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Home Posts tagged "Original Medicare"
Understanding Medicare Deductibles for 2026

Understanding Medicare Deductibles for 2026

By Ed Crowe | General Articles | 0 comment | 5 December, 2025 | 0

What to Know About Medicare Deductibles in 2026

Each year, Medicare updates its premiums, coinsurance, and deductibles. Understanding Medicare deductibles for 2026 is very important for beneficiaries. There are some important changes; especially for Medicare Part A and Medicare Part B.

Medicare Part A (Hospital Insurance)

Part A helps cover inpatient hospital stays, skilled nursing facility care, hospice, and some home-health services. In 2026, the inpatient hospital deductible for Part A is $1,736 per benefit period.
A “benefit period” begins at admission to the hospital and ends when you’ve been out of inpatient care (hospital or skilled nursing) for 60 consecutive days. That means every time a new benefit period starts, the deductible resets.

If your hospital stay extends past 60 days, daily coinsurance for days 61–90 (and beyond) will apply. These additional costs can add up underscoring why understanding the deductible is important for budgeting.

Medicare Part B (Medical Insurance)

Part B covers doctor visits, outpatient services, durable medical equipment, and more. For 2026:

  • The standard monthly premium is $202.90.
  • The annual deductible is $283.00.

You only pay the Part B deductible once per calendar year (if you receive Part B-covered services). After that, Medicare generally covers 80% of approved costs; you pay the remaining 20% (assuming your provider accepts Medicare assignment).

Learn the differences between Medicare Advantage vs Medicare Supplements

What This Means in Practice

  • If you’re admitted to the hospital under Part A in 2026, you’ll need to pay $1,736 before Medicare begins to pay (for up to the first 60 days of a stay).
  • If you use outpatient services or see a doctor under Part B, you’ll first need to meet the $283 annual deductible; once met, most services are covered at 80%.
  • Because Part A’s deductible applies per benefit period (not per calendar year), multiple hospitalizations in one year could mean paying more than once.

Why You Should Care

Understanding Medicare deductibles is key to predicting out-of-pocket costs. For someone watching their budget, a hospital stay could require a substantial lump sum before coverage kicks in; for routine care under Part B, costs are more manageable, but still meaningful, especially for those on fixed incomes.

These 2026 changes also underscore the importance of evaluating supplemental coverage (like Medigap) or alternative plans to mitigate risk.

Stay up-to-date on agent events and information

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Medicare Part B Enrollment Periods

Medicare Part B Enrollment Periods

By Ed Crowe | General Articles | 0 comment | 26 November, 2025 | 0

Medicare Part B Enrollment Periods

Medicare Part B is a vital part of your healthcare coverage, helping to pay for doctor visits, outpatient care, preventive services, and medical supplies. However, knowing when to sign up is just as important as understanding what Part B covers. Enrolling at the right time ensures you avoid costly late penalties and gaps in coverage. Here’s a breakdown of the key Medicare Part B enrollment periods and what each means for you.

Initial Enrollment Period (IEP)

Your Initial Enrollment Period is your first chance to enroll in Medicare Part B. It lasts seven months — beginning three months before, including your birth month, and continuing three months after you turn 65.

  • If you enroll before your birthday month, your Part B coverage starts the month you turn 65.
  • If you enroll during or after your birthday month, coverage begins the month after you enroll.

Tip: Even if you’re still working, check with your employer’s HR department to see whether you should enroll right away or delay Part B to avoid duplicate coverage.

Special Enrollment Period (SEP)

If you or your spouse are still working past 65 and have employer-sponsored health coverage, you can delay enrolling in Part B without penalty. Once that coverage ends, you qualify for a Special Enrollment Period.

The SEP lasts eight months from the date your employment or group coverage ends — whichever comes first. Enrolling during this window ensures you don’t face the Part B late enrollment penalty, which can increase your premium by 10% for every 12 months you were eligible but didn’t sign up.

Important: COBRA or retiree coverage doesn’t count as active employer coverage, so your SEP clock may start ticking sooner than you think.

Watch a YouTube video on Medicare OEP, SEPs and Late Part B Enrolllments

General Enrollment Period (GEP)

If you missed both your Initial and Special Enrollment Periods, the General Enrollment Period gives you another chance. The GEP runs every year from January 1 to March 31.

  • Coverage begins the first day of the month after you enroll.
  • You may owe a late enrollment penalty added to your monthly premium for as long as you have Part B.

While this period can be a helpful safety net, it’s best to avoid relying on it if possible due to potential penalties and delayed coverage.

Agents; are you ready to join the Crowe team – click here for online contract

Medicare Advantage (Part C) and Other Related Enrollment Periods

Once you have Part B, you can explore Medicare Advantage (Part C) or Medigap plans to supplement your coverage. Enrollment in these plans often depends on your Part B effective date, so timing your Part B enrollment correctly is crucial for coordinating your full Medicare coverage.

Understanding Medicare Part B enrollment periods can save you money and prevent headaches down the road. Whether you’re turning 65 soon, working past retirement age, or helping a loved one with their coverage decisions, planning ahead is key.

If you’re unsure when to enroll, a licensed Medicare agent can review your situation, explain your options, and help you avoid penalties or coverage gaps.

Stay up-to-date on agent events and information

Medicare A and B Basics

Medicare A and B Basics

By Ed Crowe | General Articles | 0 comment | 20 November, 2025 | 0

Medicare A and B Basics

Understanding Medicare can feel overwhelming at first, but it becomes much simpler once you break it down into the two core parts of Original Medicare: Part A and Part B. These two components form the foundation of Medicare coverage and help beneficiaries access essential hospital and medical care. Whether you’re approaching age 65 or helping a loved one navigate enrollment, here’s the Medicare A and B Basics.

What Medicare Part A Covers (Hospital Insurance)

Medicare Part A is often called hospital insurance because it helps cover care you receive in a hospital or similar inpatient setting. Most people receive Part A premium-free as long as they or their spouse worked and paid Medicare taxes for at least 10 years.

Part A covers:

Inpatient Hospital Care

This includes semi-private rooms, meals, nursing care, medications given in the hospital, and other hospital services. Part A does not cover private rooms unless medically necessary.

Skilled Nursing Facility (SNF) Care

Part A may cover care in a skilled nursing facility after a qualifying three-day inpatient hospital stay. This is not long-term custodial care, but medically necessary rehabilitation services such as physical or occupational therapy.

Home Health Care

If ordered by a doctor and medically necessary, Part A can help cover intermittent skilled nursing care, physical therapy, or speech therapy delivered in the home.

Hospice Care

For patients with a terminal illness and a prognosis of six months or less, Part A provides comprehensive hospice benefits, including pain relief, symptom management, and family support.

Part A Costs

Most beneficiaries pay no monthly premium, but deductibles and coinsurance still apply. For example, there is a per-benefit-period deductible for hospital stays and daily coinsurance after certain lengths of inpatient care.

Watch a YouTube video on Medicare Enrollment Periods

What Medicare Part B Covers (Medical Insurance)

Medicare Part B is medical insurance that covers outpatient and physician services. Unlike Part A, everyone pays a monthly premium for Part B, and higher-income beneficiaries may pay more.

Part B covers:

Doctor Visits

This includes primary care, specialists, and certain preventive screenings and exams.

Outpatient Services

Such as X-rays, lab work, outpatient surgeries, and emergency room or urgent care services (when not admitted as an inpatient).

Durable Medical Equipment (DME)

Items like walkers, wheelchairs, CPAP machines, and home oxygen equipment.

Preventive Care

Medicare Part B provides a wide range of preventive services at no extra cost when using participating providers; annual wellness visits, vaccines, mammograms, colonoscopies, and more.

Mental Health Services

Includes outpatient therapy, psychiatric evaluations, and some partial hospitalization programs.

Part B Costs

Beneficiaries pay a standard monthly premium, an annual deductible, and typically 20% coinsurance for most covered services. Part B has no out-of-pocket maximum unless you pair it with a Medigap plan or choose a Medicare Advantage plan.

Agents, are you ready to join the team at Crowe; click here

How Medicare A & B Work Together

Part A and Part B complement each other to provide broad medical coverage. Part A focuses on inpatient care, while Part B handles outpatient and ongoing medical needs. Many people choose to add:

  • A Medicare Supplement (Medigap) to reduce out-of-pocket costs
  • A Part D prescription drug plan
  • Or a Medicare Advantage plan that bundles A, B, and often D into one

Your choice depends on your budget, health needs, and preferred style of coverage.

Understanding the basics of Medicare Parts A and B is the first step in building reliable coverage for your healthcare needs. By knowing what each part covers and what it doesn’t; you can make confident decisions as you prepare for enrollment or compare additional coverage options

Agents, stay up-to-date on the our latest webinars an agent events.

Understanding Medicare Part B

Understanding Medicare Part B Coverage

By Ed Crowe | General Articles | 0 comment | 16 July, 2025 | 0

Understanding Medicare Part B Coverage

Both Medicare Part B (medical insurance) and Part A (hospital insurance), make up Original Medicare and play a vital role in healthcare for millions of Americans. Because Part B provides essential coverage for outpatient care, doctor visits, preventive services, and more; understanding Medicare Part B coverage is essential.

What’s Covered by Medicare Part B

Part B helps pay for a range of services and supplies, including but not limited to:

  • Doctor’s visits (primary care and specialists)
  • Wellness and preventive visits
  • Urgent care services
  • Laboratory tests (e.g., blood work, urinalysis)
  • Diagnostic imaging (X‑rays, scans)
  • Emergency ambulance transportation
  • Mental health services (outpatient therapy, counseling)
  • Durable medical equipment/DME (e.g., wheelchairs, oxygen tanks)
  • Rehabilitative services (physical, occupational, speech therapy)
  • Preventive services (e.g., flu shots, pap smears, cancer screenings)

Beneficiaries may receive these services in doctors’ offices, hospitals, clinics, and other outpatient facilities.

Medicare Part B Costs (2025 Rates)

Premium

  • Standard monthly premium: $185.00 in 2025; up from $174.70 in 2024.
  • Beneficiaries who receive Social Security payments have this amount automatically deducted from their Social Security checks. Those who opt not to take Social Security payments receive a quarterly bill for $555.00.

High-income earners pay higher premiums under IRMAA (Income‑Related Monthly Adjustment Amounts), with surcharges ranging from an additional $74 to $443.90, depending on tax filing status and income level.

Deductible & Coinsurance

  • Annual deductible: $257 for 2025, this amount is up from $240 in 2024
  • Coinsurance: Once the beneficiary meets the deductible, they pay 20% of the Medicare-approved cost for most services after Medicare pays it’s share (80%).

Late Enrollment Penalty

Those who don’t sign up for Part B when first eligible (and don’t qualify for a Special Enrollment Period), incur a 10% penalty for each full 12 months they were eligible but didn’t enroll. This penalty is added to the monthly premium and lasts for as long as they have Part B.

Watch a YouTube video on OEP, Special Elections & Late Part B Enrollments

How to Enroll

You can sign up for Medicare Part B online via the Social Security Administration, by phone at 1-800-772-1213 (TTY: 1-800-325-0778), or in person at your local Social Security office.
Ready to sign up for Part B? Click here to enroll now.

We’re Here to Help

Medicare agents can be a valuable source of information and guidance. There is no fee for the appointment. Whether you’re new to Medicare or looking to optimize your coverage, licensed agents are ready to assist.

Agents: if you are ready to join the team at Crowe; click here for contract.

Get all the latest agent news and event information; click here!

Keeping up with annual updates, such as; Part B premiums and deductible as well as nay plan changes, can help you budget effectively and avoid surprises.

What is Original Medicare

What is Original Medicare

By Ed Crowe | General Articles | 0 comment | 7 May, 2025 | 0

Although there are millions of people on Medicare, many find it a confusing subject especially since there are so many different parts to it. For individuals approaching 65 or anyone who or just wants to understand more about how this insurance works, here’s a brief answer to the question; what is Original Medicare and what does it cover.

What Is Original Medicare

The federal government established Original Medicare, a federal health insurance program, in 1965. The following individuals may qualify for Medicare benefits:

  • People age 65 or older
  • Certain younger people with qualifying disabilities
  • People with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)

There are 2 parts of Original Medicare: Part A and Part B.

Medicare Part A

Medicare Part A is sometimes referred to as hospital insurance. It provides coverage for:

  • Inpatient hospital care (once the enrollee is formally admitted)
  • Skilled nursing facility care (following a qualifying hospital stay)
  • Home health care (limited and medically necessary services)
  • Hospice care for individuals with a terminal illness

For most people, Part A is free,there is no premium payment as long as eiither the beneficiary or thier spouse worked and paid Medicare taxes for a minimum of 10 years.

Please note: Although Part A covers hospital stays, it doesn’t cover long-term care such as; nursing homes, custodial care or unlimited days in a hospital or facility. There are limits to what it pays; beneficiaires must pay a portion of their expenses (cost-sharing), such as deductibles and coinsurance and copays.

Medicare Part B

Medicare Part B is also known as medical insurance. It provides coverage for the following:

  • Doctor visits and outpatient medical care
  • Preventive services such as; wellness visits, flu shots and cancer screenings
  • Durable medical equipment (DME) this include things like; walkers, wheelchairs, oxygen as well as some diabetes supplies and more
  • Lab tests and diagnostic imaging
  • Mental health services
  • Some home health care

Unlike Part A, beneficiaries do pay a monthly Part B premium. Fo rmost people, this is a standard amount although higher-income beneficiaries may pay an additional cost.

Click here to learn more about Part B eligibility

Part B coverage includes an annual deductible (this amount is adjusted annually). Typically beneficiaries pay 20% coinsurance for most covered services; in other words, Medicare pays about 80% of the cost leaving enrollees responsible for the remaining 20%.

What Original Medicare Doesn’t Cover

Original Medicare provides coverage for many medical expenses; although, they do not cover everything. Some important things to know about what Medicare does not cover:

  • Prescription drugs (beneficiaries must enroll in separate Part D plan)
  • Routine dental, vision, and hearing care
  • Long-term custodial care
  • Most care received outside the U.S.

In order to fill some of these coverae gaps, many people purchase additional insurance. Some of the plans people choose are; Medicare Supplement (Medigap) plans, Stand-alone PDP (prescprion Drug) plans, Medicare Advantage (Part C) plans. Beneficiaries also may opt for ancillary coverage like dental, vision and hearing or cancer heart attack and stroke plans.

Medicare agents; learn how to sell ancillary products with Medicare – watch a quick video.

Original Medicare provides valuable health coverage for millions of Americans, but it’s important to understand what it cover and what it doesn’t. Knowing the basics helps beneficiaries make informed decisions and avoid unexpected costs.

Medigap Standardized Benefits

Medigap Standardized Benefits

By Ed Crowe | General Articles | 0 comment | 6 May, 2025 | 0

Navigating the world of Medicare can be overwhelming, especially when it comes to choosing the right supplemental coverage. That’s why it is important to understand what Medigap standardized benefits are and how they work.

Medigap is a type of private insurance that helps beneficiaries cover the “gaps” in Original Medicare (Parts A and B). Medigap plans cover things like; deductibles, coinsurance, and copays. What many people don’t realize is that Medigap policies are standardized, meaning the benefits for each plan type are the same, no matter which insurer you choose.

What “Standardized” Means

Starting in 1992, federal law requires all Medigap policies to adhere to standardized benefit structures, designated by letters: Plans A through N. The only real difference in plans is the premium each carrier charges for the plan. Although insurance companies charge different premiums, the benefits for each plan letter must be identical no matter who the provider is. In other words, every Plan N has to provide the exact same coverage for medical expenses no matter what company offers it.

Standardization makes it easy for beneficiaries to compare plans without worrying about differences in coverage. They can simply compare cost and company ratings to find the best options.

Examples of Medigap Plan options

  • Plan A: This is the most basic plan option. It provides coverage for Medicare Part A coinsurance and hospital costs, Part B coinsurance, and the first three pints of blood.
  • Plan G: The most comprehensive plan available to those who turned 65 after 1-1-2020. It covers all Medicare approved expsnes with the exception of the Part B deductible.
  • Plan N: Offers lower premiums than Plan G and covers a portion of the copays for doctor visits and hospital visits. The enrollee will still have a small copay for Medical services. This plan does not cover the Part B deductible or excess charges.

Some States Have Different Medigsp Standards

Although most states follow the federal standardization model, Massachusetts, Minnesota, and Wisconsin have their own versions of standardized Medigap plans. These states use their own benefit structures however, they still follow the principle of offering consistent benefits across insurers within their states.

Please Note

  • Plan C and Plan F are no longer available to beneficiaries who became eligible for Medicare on or after January 1, 2020. These plans provided coverage for the Medicare Part B deductible, which new legislation phased out to cut back on the overuse of services.
  • Beneficiaries must have both Medicare Part A and Part B to enroll in a Medigap plan. There is a premium for Medigap plans in addition ot the Part B premium.
  • Medigap works with Original Medicare, beneficiaires cannot use a Medigpa plan with a Medicare Advantage (Part C) plan.

Why Standardization is Important

Standardization simplifies decision-making for Medicare beneficiaries. It eleiminates the need to decipher insurnace benefits accross multiple insurance companies; instead, the focus is on price, company reputation, and rate increase history.

Watch a quick YouTube video on Medicare Supplement Underwriting

This helps foster competition between companies based on cost and service quality instead of confusing plan designs.

Choosing a Medigap plan doesn’t have to be a guessing game. With standardized benefits, benficiaries can make apples-to-apples comparisons between insurers and choose the coverage that meets both healthcare and financial needs.

Agents, are you ready to join the team at Crowe; click here

Medicare Premiums and Deductibles 2025

Medicare Premiums and Deductibles 2025

By Ed Crowe | General Articles | 0 comment | 5 January, 2025 | 0

Now that is 2025, both Medicare beneficiaries and agents need to know what the Medicare premiums and deductibles 2025 are so that everyone can plan accordingly. 2025 is the same as previous years; CMS has made changes to both Medicare Part A & Part B premiums and deductibles.

Medicare Part A costs 2025

The majority of beneficiaries do not have to pay a Part A premium if they have worked for at least 40 quarters (10 years) and paid Medicare taxes. Although if they do not qualify for premium free Part A, there are a couple different premium amounts they can pay if they want Part A benefits.

When either the beneficiary or their spouse worked and paid Medicare taxes between 30 and 39 quarters, the monthly premium cost is $285 in 2025. This is an increase of $7 from the 2024 cost of $ 278.

If the beneficiary or their spouse worked at a job and paid Medicare taxes for less than 30 quarters, the premium in 2025 is $518. This an increase of $13 from the cost of $505 in 2024

Part A Deductible and Coinsurance 2025

Part A covers inpatient hospital costs. In 2025, the Part A deductible has gone up $1,676 for each benefit period. This is an increase of $44 from the cost of $1,632 in 2024.

On original Medicare once the beneficiary meets the deductible, the cost for a hospital stay is $0 for days 1-60. The cost for days 61-90 is $419 per day. This is $11 over the cost of $408 in 2024. Once the beneficiary reaches day 91 and over, they start to use their lifetime reserve days and pay $838 per day. that is up from $816 in 2024.

There is no coinsurance charge for days 1-20 in skilled nursing facility stays. The cost for days 21-100 are $209.50 per day in 2025. This is a $5.50 increase from the 2024 cost of $204.

Click here to learn about the Part D drug cap

Part B costs 2025

In contrast to the Part A premium, almost all beneficiaries have to pay a Part B premium. In special circumstances, if a beneficiary qualifies for extra help due to limited income and resources, they may not have to pay the Part B premium.

Part B Premiums & Deductibles

For 2025, the standard monthly premium has gone up $10.30 to $185.00. The premium was $174,70 in 2024.

Learn more about Part B costs

Those with an income level over a specified amount pay an IRMAA. The CMS adds the IRMAA to the standard monthly premium amount. The premium amount each beneficiary pays ranges from $259 to $628.90 per month if the beneficiary pays an IRMAA. The amount is based on their specific income level.

If you have been incorrectly charged an IRMAA, learn how to file an appeal.

The deductible amount for Part B in 2025 is $257, an increase of $17 from the 2024 cost of $240.

It is important for beneficiaries to stay updated on healthcare costs each year to manage their budgets and avoid surprises. CMS makes decisions on Medicare costs based on the projected rise in costs and use of healthcare.

Agents who want to join the team at Crowe, click here for contracting.

Medicare income limits 2024

Medicare income limits 2024

By Ed Crowe | General Articles | 0 comment | 1 April, 2024 | 0

Medicare income limits 2024

The Medicare income limits 2024 effect about 7% of Medicare beneficiaries.  Each year, the Social Security Administration determines the income limit that the IRMAA is based on.  It’s crucial to stay up to date on the annual income limits weather you are an agent or a beneficiary. In this post, we go over Medicare income limits for 2024 and how they can impact beneficiaries.

Why Medicare income limits matter

The income limits come into play with both Medicare Part B & Part D. The limits are used to determine if an individual pays either the standard premium amounts or a higher income-based premium for Part B & Part D.

Beneficiaries who earn more than the Medicare income limit have to pay an IRMAA for their Part B & Part D coverage.  In 2024, the income limit is $103,000 for an individual.  The income limit is $206,000 per couple.

Which Medicare coverage is income based

Medicare Part A is free to most beneficiaries and no IRMAA applies.

Part B of Medicare is income based as most beneficiaries have to pay for it, with the exception of those who qualify for “Extra Help“.

Learn more about help for Medicare beneficiaries with limited resources.

Beneficiaries of Medicare Part C (Medicare Advantage Plans) only have to pay the IRMAA when the plan they choose includes prescription drug coverage.  Few plans called MA only do not include prescription drug coverage and therefore, the IRMAA does not apply to those plans.

The IRMAA does apply to Medicare Part D (PDP) plans.

How is individual income determined

For 2024, the income limit is based on the beneficiaries’ 2022 tax return.  In other words, each year the IRMAA is based on the tax return from 2 years prior.  Medicare uses the MAGI (modified adjusted gross income) to determine who pays the IRMAA.

Although beneficiaries don’t see this amount on their tax return, they can find it by adding their income after deductions to any tax-free interest they earned.

Agents: Learn more about IRMAAs; watch our  YouTube video.

More about income limits in 2024

For 2024, there is more than one income threshold used to determine the IRMAA amount each individual pays for their Part B and Part D coverage.  Here are the Part B & Part D IRMAA amounts:

Single
Married Filing Jointly
Married Filing Separately
Part B Premium
Part D IRMAA
$103,000 or less
$206,000 or less
$103,000 or less
$174.70
$0 + plan premium
$103,000 up to $129,000
$206,000 up to $258,000
N/A
$244.60
$12.90 + plan premium
$129,000 up to $161,000
$258,000 up to $322,000
N/A
$349.40
$33.30 + plan premium
$161,000 up to $193,000
$322,000 up to $386,000
N/A
$454.20
$53.80 + plan premium
$193,000 less than $500,000
$386,000 less than $750,000
$103,000 less than $397,000
$559.00
$74.20 + plan premium
$500,000 or above
$750,000 or more
$397,000 or more
$594.00
$81.00 + plan premium

Most people pay the standard Medicare Part B premium rate.  The premium rate for Part D varies according to the plan selected. Beneficiaries with higher incomes pay extra for both Part B and Part D.

IRMAAs for Part B and Part D are automatically taken from their Social Security or Railroad Retirement Board benefits. Beneficiaries who do not receive monthly benefit payments receive a bill from Medicare.

How to handle an IRMAA

For beneficiaries subject to an IRMAA for Medicare Part B & Part D, there are ways to potentially lower your MAGI and reduce premiums.  Beneficiaries can consult their accountant and or financial advisor to help lower taxable income amounts.

How to request an IRMAA redetermination

Because the Social Security Administration bases their IRMAA determination on income reported on tax returns from 2 years prior, beneficiaries may have had a reduction in income.   There are some life events that can cause a reduction in income, these include:

  1. Death of a spouse, a divorce or annulment or a marriage
  2. When either spouse stops or reduces the number of hours they work
  3. If either spouse loses a pension
  4. Loss of income due to income producing property loss because of a natural disaster, fraud or similar circumstances

When beneficiaries receive notice of an IRMAA, they also receive information that explains how to request a new initial determination.

If Social Security receives a new initial determination, they may revise the amount of the IRMAA or dismiss it all together.  Beneficiaries can request a redetermination by either scheduling an appointment with their local Social Security office or by submitting the following form:

Medicare IRMAA Life-Changing Event form

beneficiaries must provide documentation of correct income or life-changing event that affected their income level in a negative way.

Beneficiaries can also call the representatives at SSA +1 800-772-1213 and request help lowering their IRMAA.  Explain that Social Security used outdated or incorrect information when calculating the IRMAA.

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Medicare enrollment dates

Medicare enrollment dates

By Ed Crowe | General Articles | 0 comment | 20 March, 2024 | 0

Medicare enrollment dates

If you are either getting close to your 65th birthday or are in Medicare sales, you should understand the Medicare enrollment dates.

Enrolling in Medicare can be confusing for beneficiaries and understanding the enrollment process is crucial to access the benefits your clients need. From IEPs to SEPs, the Medicare system is designed to accommodate various life circumstances. In this post, we go over several of the Medicare enrollment periods and how beneficiaries can use them to get the healthcare coverage they need.

Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) is the first opportunity for most individuals to enroll in Medicare. IEP is a 7 month time frame that starts 3 months before the month of your 65th birthday, includes your birthday month, and ends three months after the month you turn 65.  During this period, individuals can sign up for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) if they choose to.

Learn more about enrollment periods

Special Enrollment Periods (SEPs)

Special Enrollment Periods (SEPs) are designated times outside the initial enrollment period when individuals can sign up for Medicare due to specific qualifying events. Some of the most common qualifying events include:

Loss of Employer Coverage

If a beneficiary is covered under a group health plan through their own  or their  spouse’s current employment, they are eligible for an SEP when they lose the employer coverage.

Moving out of the plans service area

When a client moves out of their plan’s service area, they qualify for an SEP to enroll in a new Medicare plan.

Becoming Eligible for Extra Help

Individuals who become eligible for Extra Help with Medicare prescription drug costs qualify for an SEP to enroll in a Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan (Part C) that includes prescription drug coverage.

General Enrollment Period (GEP)

For individuals who miss their initial enrollment period, the General Enrollment Period (GEP) provides another chance to enroll in Medicare. The GEP runs each year from January 1st to March 31st. Coverage obtained during this period begins the first of the month after you enroll.  it’s important to note, beneficiaries who wait until the GEP may have to pay a late enrollment penalty.

Click here to learn about late enrollment penalties LEPs

Annual Enrollment Period (AEP)

The Annual Enrollment Period (AEP), also known as the Medicare Open Enrollment Period, runs each year from October 15th until December 7th. During this time, Medicare beneficiaries can make changes to their Medicare coverage.  This includes; switching from Original Medicare and Medicare Advantage plans, as well as joining, dropping, or switching prescription drug plans.

How to best use the Medicare enrollment dates

  1. Stay Informed: Keep track of your eligibility and enrollment periods to ensure you don’t miss important deadlines.
  2. Review Your Coverage Needs: Regularly assess your healthcare needs to determine if  current coverage is still suitable or if changes are necessary.  Agents make sure you contact your clients regularly, especially during AEP to go over coverage options for the following year and ensure they are happy.
  3. Seek Assistance if Needed: If you have questions or need guidance regarding Medicare enrollment, it is best to reach out to a licensed insurance agent.

Medicare agents be sure to maintain your book of business, click here for some ideas.

Agents, are you ready to join a winning team, click here for Crowe contracting!

Understanding Medicare enrollment dates is essential for to ensure beneficiaries have access to the healthcare coverage they need. By familiarizing yourself with the various enrollment periods and their significance, you can navigate the Medicare system with confidence and peace of mind. Remember, staying informed and proactive is key to making the most of your Medicare enrollments.

 

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How to get a replacement Medicare card

How to get a replacement Medicare card

By Ed Crowe | General Articles | 0 comment | 6 February, 2024 | 0

How to get a replacement Medicare card

If you find yourself in need of a replacement Medicare card due to loss, damage, or a name change, the process is straightforward. We will go over the process to get a replacement Medicare card, ensuring you have access to your necessary healthcare information when you need it.

Find out about Medicare premiums.

The importance of a Medicare card

Before we dive into the replacement process, it’s essential to recognize the significance of your Medicare card. This card contains valuable information, such a as your Medicare number as well as the effective dates of your Part A and Part B coverage. Beneficiaries need to have access to it as proof of Medicare coverage when they require necessary medical services. Whether you’ve lost your card, or it’s been damaged, it is important to obtain a replacement card quickly.  This will help enrollees maintain their access to healthcare.

Ensure eligibility

If you are eligible for Medicare but have not enrolled yet, you need to complete the initial enrollment process before you request a replacement card. Once you complete your initial enrollment, you will receive your card within a few weeks.

Click here to learn about Medicare enrollment periods.

Ways to obtain a new Medicare card

There are a couple different ways to obtain a replacement Medicare card.  Because of this, beneficiaries can choose the method that they are most comfortable with. The two ways to get the new card are:

Online:

Beneficiaries can log into their personal account on the official Medicare website www.medicare.gov.  Once they are logged in, it is easy to follow the prompts and request the replacement card. This method is convenient and typically provides a quicker turnaround. Beneficiaries can print an official copy of their card from their online account to retrieve an immediate copy.

Over the phone:

To request a replacement card over the phone, contact Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778). Beneficiaries need to have their Medicare number as well as other pertinent information to verify your identity.

Provide necessary information

No matter what method you opt for, you need to provide personal information to verify your identity and facilitate the replacement of your card. It is imperative that you use only official channels to request the new card.  Medicare will need details such as your full name, Social Security number, date of birth, and even your Medicare number to verify your identity before they can process the request.

Confirm Your Address

Because Medicare will send the replacement card to the address on record, it is important to make sure you update your current address in the Medicare system if you move.  Keeping your records up to date will ensure you receive your new card a quickly as possible.

Learn the difference between Medicare Advantage and Medicare Supplement plans – watch a quick YouTube video

Be Patient

Once you submit your request your replacement card, it will take time for the request to be processed and sent out to you. The time required to process the request will vary depending on how busy the Medicare office is, so you need to be patient while you wait for the Medicare card to arrive.

Obtaining a replacement Medicare card is a straightforward process.  Following these steps and keeping your information current, will ensure the process is smooth should you need a replacement card.

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