FAQ
Initial Enrollment Period – Period three months before your 65th birthday month, your birthday month, and three months after your 65th birthday month.
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 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 Supplement plan that begins 30 days before your birthday.
Medicare only pays 80% of your Part B Medical Services and your Part A Hospital Services have co-pays once you’re in a facility over 60 days. Both Parts A & B have yearly deductibles. You may also have to pay “Excess Charges” if you go to doctors who are not “assignment” doctors with Medicare (which means they can charge you an extra 15% over what Medicare charges. )
Medicare Supplemental Plans and Medicare Advantage Plans are two ways to cover all or some of these gaps.
If you are still working and covered under an employee group plan, you can defer signing up with no penalty as long as your current plan is considered Creditable Coverage (coverage which is as good as what Medicare offers.)
Once you retire or lose group coverage, you will have a Special Enrollment Period to sign up for Medicare and/or a Supplemental, Advantage and Part D Drug Plan.
Supplemental Policies
Supplemental Policies Offer Coverage to Cover Most or All of the Gaps. They work like a PPO-type plan. You can go to any doctor that takes Medicare, and they are good throughout the United States. You don’t need referrals to go to specialists.
Supplemental Plans do not include Part D Drug coverage. If you want prescription drug coverage, you would add a Part D Rx plan to a Supplemental Plan.
Medicare Advantage
Or Medicare Part C
Medicare Advantage Plans are administered by Private Insurance Companies and include your Part A, Part B, and Part D in one Plan. Most are HMO’s, and you have to go to Network Doctors to be covered, live within the Service Area of the Plan and need referrals to go to specialists
Original Medicare Consists of Parts A & B
Part A – Hospitalization
Skilled Nursing
Home Health Care
Hospice
Part B – Doctors’ Services
Other Health Care Provider Services
Hospital Outpatient Care
Durable Medical Equipment
Preventative Services
Other Parts of Medicare May Include
Part C – Medicare Advantage (Includes Part A, B, and D, Provided by Private Insurance Companies)
Part D – Prescription Drug Coverage (Provided by Private Insurance Companies)
The penalty for not signing up during your initial enrollment period is 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. You can defer signing up without incurring a penalty if you have coverage under a group employee health insurance plan, and you are actively working.
There is also a penalty on your Part D Prescription Drug plan if you do not sign up during your initial enrollment period. It is 1% of the “national base beneficiary premium” ($35.02 in 2017) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium. As with Part B, you can defer signing up without incurring a penalty if you have coverage under a group employee health insurance plan, and you are actively working.
