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How to begin
Navigating into the Medicare world can be mind boggling, there are many things that must be considered and done in a timely manner. However, the benefits are often times wonderful!
Medicare is available to people who have turned 65 or have received Disability benefits for 24 months. US citizens are entitled to Medicare Part A & B the first day of the month of their 65th birthday. If your birthday falls on the first day of the month, you are entitled to Medicare Part A & B the first day of the prior month. The best rule of thumb is to contact Hourglass Insurance Services (or the Social Security office) 3 or 4 months prior to your 65th birthday. Medicare Part B has a cost associated with it, Part A is a free benefit as long as you have worked and paid Medicare Taxes for 40 quarters.
Medicare is complicated, contact us while you are still 64….***
Original Medicare Part A covers part of Hospital related care.
Original Medicare Part B covers part of Doctors’ Services and other medically necessary items including preventative services.
Medicare Advantage Part C are private insurance company plans that usually use HMO’s, POS’s or PPO’s and typically include Part A, B and D.
HMO is a health maintenance organization where all of the doctors must be in the network.
POS is a point of service network that allows in and out of network coverage.
PPO is a preferred provider organization that also allows in and out of network care.
Medicare Part D is Prescription Drug Coverage, it is optional, however, you may have to pay a lifetime penalty if you do not acquire it when you become eligible. *** See more information under the Rx section.
Medigap aka Medicare Supplemental Insurance plans help cover the out of pocket costs of Original Medicare.
**There are rules that must be followed to meet the eligibility requirements if you are not a US citizen and do not have at least 40 quarters of paying into Social Security/Medicare.
How to Begin?
Contact us at least 3-4 months prior to your 65th birthday and we will guide you, at no cost, through the necessary steps. You may be wondering, “Should I keep my company’s coverage?” We will compare your options, at no cost, so you can make an informed decision.
All we ask in return is, if you like us - refer us to your friends.
It is best to sign up for your Medicare Part A & B Benefits before your 65th birthday, unless you or your spouse are still working and are covered by your employer’s health insurance plan and that plan has a Prescription Benefit that is equal to or better than what it provided through the optional Medicare Part D plans. You have a 7 month window to sign up for Medicare: 3 months before your birthday month, during your birthday month and 3 months after your birthday month. If you wait beyond that time frame and you do not have a Special Enrollment Period then you must wait for the General Enrollment Period to sign up between January 1st and March 31st of each year, however your coverage will not start until July 1st of the year you sign up. You may have to pay a penalty for late enrollment. The best rule of thumb is to contact Hourglass Insurance Services (or the Social Security office) 3 or 4 months prior to your 65th birthday to find out which options are best for your situation. If you are already receiving Social Security income you will automatically get your Medicare Part A and B Card in the mail, usually 3 months before your birthday. They will automatically begin taking your Medicare Part B Premium out of your check in the month you become eligible. If you do not get it 2 -3 months before your birthday contact the Social Security office. If you have not started taking your Social Security income you may go online and sign up, we can help you with that or you can go to the Social Security office and sign up.
You do not have to wait in line to see us and we are really nice. 😊
Supplemental Plans
Some people prefer supplemental plans to coordinate with their Medicare benefits. We will explain the different options available to you, in your location, so you can feel comfortable about your decision. We are licensed in 8 states (CT, FL, IN, OH, RI, SC, TN, WA) at this juncture and the rules can be different in each one.
There are a wide variety of supplemental plans. Medicare covers 80% of the Medicare allowed services. Some of the supplemental plans cover approximately 20% of the Medicare allowed services. Basically they supplement What Medicare does not pay. Besides having the supplemental plan you should also purchase a separate prescription drug plan for an additional cost. Some of the plans have foreign travel coverage but it is limited compared to some of the medicare advantage plans’ travel coverage.
They have also come out with newer plans that aren’t quite as comprehensive but are less expensive. Here we go again, with that familiar mantra, "Medicare is complicated!" We are here to uncomplicate things for you and give you options for the plans that are most comfortable to you. We are licensed with many different companies and in different states.
An important item to be aware of when you purchase a supplemental plan is that if you are in the hospital and require an amount of time in a skilled nursing facility for rehabilitation, you must be ADMITTED into the hospital a minimum of 72 hours. That is three full days of hospitalization before you are eligible to be referred into a skilled nursing facility. Whereas with the medicare advantage plans there is no minimum hospital stay to be eligible to be referred to a skilled nursing facility for rehabilitation. On the other hand when you go into a skilled nursing facility for rehabilitation the supplemental plan continues to pay after the first 20 days of coverage. With an Advantage plan you would pay $167+ per day after the first 20 days of copays. However, with an Advantage Plan you may change to Original Medicare the 1st of the following month that you are admitted to a skilled nursing facility. Complicated rules....
Prescription Plans
People who choose to purchase a Supplemental Plan should purchase a stand-alone Rx plan, see more important information below. Again, there are many options to choose from and it helps to have the advice of knowledgeable people on your team. This area gets very tricky when it comes to some of the newer, expensive prescriptions. We often have to search many different companies’ plans to find the right fit for a person’s needs.
The prescription drug plans that are now available are changing on an annual basis. Congress passed a law in 2018 to get rid of the Medicare Rx "gap" ASAP. There are many plans available that cover the majority of prescriptions that are normally used by senior citizens. Of course, there are other circumstances where new drugs are coming out or the medication is extremely expensive and they may not be covered on the plan’s formulary. However, once you are in a plan you can ask for an “exception” to that particular prescription and your insurance company may or may not choose to reduce the tier, which causes the cost to be lowered. I repeat, “Medicare is complicated”. We often have to research to find a company that will cover some particular medication because the companies vary in what they will and will not cover. We at Hourglass are willing to put in that extra step on your behalf.
If you choose not to participate in the available Rx plans at the time you are eligible to purchase your Medicare part B, you may pay a lifetime penalty once you do sign up for a plan later. I have had clients who were not needing any prescriptions at the time they got the Medicare part B, so they assumed they could go without purchasing a Medicare prescription drug plan. As they matured they needed to get prescriptions and because they had not purchased it when they were first eligible they ended up having to pay a lifetime penalty of 1% per month of the average cost of an average Medicare prescription plan. And since they had gone several years without a prescription drug plan it ended up being $13 or $14 a month extra for each of them. The reason for this is because insurance is what you purchase in case you need it. Everybody jumps into the pool when they’re healthy so that if they get sick they have coverage available. It works the same way with your home insurance and your car insurance. You cannot buy car insurance after you have already gotten in an accident, and you shouldn’t wait until you’re sick to buy health insurance. I know that buying health insurance without underwriting (the ability to buy into a plan at regular costs even if you have pre-existing medical issues) became a law under President Obama, but then it is no longer true insurance, it’s more of an entitlement. And financially that does not work for the companies who have to cover the medical expenses.
Medicare Advantage Plans
Some people prefer medicare advantage plans to coordinate with their Medicare benefits. We will explain the different options available to you, in your location, so you can feel comfortable about your decision. We are licensed in 8 states at this juncture and the rules can be different in each one.
I have been working with advantage plans since 2006. One of the differences between medicare advantage plans and medicare supplemental plans is that the advantage plans may be more similar to the health insurance you had before you turned 65. There are co-pays for non prevenative office visits, the plan usually includes prescription drugs, (which may or may not have an Rx deductible) and you may be able to buy optional services like dental or vision plans. A fitness plan is often an included benefit. Again there are many plans and companies to choose from, it is important to make an informed decision.
We at Hourglass Insurance Services are here to help you. We can make your Medicare enrollment experience pleasant and comfortable. We are also available to help you each year going forward. We offer annual meetings to go over any changes that occur to your plan.
FAQ
It is very difficult to come up with a list of frequently asked questions because there are literally hundreds of them and each state has different rules and then each plan has different rules on top of that.
I have answered many questions in the sections I have written above.
IF YOU HAVE A QUESTION CALL US AT 860-464-0121. WE ARE HAPPY TO HELP.
IF WE ARE IN THE OFFICE, WE ANSWER OUR PHONES!