Can you explain Medicare Part A, B, C, and D?
Medicare has 4 Parts, Part A is Hospital, Part B is Medical, Part C is an Advantage Plan, and Part D is your Drug plan. Part A & B is your federal coverage. Part B has a premium based on your income. If you choose Original Medicare, Part A & B will cover 80% and it leaves a 20% gap. A Medigap or a Supplemental policy picks up the 20% gap. Part D is for your prescriptions or D for drugs. Part C, Medicare Advantage Plan, it will bundle your A, B and D. It is a managed healthcare plan, and government subsidized. When starting on Medicare, you have 2 choices. Either a Medicare Advantage Plan (Part C) or Original Medicare with a supplemental policy.
When is my Initial Enrollment Period?
Your initial enrollment period begins three months before your 65th birthday month and three months after your birthday month. It is a seven-month window. You apply for Part B through Social Security.
What is a common mistake people make when enrolling in Medicare?
A common mistake people make is not understanding the differences between Part C (Medicare Advantage Plan) which is not guaranteed renewable. And Original Medicare with a Supplemental (Medigap) policy, which is private insurance and is guaranteed renewable for the rest of your life as long as you have no lapse in coverage. When you are new to Medicare you are a GI (guaranteed issue), and you will have no underwriting. Pre-existing conditions don’t matter. If a person chooses a Part C plan and realizes it was a mistake in a few years. They will have to now pass underwriting to get a Supplement to Original Medicare.
I just moved to Venice from out of state and I am losing my Medicare Advantage Plan, what do I do?
You will get a letter from your MA plan. Keep it, that is proof to get back to Original Medicare without underwriting! Moving out of coverage area puts you in a Special Enrollment Period. (SEP)
Can I move out of state and take my Medicare Supplemental Insurance with me, or do I have to buy a new policy in my new state?
All standard Medicare Supplement Plans are portable, so there is no need to change when moving.
Can I take a trip within the U.S. and still be covered by my Medicare Supplement Plan?
Yes. One of the main advantages of Original Medicare with a Supplement is the ability to go to any doctor, any specialist, any hospital nationwide, as long as Medicare is accepted. A Medicare Supplement is your secondary coverage.
In 2024 and 2025 many of the companies are doing away with PPO’s. What should I do?
The insurance company will send a letter. Save the letter, it’s proof of involuntary disenrollment. You can get Original Medicare with a Supplement as a GI without going through underwriting. Then you can go to any doctor, any specialist, and hospital anywhere in the US that takes Medicare. Medicare A & B will pay 80 % and the Supplement picks up the 20% gap.
What is Medicare General Enrollment Period (GEP), or the Medicare Advantage Open Enrollment was formerly known as the Medicare Disenrollment Period?
The Medicare General Enrollment is January 1-March 31. During this time a person could enroll in Medicare if they missed their Initial Enrollment Period (IEP) when they turned 65. Coverage will not start until July 1st and a penalty is applied to their Part B premium. Also, during this time, you can make changes to your existing coverage. Some people have made selections during the Annual Enrollment Period that they regret. During this time, you can switch from a Medicare Advantage Plan back to Original Medicare if you can pass underwriting.
I am ready to leave my employer coverage. How do I apply for Medicare?
You have guaranteed issue rights for a supplement with all health conditions accepted and any waiting periods waived regardless of if it’s voluntary or involuntary. When applying for your Part B, you will need to show proof of employer coverage as not to be penalized.
How do I make changes to the Part D prescription plan?
Part D plans can be changed once a year during the annual enrollment period from October 15th to December 7th and coverage begins the following calendar year.
Karla Blake, Medicare Specialist
The Medicare Specialist Team, LLC
954.612.1754
karlablakemedicarespecialist.com