DISCLAIMER

The content included on this website page is for informational purposes only.  It should not be considered, or substituted for, licensed professional advice or as the legal interpretation of benefits provided by Original Medicare or Medical Supplemental Plans offered by private insurance companies.

MEDICARE, SUPPLEMENTAL PLANS, & MEDICARE ADVANTAGE PLANS

WHAT IS INCLUDED IN ORIGINAL MEDICARE?

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INITIAL  ENROLLMENT  FOR MEDICARE BEGINS WHEN YOU

  1. Turn 65 yrs. of age.
  2. You can enroll for Original Medicare up to (3) months in advance of your 65th birthday.
  3. When you enroll in Medicare, you should choose a supplemental medical plan & prescription drug insurance, because Medicare  does not cover all the medical expenses you can incur.


Original Medicare is administered by Federal Government.

Part A - Hospital Insurance

Part B - Medical Insurance

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Plan C - Medicare Advantage

Plan D - Prescription Insurance

Plan F - Supplement to Plans A & B

Plan G - Supplement to Plans A & B


ORIGINAL MEDICARE Plan A & Plan B 

  •  Under Original Medicare, the government pays directly for the health care services you receive. 
  • You can visit any hospital or see any doctor that accept Medicare.  

PREMIUMS

  • There is no premium for Part A, if you worked 40 quarters and paid taxes to Medicare.
  • There is a monthly premium for Part B.
  • The premium for Plan B is deducted from your Social Security Benefits  (unless you do not yet collect benefits).

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Plan A - Hospital Coverage

  • Hospital insurance coverage for inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care.

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Plan B - Health Insurance 

Provides coverage for (2) types of services;

  • Medically necessary services to treat illnesses or conditions, such as, doctor's office visits, lab work and x-rays.
  • Outpatient surgeries, and preventive services to keep you healthy, like cancer screenings, including 3-D mammograms, pneumonia and flu shots. 

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Plan D - Prescription Drug Insurance 

  • Other vaccines, such as, Shingles, Diphtheria, Tetanus, Pertussis are not covered under Medicare, however, they are generally covered under a stand-alone Plan D  or  a Medicare Advantage Plan that includes Prescription Drug Coverage. 

www.medicare.gov

MEDICARE ADVANTAGE PART C

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PURCHASED FROM PRIVATE INSURANCE COMPANIES


The words 'Supplemental' and 'Medigap' are INTERCHANGABLE TERMS.


Original Medicare and Medicare Advantage are NOT the same.


Original Medicare (Parts A & B) is administered by the Federal Government.


Medicare Advantage (Plan C) is purchased from private insurance companies and is considered a Supplemental Medical Plan.


OCT 15 - DEC 7 

ANNUAL ENROLLMENT PERIOD 

For PLAN C - Advantage Plans          

For PLAN D - Drug Coverage


JAN 1 - MAR 31

OPEN  &  DIS-ENROLLMENT PERIOD  

For Medicare Advantage Plan(s)

During this time, eligible beneficiaries may make the following changes:        

  • Switch between Medicare Advantage Plans        
  • Or
  • Switch to Original Medicare with or without Part D (Prescription Drug Coverage).
  • Any changes made during this period are effective on the 1st day of the following month. 
  • Previously, if you were not satisfied with your Advantage Plan you could only use this period to enroll in Original Medicare but not  change to another Advantage Plan.

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Plan C - Medicare  Advantage  Plans 

These Plans are  NOT  part of 'Original Medicare' offered by the  federal  government. You will not be enrolled in Parts A & B of Original Medicare if you choose a Medicare Advantage Plan.


  • 'Medicare Advantage Plans are offered by Private Insurance Companies (HMOs or PPOs).
  • Advantage Plans cover most costs, but coverage is LIMITED to Medicare Approved Charges. You may be responsible for additional out-of-pocket expenses if your doctors charge more than what is allowed by Medicare. 
  • You can purchase an Advantage Plan that includes Prescription Drug Coverage, or one, that does not.


 

SUPPLEMENTAL PLANS PARTS: D, F, G

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PURCHASED FROM PRIVATE INSURANCE COMPANIES 


Part D - Prescription Drug Coverage 

  • This Plan is provided only by Private Insurance Companies who have contracts with the federal government.
  • Your prescription drug costs will be based on the Tiers of Drugs under which your current medications are categorized.  
  • If you choose an Advantage Plan that does not include Prescription Drug Coverage, then you should purchase Plan D. 
  • PENALTY APPLIED: If  you choose not to purchase Plan  D for Prescription Drug Coverage when you are eligible to enroll in Original Medicare, or an Advantage Plan  a life-long penalty will be imposed when you do decide to purchase Plan D coverage in the future. 

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Plan F - Supplemental Medical Coverage to Parts A & B of Medicare. This plan pays 100% of any excess charges not covered by Medicare including your annual deductible. It provides as close to zero out-of-pocket costs as possible for hospital and services from medical providers.


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Plan G -  Supplement Medical Coverage to Parts A & B of Medicare. This plan is nearly identical to Plan F and is designed to cover “excess costs” from healthcare providers (charges exceeding Medicare approved charges). 

  • This plan covers 100% f Plan A excess amounts, except it does not pay the annual deductible required by Plan A.
  • This plan covers 100% of Plan B excess amounts.  
  • Excess charges occur when medical providers charge more than what Medicare allows. By law, providers can't charge more than 15% of what Medicare covers.


 TERMS TO UNDERSTAND

  1. Initial Medicare Enrollment Period
  2. Annual Enrollment Period
  3. Open Enrollment Period
  4. Original Medicare
  5. Medicare Advantage
  6. Supplemental Plan (Medigap)
  7. Private Insurance Company
  8. Medicare Approved Charges
  9. Annual Deductible
  10. Out-of-Pocket Expenses
  11. Maximum Out-of-Pocket Expenses
  12. Tiers of Prescription Drugs

AMRRC ~ RECOMMENDS

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Supplemental Plans should be specifically chosen with the help of a "licensed professional" and are based on your medical history and the state in which you reside. 


AMRRC recommends that you consult AMERICAN SENIOR BENEFITS to assist you with the Medicare, Medicare Advantage and other Supplemental Plan information which you need to make the best possible decision about your healthcare insurance coverage.


Contact Kobey Liles, a licensed professional, with American Senior Benefits to assist you and explain the various plans for which you are eligible. 


(972) 740-2658 

OR 

Email:  kliles@asbtex.com


Please let Kobey know you are an AA retiree and an AMRRC member. You will 'always' receive a return call from him if he is not immediately available. There are NOT numerous pre-recorded prompts to reach him. 

American Seniors Benefits - Kobey Liles

NEW MEDICARE CARDS

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www.medicare.gov 


New Medicare Cards are being issued and mailed to you to ensure improved privacy (the new card will not include your Social Security Number). 


If you have a Medicare Advantage Supplemental Insurance Plan - you must keep your Medicare Advantage Plan Card. 


You should also carry your new Medicare Card with you even if you’re in a Medicare Advantage Plan. Continue using your Medicare Advantage Plan ID Card whenever you need care. 

Medicare Website