Medicare can be confusing, but HealthMatchup is here to help guide you through your Medicare options so you can find the plan that best fits your needs. Let’s look at the basics:
Medicare is a benefit granted to eligible people when they turn 65 or when they suffer from certain illnesses or disabilities. Medicare comes in four parts:
You have a number of options when it comes to Medicare, you can choose to stick with your Original Medicare, or you can enroll in a number of different types of Medicare Plans that can offer additional benefits. There are three main options you can use to personalize your Medicare Coverage.
If you have Medicare Part A and/or Medicare Part B, this is your opportunity to add or change Part D coverage.
If you have both Part A and Part B Medicare you can use this time to enroll, change or opt out of a Medicare Advantage Plan.
Medigap Supplemental Insurance works in tandem with Parts A and B of Original Medicare. Medigap Supplemental coverage is designed to cover the gaps in your health insurance left by Medicare and is offered by private health insurance companies. Insurers can offer up to ten types of Medigap coverage, which are labeled A, B, C, D, F, G, K, L, M, and N. These plans offer different types of coverage, but each plan type is required by law to offer the same standardized level of coverage. So for example, a K plan differs from an A plan but all K plans will offer the same basic coverage no matter which carrier you select. This is an important fact to remember when comparing rates.
Coverage varies by letter plan type: the chart below outlines the basics for each plan type: Plans may pay all, a percentage, or zero of the costs of certain types of care. The table shows whether the plan will cover 100%, 0% or a percentage.
|Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up|
|Part B coinsurance or copayment||50%||75%|
|Blood (first 3 pints)||50%||75%|
|Part A hospice care coinsurance or copayment||50%||75%|
|Skilled nursing facility care coinsurance||50%||75%|
|Part A deductible||50%||75%||50%|
|Part B deductible|
|Part B excess charges||N/A|
|Foreign travel exchange (up to plan limits)||80%||80%||80%||80%||80%||80%|
*You may also opt for a high deductible option on this plan. If you co you will be responsible for costs up to your deductible before the plan pays for your care costs.
**The Medigap plan will pay 100% of the costs for covered services once you reach you out-of-pocket limit AND your
***The plan will pay 100% of the part B coinsurance. However, it may charge a copay up to $20 for office visits and $50 for emergency room visits.
If you are a redident of Massachusetts, Minnesota or Wisconsin, then the plans are standardized differently. We work with trusted advisors who can help you find a plan that will best fit your needs. Call Now (877) 354-4165
Medigap plans help to protect you from the gaps in coverage in Medicare Parts A and B, meaning you have a more comprehensive plan.
People who are already enrolled in Parts A and B are eligible for Medigap plans.
Medigap Plans help with costs related to Part A (hospital costs) and Part B (medical costs) of Medicare only. They do not help with Part C (Medicare Advantage) or Part D (Prescription Drug Coverage).
Most people earn eligibility for Medicare when they or their spouse have worked for ten or more years. You may also be eligible if you have been receiving disability benefits for two years, or you suffer from specific illness such as Lou Gehrig's disease or end-stage kidney failure.
Your Open Enrollment Period for Medigap plans automatically starts the month of your 65th birthday. You will have a six-month period where you will be guaranteed to receive Medigap Coverage. If you do not take out a policy in this time, you may not be able to enroll in a plan, or you may have to pay increased premiums. Knowing your options is the best way to find a plan that fits your lifestyle, and you don’t need to wait until your enrollment period to check out your choices! We work with trusted partners who can advise you up to six months before your 65th birthday on what Medigap Supplemental options will be available to you when you qualify for enrollment.
A Medigap policy only covers one person; you must take out a plan for each eligible member of your household if you all want coverage.
You Medigap Policy cannot be canceled by your insurer due to ill health, meaning you will be eligible to renew the policy each year as long as you maintain the monthly premiums.
(Your Initial Enrollment Period begins 3 months before the month you turn 65.)
Medicare Advantage, also known as Medicare Part C, are insurance plans from private health insurance companies that offer coverage for Part A and Part B of Medicare. You must be enrolled in Part A and Part B to enroll in a Part C Plan. You will also continue to pay your Part B premium in addition to the Medicare Advantage premium.
Medicare Advantage plans must offer the same minimum level of coverage as offered by Original Medicare (except for hospice care, which will remain covered by Original Medicare). However, they can also offer additional benefits such as coverage for dental and vision in addition to offering potentially lower cost-sharing such as a reduced co-pay and deductible. There are multiple types of Medicare Advantage Plans available, including PFFS, HMO, and PPO. Coverage varies by plan, so it’s important to compare multiple quotes to ensure you find the plan that best fits your needs.
Medicare Advantage Plans can offer increased coverage, helping to protect you from unexpected health care costs. You’ll also have access to a choice of plans, meaning you can find a plan with coverage that best fits your lifestyle and your budget.
People who are already enrolled in Original Medicare Parts A and B are eligible for a Medicare Advantage Plan.
You can enroll in a Medicare Advantage Plan at different times depending on your situation:
You’re about to qualify or are newly qualified for Medicare.
You can sign up during your Initial Enrollment Period that covers the three months before your birth month, your month of birth and the three months following. The same seven-month period applies to those who qualify due to their disability status; you can enroll three months before your 25th month of receiving social security, during the 25th month and the three months following.
You recently signed up for Medicare during the General Enrollment Period, which runs from January 1st to March 31st. You have both Parts A and B coverage now.
You can enroll in a Medicare Advantage Plan anytime between April 1st and June 30th. You will also be able to enroll during the annual AEP, which starts October 15th and runs until December 7th every year.
You have existing Part A and Part B coverage and are looking to enroll in a Part C Medicare Advantage Plan, or you are looking to change your existing part C coverage.
The Annual Election Period takes place yearly between October 15th and December 7th. During this period you can change from Original Medicare to a Medicare Advantage Plan, change your Medicare Advantage Plan to a different plan, or return to Original Medicare.
Medicare Part D offers coverage for prescription drugs, which isn’t included in Medigap coverage or Original Medicare. However, if you have Part C coverage through a private insurer (Medicare Advantage), you may already have prescription drug coverage.
Part D Plans help cover the costs of prescription drugs. Each drug is assigned a tier by the plan, and you will pay the associated copayment for that tier when you fill your prescription. The higher the tier, the more expensive your out-of-pocket costs will be. You can check with your plan to see what your prescriptions will cost you. Coverage varies by plan, so it’s important to compare multiple quotes to find the Part D that best fits your needs.
The cost of prescription drugs can add up quickly, especially if you need ongoing treatment. Taking out a Part D plan helps protect you against high out-of-pocket costs for prescription drugs, giving you the peace of mind that you will be able to afford medication should you need it.
You are eligible for a Medicare Part D prescription drug plan if you are 65 and over or have been Social Security Disability Income (SSDI) for two years or more. You must be enrolled in at least one part of Part A or Part B Medicare.
You are eligible to sign up for a Part D plan for a 7-month period, which begins 3 months before the month of your 65th birthday. If you enroll before your 65th birthday coverage will start on the 1st day of your birth month.
If you are eligible for Medicare plan due to a disability your enrollment period starts three months before the 25th month of SSDI, includes the 25th month, and ends three months after the 25th month, this gives you a 7-month Initial Enrollment Period.
Yearly Annual Election Period:
You can sign up for a Part D Plan during the AEP. The AEP runs from October 15th to December 7th every year. During this time, you can also make changes to your coverage including changing plans, dropping coverage or enrolling in a plan for the first time. Any changes take effect on January 1st the following year.
Special Election Period:
In some situations you will be granted a Special Election Period. Special circumstances include changes in income, moving, entering into a care facility and numerous other reasons. Advisors can help you discover your eligibility for a Special Election Period.
You may be eligible to make changes to your Medicare coverage today! If you’re about to, or have recently experienced a life event such as moving, losing health insurance, or experienced other special circumstances, you may be eligible for a Special Enrollment Period. We can help you check your eligibility when you request a quote or call us at (877) 354-4165.
If you have experienced any of these special circumstances, you may qualify for special enrollment
Lost coverage (i.e. lost Medicaid or employer health insurance, etc.)
Left a nursing facility
Recently returned to the USA
Your plan no longer works with Medicare
There was an error on your plan application
Your drug plan is no longer credible
This list is not exhaustive; please seek additional advice if you believe you may be eligible for a Special Enrollment Period.
*Not connected with or endorsed by the United States government or the federal Medicare program.
Learn more about how HealthMatchup can help you find a
plan perfect for your needs.