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It’s a great day to be Medicare Young!

If you are turning 65, or are enrolled in Medicare and want to make changes, the time to do so is from October 15 to December 7 during Medicare Open Enrollment season.

Open Enrollment is all about understanding the benefits of Medicare so you can make the right decision. It's about keeping you on the road to health while getting the most from your specific Medicate option.

More than ever, NOW is the time to finally get the best care at an affordable price!

Susana’s FAQ’s

These are the most asked questions that I get from my clients:

What is the difference between Original Medicare and Medicare Advantage Plan?

Original Medicare is provided by the Federal Government, whereas both, Medicare Supplemental Insurance and Advantage Plans are offered by private companies.

Because not all costs are covered under Medicare Parts A, B & D, enrolling in an additional insurance plan that helps with the costs is typically recommended.

This is what happens when you turn 65 and are no longer covered by an employer plan:

  • You are automatically enrolled in Medicare Part A.

  • You are responsible for enrolling in Parts B&D during a special enrollment period that is triggered three months before you turn 65, and ends three months after your birth month.

  • You have the option of getting additional coverage via a Medicare Supplement Plan-- also known as Medi-Gap -- complemented with a prescription drug plan, or a Medicare Advantage plan.

This quick guide may help you navigate the options:

What is the difference between Medicare Supplement (also known as Med-igap) and Medicare Advantage plans?

Both Plans are offered by private insurance companies, and cover services that Original Medicare doesn't. Examples include skilled costs related to a nursing facility care (for 100 days), coinsurance/copayment for hospice care, additional hospital costs, excess charges that may occur in a health-related event or international emergency services.

In an HMO Advantage Plan, costs associated within a 'network' will typically offer more affordable options. However, if you have been working with a specific team of doctors and want the freedom to change doctors, then a Medi-Gap option would be better for you.

The cost varies, and again, will depend on how comprehensive you want your coverage to be. I find this summary helpful when discussing the differences between Medi-Gap and Medicare Advantage Plans:

What happens if I miss enrolling during open enrollment season?

Let me start with... don't!

Both Medicare and most Advantage Plans may offer an extended grace period of a couple of weeks, like last year. But don’t risk it. Mark your calendar and make sure that you meet with your insurance broker to get the plan you need or make the changes you deem necessary.

Here are the basics as far as enrollment for Medicare is concerned:

  • When you turn 65 you are automatically enrolled in Medicare Part A, providing you or your spouse has registered 10 years of full time work. It is easily verifiable at the Social Security Administration.

  • You have 3 months prior, and 3 months after the month of your birthday to enroll in Medicare Parts B & D, and Medicare Supplemental Insurance (Medi-Gap) or an Advantage Plan.

  • If you sign up late for Medicare Part B, you will have to pay a late penalty premium every month for the rest of your life, in addition to your Part B premium.

  • Every year, and only during the open enrollment period, you are allowed to make changes to your healthcare plans.

  • There most common exceptions to open enrollment rules do not are:

1. When you are leaving an employer medical plan 2. When you are moving to another state 3. If you qualify for Medi-Cal 4. When you go into a nursing home

Susana’s Tips

  • Make sure there is an in-depth understanding of YOUR options. How’s your health? Will you need additional services down the road? Work on a plan that covers YOUR needs. Let’s face it: as we get older, our sight and hearing are not so good. Many advantage plans offer additional benefits that you might want to consider when shopping for a plan, mainly those associated with Dental/Vision/Hearing benefits.

  • If opting for an Advantage Medicare Plan, the first and most important recommendation is to do an analysis of benefits offered by each provider as well as the maximum annual out-of-pocket cost. Unexpected costs can have a devastating effect on your financial health.

  • Make sure you are capitalizing on all the additional benefits offered. Some Advantage plans, may include a wellness program that establishes a concrete plan of action based on your health. This may include disease screening, exercise routines, depression screening, smoking cessation counseling, alcohol counseling, or obesity counseling. Some plans may include perks such as discounted prices at gyms (silver sneakers), rides to medical appointments, access to your doctor or nurse via telephone or meals delivered to your home.

  • Please, please, please! Remember to make sure you confirm your doctor is “in network”, especially if considering an Advantage Plan.

  • went through major changes this year, the first in 10 years! It may have some glitches, but the overall information is very useful, especially regarding information on Part D.

Enrolling in a Medicare plan that covers YOUR specific needs requires significant research. Ultimately it will depend on your health care needs vs. your budget: what complements your lifestyle the most, Medicare Part A, B and D with a Medicare Gap policy, or a Medicare Advantage plan?

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