Medicare benefits Archives

When to start Medicare coverage

By Ed Crowe | General Articles | 0 comment | 12 April, 2023 | 0

When to start Medicare coverage

If you are getting close to your 65th birthday, you are probably wondering when to start Medicare coverage. The start date for your Medicare coverage is based on when you sign up and which election period you’re in.

If you already receive Social Security benefits, there is no need to apply for for Medicare Part A or Part B. You are enrolled in both A and B automatically. Because you will pay a premium for Part B coverage, you can turn down Part B coverage.

Please Note: If you are a resident of either Puerto Rico or a foreign country, you do not get Part B automatically. You must sign up for it.

How soon can I sign up; Initial Enrollment Period:

Generally, when you turn 65. This is called your Initial Enrollment Period or IEP. Your IEP lasts for 7 months. It starts 3 months before you turn 65, and ends 3 months after the month you turn 65.

If your birthday is the first day of the month (ex. May 1st), your initial enrollment period will begin earlier than most people. Your enrollment period begins 4 months before you turn 65 and ends 2 months after you turn 65.

When to Start Medicare coverage; There are a few different ways to sign up for Medicare:

Probably the easiest method is to sign up online. Once you create a my Social Security account, you can move forward and sign up for both Medicare A & B benefits. Important: be sure the website you are using to sign up has a URL ending in .gov. This way you can be sure you are on an official government website and your personal information is safe.
You can call Social Security at 1-800-772-1213, TTY users call 1-800-325-0778.
Apply in-person at your local Social Security office. Click here to locate an office near you.
If either yourself or your spouse worked for the railroad, you can contact the Railroad Retirement Board by calling 1-877-772-5772.you sign up for Medicare, you can also apply for Social Security benefits at the same time if you want.

Note: If you would like, you can also sign up for Social Security benefits while you are signing up for Medicare A & B.

Click here for more information on when to sign up for Medicare

Although many people are not able to enroll in Medicare until they are close to their 65th birthday, some people qualify to enroll in Medicare due to a qualifying disability. Once an individual has received disability benefits for 24 months, or has been diagnosed with a qualifying medical condition, such as ALS ( Lou Gehrig’s disease) or end-stage renal disease (ESRD).

When to start Medicare coverage; One more thing:

Once you are eligible for Medicare if you neglect to sign up, you’ll have to wait until the general enrollment period to enroll. Each year, the general enrollment period runs from January 1 until March 31. Once you apply, your plan will start the first day of the following month. Please keep in mind, you may have to pay a late enrollment penalty if you do not enroll in Medicare during either your initial election period or a special election period.

Find out what Medicare covers

If you would like more information on Medicare enrollment, you can find it at Medicare.gov.

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Medicare inflation reduction act

By Ed Crowe | General Articles | 0 comment | 29 March, 2023 | 0

Medicare inflation reduction act

If you want information about what the Medicare inflation reduction act will provide to beneficiaries and what effect it will have on the Medicare program, you should read the information in this post.

Medicare inflation reduction act – Improvements to Medicare Part D:

Moving forward, people on Medicare will benefit from lower prescription drug costs as well as a redesigned prescription drug program. Updated benefits include:

Insulin will be available at $35 per month, as long as it is on Medicare’s list of approved insulin prescriptions. This program does not apply to the very expensive insulin type drugs like Toujeo, Tresiba, Victoza, Januvia or Ozempic..
Beneficiaries can access recommended adult vaccines without cost-sharing, such as Shingrix.
Starting in 2025, the out-of-pocket costs of prescription drugs for Medicare plan members will have an annual cap of $2,000.
The low-income subsidy program (LIS or “Extra Help”) under Medicare Part D will be expanded to 150% of the federal poverty level starting in 2024.

Medicare Drug Price Negotiation:

Medicare will be able to negotiate directly with drug manufacturers to lower the price of some prescription Medications. This applies to many of the most expensive, single-source, brand-name Medicare Part B and Part D drugs. In other words, people on Medicare will have more access to both innovative & life-saving treatments as the costs of these prescription drugs will be more affordable to them as well as to Medicare.

Inflation Rebates:

The new law will require any drug company that raises their drug prices faster than the rate of inflation to pay Medicare a rebate. This law will protect Medicare beneficiaries from unreasonable drug price increases put in place by the drug companies. This will ensure that both current and future Medicare enrollees are protected by a strong Medicare system.

Medicare inflation reduction act – Medicare Part B changes:

Changes in the Medicare Part B program will improve access to high quality, affordable biosimilars for people with Medicare as well as impose a $35 a month cost-sharing cap on insulin used in durable medical equipment pumps.

Click here to learn more about this program

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Medicare Advantage Plans

By Ed Crowe | General Articles | 0 comment | 15 June, 2016 | 0

Medicare Advantage Plans

Medicare Advantage Plans are managed health programs that serve as a substitute for both “Original Medicare” Part A and B benefits. There are a number of types of Advantage plans. The majority are either HMO or PPO plans. Medicare Part A provides payments for in-patient hospital services and stays. Part B provides coveage for outpatient services. Doctors visits, lab work, scans and x-rays all fall under part B. Original Medicare claims are processed through the Centers for Medicare and Medicaid Services (CMS). Medicare Advantage plans are offered by commercial insurance companies. They receive compensation from the federal government, to provide all Part A and B benefits to enrollees, but do not pay claims through the CMS.

Most Medicare Advantage plans (sometimes referred to as “Part C”) include the Part D prescription drug benefits, and are known as a Medicare Advantage Prescription Drug plan (MAPD). The government makes seperate payments to the plans offering drug benefits with the advantage plan. Medicare pays the insurance company a set amount every month for members enrolled in the plans.

Medicare Advantage plans

must offer a benefit that is at least equal to Medicare’s and covers what Original Medicare covers. They do not have to cover every benefit in the same way. Plans that require higher out-of-pocket costs than Medicare for some benefits, can balance it out by offering lower copayments for doctor visits or other benefits. CMS limits how much the Medicare Advantage plans can vary from benefits under Original Medicare. Many plans offer benefits which are not covered by Original Medicare. They do this as a value added benefit to entice more people to enroll in the plan.

All Medicare Advantage plans must have out of pockets maximums for medical services.

The limit for 2016 is $6,700 medical out of pocket. This applies to in-network services only. Once the out of pocket maximum is obtained, the plan will pay all additional costs. This assumes the services received are in network. Medicare advantage plan have networks. This means the enrollee must use in network doctors to be covered. There are exceptions to this such as with a PPO plan.

Other ways to get care out of network would be for an emergency or urgent care situation. Enrolling in a PPO plan provides the ability to go out of network. PPO plans permit a subscriber to use any physician or hospital, but at a somewhat higher expense. Certain PPO plans can lead to much higher costs for going out of network. The combined out of pocket max goes up to $10,000 on a PPO. The total is for in and out of network usage.

People can enroll in a Medicare Advantage plan

when first eligilble for Medicare A and B. They must enroll in A and B prior to enrolling in an advantage plan. Under most situations, the member can change plans every January during AEP. There are exceptions to this rule however. Many states have multiple Advantage plans offered by various companies. Some states have over 20 different plans to choose from. Companies will also offer plans by county. They may offer a plan in one county but not another within the same state.

People with low medical utilization tend to migrate towards advantage plans. If someone is going to the doctor a few times a year on average, they tend to look at the low Advantage premiums as a way to save money. Those with higher medical utilization will have a tendency to go with a Medicare supplement plan of some type. Supplements tend to have higher premiums and less out of pocket costs which appeals to someone utilizing care more often. Supplements are also attractive to those that do not want to abide by a network of doctors. Others tend to go with a supplement to avoid the need for prior authorization which is required on advantage plans.

Trial Right–

Medicare Advantage trial rights are rules that allow someone to switch out of their advantage plan. There are two cases in which a trial right is created.

Taking an advantage plan when first eligible for Medicare. A trial right is created allowing the member to change back to Original Medicare any time in the first 12 months. They can go to Original Medicare with a supplement and/or Rx plan the first of any month
Taking an advantage plan for the first time. If someone is taking an Advantage plan for the first time. (Even if they have been on a supplement previously). They will have a trial right for the first year they are in the advantage plan. This would allow them to change to a supplement and/or drug plan

AEP- At this time you can change your plan (Advantage to supplement or supplement to advantage) every January 1st during AEP. At this time someone can make any change they would like. Some states will underwrite a move to a supplement however.

MADP- During this period, a person may leave an advantage plan and go back to Original Medicare. MADP runs from January 1 through February 14th every year. They can also enroll in a supplement and/or Rx plan if they would like.

SEP- A Special Election Period allows someone to make a change outside of AEP. Certain circumstances will create a SEP. Moving outside the plan service area, qualifying for extra help, lose of employer coverage. These are all examples that would create a special election.

Additional Resources:

Medicare Basics Video – Click here

For Medicare Advantage Basics Video Click

Click for Medicare Supplement Basics Video

Medicare Information for state of Connecticut

Medicare A and B Benefits 2013

By Ed Crowe | Latest news | 0 comment | 19 December, 2012 | 0

The original Medicare A and B benefits are updated every January. The benefits do not change drastically from year to year but they usually increase slightly . The changes are made areas such as the Medicare Part A Inpatient Hospital Deductible, daily skilled nursing home copy, annual Medicare part B deductible, etc….. Read more

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When to start Medicare coverage

When to start Medicare coverage

How soon can I sign up; Initial Enrollment Period:

When to Start Medicare coverage; There are a few different ways to sign up for Medicare:

Note: If you would like, you can also sign up for Social Security benefits while you are signing up for Medicare A & B.

Click here for more information on when to sign up for Medicare

When to start Medicare coverage; One more thing:

Find out what Medicare covers

To view more images by this artist; click here

Medicare inflation reduction act

Medicare inflation reduction act

Medicare inflation reduction act – Improvements to Medicare Part D:

Medicare Drug Price Negotiation:

Inflation Rebates:

Medicare inflation reduction act – Medicare Part B changes:

For free training videos; subscribe to our YouTube channel

Become a Medicare agent

Click here to view more images by this artist

Medicare Advantage Plans

Medicare Advantage Plans

Medicare Advantage plans

All Medicare Advantage plans must have out of pockets maximums for medical services.

People can enroll in a Medicare Advantage plan

Trial Right–

Medicare A and B Benefits 2013

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