will be effective the first of the month after the plan gets your request.

Please call us if you need assistance, we’re here to help!

Call 515-298-9540* or send us a message.

*Calling the above numbers will connect you to a licensed insurance agent.