DISCLAIMER

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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 the Federal Government.

Part A - Hospital Insurance

Part B - Medical Insurance

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Part C - Medicare Advantage (includes; Original Medicare Part B, supplement insurance coverage  (provided in stand-alone Plans F & G, and Part D for prescription drugs).

Part D - STAND-ALONE; Prescription Drug Coverage 

Plan F - STAND-ALONE; Supplement Plan to Parts A & B

Plan G - STAND-ALONE; Supplement Plan to Parts A & B

ORIGINAL MEDICARE Part A & Part B 

1.   Under Original Medicare, the government pays your healthcare providers directly for the healthcare services you receive.

2.   You can visit any hospital or see any doctor that accepts Medicare.  

PREMIUMS

1.   There is no premium for Part A,  if you worked 40 quarters and paid taxes to Medicare.

2.   There is a monthly premium for Part B and it is deducted from your Social Security Benefits.

3.  If you do not yet collect Social Security Benefits, you will be billed quarterly for Part B.  

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PART A - Hospital Coverage

Coverage for inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care.

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PART B - Health Insurance 

Offers 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. 

Original Medicare and Medicare Advantage Plans are NOT the same.

The Annual Election Period (AEP) occurs EVERY YEAR  from October 15 - December 7.

AEP - DOES NOT impact those who are enrolling in Medicare for the first time.                

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During the AEP those who are already enrolled in Medicare can RE-EVALUATE their coverage and make 'some' changes to their Medicare Advantage Plan C,  and to Prescription Drug Coverage, Part D.  

WHAT Can You Change During the AEP?

• Switch from Original Medicare to Medicare Advantage, or vice versa.
• Switch from one Medicare Advantage plan to another.
• Switch from one Medicare Part D (prescription drug) plan to another.
• If you did not enroll in a Medicare Part D (Prescription Drug) Plan when you were first eligible for Original Medicare; you can do it during the Open Enrollment period although a late enrollment penalty fee may apply.
• If you want to switch to a Medicare Advantage (Part C) Plan, you must meet some basic criteria.
• You must be enrolled in  Original   Medicare Parts A and B.
• You must live in the plan’s service area.

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 MEDICARE ADVANTAGE PLANS 

You will keep your original Medical Part A (for hospital coverage) if you choose an Advantage Plan for your Supplement Health Insurance Coverage.

Advantage Plan will include Part B,  Part D, and supplemental insurance coverage for costs not covered by Medicare.  

A Medicare Advantage Plan should include the coverage provided by Parts A & B of Original Medicare. 

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PLAN C - MEDICARE ADVANTAGE

1.   'Medicare Advantage Plans are offered by Private Insurance Companies (HMOs or PPOs).

2.   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. 

3.   You can purchase an Advantage Plan that includes Prescription Drug Coverage (Part D).

SUPPLEMENTAL/MEDIGAP PLANS ARE PURCHASED FROM PRIVATE INSURANCE COMPANIES. 

PART D - Prescription Drug Coverage 

>  Provided only by Private Insurance Companies who have contracts with the federal government.

>  Advantage Plans include Plan D coverage for prescription drugs. 

>  Prescription drug costs are based on the designated formularies of the drug (brand-name, or generic) and on the Tier Category to which the drugs are assigned by the drug manufacturers. 

>  Vaccines, such as, Shingles, Diphtheria, Tetanus, Pertussis are not covered under Medicare.   However, they are generally covered under a stand-alone Part D  or a Medicare Advantage that includes Plan D. 

IMPORTANT:  It is "essential" that you know what type of PHARMACY (as defined by your Plan D) that you are using for your medications.  The co-pays can be hugely different depending on the local pharmacy you use. 

• Preferred in-network pharmacy: most often offer prescriptions at lowest  cost-sharing amount.

• Standard in-network pharmacy: typically, prescriptions will have a higher  cost-sharing amount.

• Out of network pharmacy: at an out of network pharmacy you will not be able to utilize your prescription drug coverage. You will pay for the cost of the prescription. 

• Mail-Order  (Least Expensive) 

PENALTY APPLIED: If you choose NOT to purchase Plan  D for Prescription Drug Coverage when you are eligible for Original Medicare a life-long penalty can be imposed. 

CONSIDER USING the GOOD RX PROGRAM

ASK YOUR PHARMACY ABOUT USING THE GOOD RX PLAN.

There are many instances when the Good RX costs are less expensive than your Part D Prescription insurance prices.  

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PLAN F - SupplementalMedigap Coverage to Original Medicare Parts A & B. 

This plan pays 100% of any excess charges not covered by Medicare including your annual deductible for Plan B.   This Plan is no longer being offered by insurance companies.

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PLAN G -  Supplement Medical Coverage to Parts A & B of Medicare. 

This plan is nearly identical to Plan F and covers excess costs from healthcare providers (charges exceeding Medicare-approved charges). 

>  This plan covers 100% of Plan A excess amounts.

>  This plan covers 100% of Plan B excess amounts, but it does not pay the annual deductible required by Plan B. 

>  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.

Your new Social Security Card does not include your Social Security Number.

Please ensure you give your healthcare providers the new number on your Medicare Card.        

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MEDICARE ADVANTAGE PLAN

If you have a Medicare Advantage Insurance Plan - you must keep your Medicare Advantage Plan Card for your Medicare Part A coverage. 

COLA - Cost of Living Adjustment

A  1.3% cost of living adjustment in Social Security Benefits will occur in January 2021. 

The inflation catch-up will go to roughly one in six Americans. And it's more than some analysts had predicted based on the low inflation rate over the past (12) months 

The not-so-good news is that while 1.3% is more than many expected it will NOT be enough to cover higher living costs that most retirees must contend with, such as, higher healthcare premiums, higher homeowner insurance premiums, higher automobile insurances, and property tax hikes.  

JANUARY 1  -  MARCH 31

Each year you have an opportunity to change your Medicare Advantage Plan Coverage. 

The changes that can be made are:

1.   If you already have an Advantage Plan, you have the option to switch to another Advantage Plan offered by a different insurance company. 

2.    If you are enrolled in a Medicare Advantage Plan, you can leave your plan and return to Original Medicare 

Parts A & B and purchase a stand-alone Part D for prescription drug coverage.

HOWEVER ~~~ you will also need to purchase a Supplemental Plan G to cover the costs that Medicare does not cover. 

You MUST go through an under-writing process with the insurance company to obtain supplemental plan coverage.