Category: Medicare Advantage

If you’re approaching Medicare eligibility, it is important to know the various times to sign up for this important milestone.  Below are the enrollment periods that will help you determine what your eligibility is or whether you need to sign up for Medicare at all:

Annual Enrollment Period – Period every year between October 15 and December 7 when you can change your Medicare Advantage Plan or Prescription Drug Plan.

Open Enrollment Period – Additional period of time from January 1 through March 31 when you can change your Medicare Advantage Plan.  You can also return to Original Medicare with or without a drug plan.

Retirement/Loss of Group Health Insurance – Period of time once you retire or lose creditable group coverage to sign up for Medicare and a Supplemental, Advantage  Plan and/or Part D Drug plan.

Supplemental Plan Birthday Rule – Period that allows you to change your Supplemental plan that begins 30 days before your birthday up to 60 days after your birthday.

Special Enrollment Period – Period of time to change your Medicare Advantage plan or Part D drug plan because of a life event, i.e., moving out of service area, qualifying for Low Income Subsidy.    If you are still actively working and have a creditable (as good as Medicare) group employee health insurance plan, you may be able to keep the plan until you retire and delay signing up for Medicare without incurring penalties.  Check with your benefit’s administrator to see if this is a viable option for you.

While most peoples’ health insurance costs go down when they sign up for Medicare, many are surprised that Medicare doesn’t pay 100% of their medical expenses.  There are deductibles, copays, and coinsurance which can add up to hundreds, if not thousands, of dollars per year of out-of-pocket costs if you have Medicare alone.

How can you bridge the gaps and keep more money in your pocket?  There are basically two ways you can go.  Below is an explanation of each:

Medicare Supplemental Plans – You remain in Original Medicare and can go to any doctor who takes Medicare throughout the United States.  Your plan travels with you, and you do not have to get a new plan if you move out of state. You don’t need to get referrals to see a specialist.  If you want prescription drug coverage, you would have to purchase a stand-alone Part D plan to go with your Supplemental Plan since none of these plans cover prescription drugs.

Medicare Advantage Plans – You opt out of Original Medicare and go with a private company that combines Parts A, B and D into one plan (which is also called Medicare Part C).  Most plans require you to see network doctors and get referrals to see a specialist.  Some plans exclude Part D if you have other drug coverage such as VA benefits.  Advantage Plans include Special Needs Plans for people with certain chronic conditions and Medi-Medi plans for those who qualify for both Medicare and MediCal.