Medicare Supplement Plan B: Costs and Benefits

Medicare Supplement (Medigap) plans help cover out-of-pocket Medicare expenses including co-payments, coinsurance, and deductibles. Enrollment in these plans has increased every year, and more than 22% of Medicare enrollees take advantage of this type of supplemental coverage in 2019.

There are ten types of Medicare Supplement plans (A, B, C, D, F, G, K, L, M, N) and unlike Medicare Advantage plans, they provide the same basic benefits regardless of which carrier you enroll with.

Plus, most plans are “guaranteed life,” which means that as long as you pay your premium on time, you won’t be canceled from your plan if a new health condition develops.

Medicare Supplement plans are great for beneficiaries who would rather pay a small annual deductible for financial protection in the event of an unforeseen health expense.

What does Medicare Supplement Plan B Coverage Include?

Medicare Supplement Plan B is very similar to Medicare Supplement Plan A. The only difference is Plan B covers your Medicare Part A deductible. Plan B covers:

• Part A coinsurance and hospital costs
• Part B coinsurance and co-payments
• Bloodwork co-payments (up to 3 pints)
• Hospice coinsurance and co-payments
• Part A deductible

Medicare Plan B Cost

Even though the benefits are mostly the same per carrier, the costs of the plan will vary based on carrier, zip code, age, gender, and tobacco use. Some plans are as low as $80/ while some are as high as $140/month.

The fewer benefits a plan provides, the lower the monthly premium is. Since Plan B offers less coverage, it is typically one of the cheapest plans on the market.

Medicare Plan B Deductible

If you choose to enroll in a Plan B Medicare Supplement plan, you will be responsible for your Part B deductible, but your Part A deductible will be included in your plan. The 2019 Medicare Part B deductible is $185.

You will also be responsible for any skilled nursing facility care coinsurance, Part B excess charges, and emergency health costs while traveling. This is great if you rarely see unexpected health costs and would rather have lower monthly costs than high premiums for benefits you don’t use.

If you generally have high costs in the areas that Plan B does not cover, it may not be the best plan for you. Instead, you should consider the more comprehensive Plan G. Alternatively, if Plan B sounds great, but you would prefer a cheaper monthly payment, you should explore Plan A, which has fewer benefits but typically has the lowest costs.

Medicare Supplement Plan B vs. Medicare Part B

Medicare Plan B and Medicare Part B are two entirely different things but can be easily confused. Medicare Supplement Plan B is a Medigap plan and Medicare Part B works alongside Part A to form Original Medicare. It covers medically necessary doctor services and treatments as well as preventative services like yearly wellness visits. This includes lab tests, x-rays, emergency transportation, durable medical equipment, mental health, and partial hospitalization. If you want to enroll in Plan B (or any Medicare Supplement), you need to be enrolled in Part A and B first.  

Medicare Supplement Plan B Options

There are several Medicare Supplement plans on the market, but availability will vary based on your location. As we’ve mentioned, plans generally offer the same coverage regardless of carrier, so why do some plans have better reviews? Companies with higher ratings generally offer plans with higher ratings. Customer service is another factor. Here is a list of the top Medigap carriers in 2019:

• AARP
• Aetna
• Amerigroup
• Cigna
• Humana
• Mutual of Omaha
• WellCare

Use Our Medicare Supplement Plan Finder Tool to Find Plan B Options in Your Area

Our Medicare Supplement Plan Finder tool can help you find Plan B options in your area. Click here to get started. Enter your zip code in the box beside the red arrow. We chose 37209 because that’s the zip code for our corporate offices in Nashville, Tennessee.

Next, choose the appropriate circles for your gender and tobacco use and enter your date of birth. Then click “Next.”

Then select your plan preference and click “Next.”

Next enter your personal information in the boxes beside the green arrow. Then click “Search plans” beside the red arrow.

The final step is viewing the Plan B options in your area. Select “B” from the drop-down menu beside the red arrow. Then click “Search plans” beside the blue arrow.

Medicare Plan B Enrollment

You can enroll in a Medicare Supplement plan during any time of the year, but carriers can deny you or charge you more for existing conditions. The best time to enroll is during your Initial Enrollment Period (IEP), which is the seven months around your 65th birthday. During this time, you can enroll in any plan that is available in your area regardless of any health issues you may have.

If saving money is important to you, a licensed agent can help you enroll in the cheapest plan available in your area. When you meet with one of our agents, there is never an obligation to enroll, and the appointment is entirely cost-free to you. Fill out this form or give us a call at 844-431-1832.

What is Medicare Supplement Plan A?

Medicare Supplement Plan A is often referred to as Medigap Plan A or Medicare Plan A. Like other Medicare Supplements, Plan A helps cover the gaps that Original Medicare does not, including coinsurance, copayments, and deductibles. There are ten types of Medicare Supplement plans (A, B, C, D, F, G, K, L, M, N).

About Medicare Supplements

Most plans are guaranteed renewable life, meaning as long as you pay your premium on time, you won’t be canceled from your plan due to a new health condition. Plus, unlike Medicare Advantage plans, Medigap plans are generally the same no matter which carrier you enroll with. If you’re looking for coverage assistance, a Medigap plan may be the way to go – but which one? Here’s everything you need to know about Plan A.

What does Medicare Supplement Plan A cover?

Plan A offers the least amount of benefits among all Medicare Supplements, but that doesn’t mean you shouldn’t consider it! The less benefits a plan provides, the lower the monthly premium is. Since Plan A offers the least coverage, it is typically one of the cheapest plans on the market. Plan A covers:

• Part A coinsurance and hospital costs
• Part B coinsurance and co-payments
• Bloodwork co-payments (up to 3 pints)
• Hospice coinsurance and co-payments

Plan A Costs

All Medigap plans provide the same basic benefits regardless of which carrier you choose. This means if you want to purchase Plan A, you will have the same coverage whether you enroll with Aetna, Blue Cross Blue Shield, or Cigna, etc. However, here’s the catch… the costs will vary based on carrier, zip code, age, gender, and tobacco use. Some plans are as low as $70/month while some are as high as $140/month. Certain plans can add extra benefits, like SilverSneakers®, but this is rare.

If you choose to enroll in a Plan A Medicare Supplement plan, you will be responsible for your Medicare Part A and B deductibles. You will also be responsible for any skilled nursing facility care coinsurance, Part B excess charges, and emergency health costs while traveling. This is great if you rarely see unexpected health costs and would rather have lower monthly costs than high premiums for benefits you don’t use.

You know your health better than anyone, and if you generally have high costs in the areas that Plan A does not cover, it may not be the best plan for you. Instead, you should consider the popular, more comprehensive, Plan G.

Plan A Reviews

If the benefits are going to be mostly the same no matter which carrier you choose to go with, why do the prices differ? There is no reason to overpay when the benefits are the same. There are so many top rated companies that sell Medigap. Companies with higher ratings have plans with higher ratings. Customer service is also an important factor. Here is a list of the top Medigap carriers for 2019:

• AARP
• Aetna
• Amerigroup
• Cigna
• Humana
• Mutual of Omaha
• WellCare

Plan A for Disabled People

If you are under 65 and qualify for Medicare through a disability, you may be able to enroll in a Medicare Supplement plan. The availability of these plans will vary depending on where you live. Federal law doesn’t require companies to sell you a plan if you are under 65 unless you live in California, Massachusetts, or Vermont. These states are required to offer at least one Medigap policy. Other states may offer Medigap plans, but they are not required to by law. Policies for those under 65 often cost more, so you may want to consider a Medicare Advantage plan instead.

Medicare Part A vs. Plan A

Medicare can be confusing, and it’s easy to confuse all the different parts and plans. We don’t want you to confuse Medicare Supplement (Medigap) Plan A with Medicare Part A. Part A is part of Original Medicare and covers hospital care, skilled nursing facility care, hospice, and home health services.  Plan A is one of the ten Medicare Supplement Plans. You may hear Plan A referred to as Part A, but Plan A is the correct term. Here’s an easy way to remember it: Medicare only has four parts (A, B, C, and D), while all Medicare Supplements are referred to as plans.

Enroll in Medicare Supplement Plan A

The best time to enroll in a Medicare Supplement plan is during your initial enrollment period (three months before and after your 65th birthday). During this time, you can enroll in any plan that’s available in your area regardless of any health issues you may have. Outside of your IEP, you can enroll year around, but carriers can deny you or charge you more for existing conditions. Your best bet is to speak with a licensed agent. There is never a cost for meeting with one of our agents, and you are never obligated to enroll. Fill out this form or give us at a call at 844-431-1832.

Understanding Medicare and Employer Coverage/COBRA

In 2019, there are more older people continuing their career after age 65 than ever before. In 1985, senior Americans made up 11% of the workforce, but today that number is as high as 20%. If you are nearing 65 and wondering how your job impacts your Medicare options, look no further! Here is everything you need to know about Medicare and employer coverage.

Active Employer Coverage

If you are 65 (or soon-to-be 65)  and have employer health coverage, you’ll have the option to keep your current coverage or enroll in a Medicare plan. It’s important that you understand the different coverage options available to you so you can compare and find the most cost-effective alternative.

Can I keep my employer health insurance with Medicare?

Yes. If you are actively working, you have the right to remain on your employer’s coverage plan even if you are eligible for Medicare. If you choose to keep your employer plan, your Medicare benefits can coordinate with your current coverage.

If your company has more than twenty employees, Medicare is secondary. This means that your group plan will pay first, and then Medicare. Part A can coordinate with your employer plan to lower your costs regarding a hospital stay. Most working seniors should enroll in Part A regardless of other coverage because it will be premium-free if you have worked for at least 10 years. Part B is not premium-free, and you will pay a monthly premium based on your income. You can choose to delay enrolling in Part B if you prefer. You can avoid Part B (or Part D, prescription drug plan) late penalties by showing a creditable coverage letter (proof of last coverage) when you enroll at a later date.

If your company has less than twenty employees, Medicare is primary. This means that Medicare will pay first, then your group plan. When Medicare is primary, you need to enroll in Medicare Part A and B. You can delay enrolling in a Part D plan (prescription drug plan) and avoid a late penalty fee if your group plan has prescription coverage. However, it is important to compare costs because it can be cheaper to leave your group plan and enroll in a Medicare Supplement plan as your secondary coverage instead. These plans are a great way to help pay for your copayments, coinsurance, and deductibles.

Can an employer pay for Medicare supplemental insurance?

Your employer generally does not pay for any of your Medicare premiums. However, your employer can set funds aside for you to use towards health coverage. This is done through a form called “Section 105 Medical Reimbursement Plan” and is a tax-free reimbursement of your medical and other health expenses.

Some employers may prefer to pay for a Medicare Supplement plan for you because carrying an employee over the age of 65 on a group health plan can be expensive. Plus, you may be able to get more comprehensive coverage through a Medigap plan, like the popular Plan G, instead of your employer or union plan.

Do I need Medicare if I have employer insurance?

The short answer is “maybe.” If you are about to turn 65 and have health coverage through your employer (or your spouse’s employer), you should talk with your benefits administrator and find out if you’re required to enroll. If your employer doesn’t require you to sign up for Medicare, you don’t have to. Instead, you can sign up when you retire or otherwise lose your employer’s coverage during a temporary Special Enrollment Period (SEP). As long as you enroll during your temporary SEP, you can avoid any late-enrollment penalties. These penalties typically result in a higher monthly premium as a result of postponing enrollment.

Can I work full time while on Medicare?

Yes, you can work full time while on Medicare. As we mentioned above, your Medicare and employer coverage will differ depending on your company size. If you have specific questions for your unique situation, click here.

What benefits are not included in employer coverage?

Your employer coverage can differ depending on your group plan. Some employer group plans may cover dental, vision, and hearing coverage, but these benefits can also be found in a Medicare Advantage plan. MA plans also offer benefits like group fitness classes, meal delivery, and transportation. If you’re interested in learning more about an MA plan or looking to enroll, click here.

Employer Union Coverage

Employer union coverage is a bit different than employer coverage. Your employer or union should let you know if your coverage will continue once you turn 65. You should contact your group coverage provider to get more detailed information.

Medicare COBRA Qualifying Events

COBRA is a continuation of coverage for someone who is no longer part of a company or union. Under COBRA, an employee has the option to continue group coverage for a limited amount of time, however, it is generally at your own expense.

If you enroll in Medicare BEFORE you become eligible for COBRA, you can keep your COBRA coverage. If you are not yet eligible for Medicare when you get COBRA, your COBRA coverage will end on the day that you become eligible for Medicare.

*Additionally, gaining or losing a job with health coverage is considered a qualifying event for you to have a Special Enrollment Period (SEP), but you do not have a SEP once your COBRA coverage ends.

Can you have both Medicare and COBRA?

It is possible to have both Medicare and COBRA if you already had Medicare when you became eligible for COBRA. In that case, Medicare will pay first, but you can use COBRA for additional costs.

If you are under 65 and on COBRA, you must enroll in parts A and B as soon as you become eligible. Failure to do so can result in a late enrollment penalty fee.

Find Your Best Coverage Option

If you are nearing 65 and still have health coverage through an employer, we want to help! Medicare and employer coverage can be confusing, and we understand that all situations are unique. Our licensed agents want to make sure you’re enrolled in the best coverage for your needs and budget. Plus, they are contracted with all the major carriers so they can help you enroll with an unbiased approach. They can help answer any questions about employer coverage, Medicare Advantage plans, Medigap, prescription drug coverage, and so much more! Click here to get in contact with a licensed agent or give us a call at 844-431-1832.

This blog was originally published on 11/30/17, but was updated on 4/2/19 and again on 7/11/19.

A Guide to 5 Star Medicare Plans

There are 2,734 Medicare Advantage (MA) plans on the market nationwide in 2019. This is an increase of 417 plans since 2018! Based on location and eligibility, the average enrollee has 24 plan options, but only 10 percent of beneficiaries are enrolled in 5 star Medicare plans. These star ratings can help you understand the quality of services and care within the plan.

What is a Medicare 5 star rating?

Medicare has four main parts (A, B, C, and D), but not every part is rated. The Centers for Medicare and Medicaid Services (CMS) uses a rating system to rate Medicare Advantage and Part D plans. The rating system is as follows:

• Five stars: Excellent
• Four stars: Above average
• Three stars: Average
• Two stars: Below Average
• One star: Poor

Medicare Advantage and Part D may have the same star system, but they have different factors that are weighted in the rating process. This is because they have primarily different purposes.

MA plans can provide additional benefits beyond Original Medicare like hearing, vision, or dental coverage. On the other hand, Part D plans provide prescription drug coverage.

Medicare Advantage plans are rated on the following factors:

• Level of access to preventive services (including annual physical exams and screenings)
• Care coordination
• How often members receive treatment for long-term conditions
• Current member satisfaction
• Plan performance in comparison to the previous year
• Customer service quality

Part D plans are rated on the following:

• Number of member issues with the plan
• How many people left over one year
• Patient safety while using prescriptions in the plan
• Accuracy of pricing
• Quality of care
• Customer service quality

What is a 5 star Medicare plan?

A 5 star plan is a plan with a 5 star rating! Rating information is released annually in October. You can review the ratings and compare plans here.

If a plan receives a rating below three stars for three consecutive years, it will be flagged by CMS. If the plan continues to rate poorly, it may be removed entirely from the marketplace.

This ensures that you are given the best plan options when you are enrolling. In 2019, most beneficiaries can enroll in a Medicare Advantage or Part D plan with four or more stars.

Are 5 Star Medicare Advantage Plans PPOs or HMOs?

Many Medicare Advantage carriers offer both PPOs (preferred provider organizations) and HMOs (health maintenance organizations). Both options provide top-quality healthcare services, but there are some differences:

• HMO: With a HMO, you will need to select a primary care provider (PCP). Your PCP will need to make a referral in order for you to see a specialist.
• PPO: You will not need to select a PCP with a PPO, nor do you need a referral to see a specialist in most cases.

The key difference that may help many people choose an option is cost. HMOs typically have lower monthly premiums than PPOs.

A licensed agent with Medicare Plan Finder can help you determine which type of plan is best for you. Our agents are highly trained and they can discuss the benefits of the plans in your area so you can make an informed decision.

5 Star Medicare Advantage and Part D Plan Carriers

5 Star Medicare Advantage plan (and Part D plan) carriers include:

• Anthem
• Cigna
• Humana

Please note, ratings change annually, and each specific plan can have a different rating. We can not guarantee placement in a top-rated Medicare plan and this list is subject to change.

When can you enroll in a 5 star plan?

Several enrollment periods allow you to enroll in a Medicare Advantage plan, but did you know there is an enrollment period specific for 5 star plans?

5 Star Medicare Plans Special Enrollment

If you do not currently have top-rated Medicare Advantage plans available in your zip code, and a new plan becomes available, you can switch from your current plan to a 5 star plan even if it is not the Annual Enrollment Period. This means that you have a Special Enrollment Period. This enrollment period lasts from December 8 to November 20 of the following year. During this time you can:

• Switch from Original Medicare to a 5 star plan
• Change from a lower-rated plan to a 5 star plan
• Switch between different 5 star plans

How to Find 5 Star Medicare Advantage Plans Near You

Are you looking for top-rated Medicare plans near you? Our licensed agents can answer any questions about how to enroll, when you can switch, and plans that are available to you.

Interested in arranging an appointment? There is no cost to you and never an obligation to enroll. Fill out this form or call us at 844-431-1832.

What Disabilities Qualify for Medicare Under 65?

Most people are not eligible for Medicare until they turn 65, but that’s not the case for those with a long-term disability or disease. Did you know roughly 9.1 million people under 65 with disabilities are enrolled in Medicare? It’s important to understand the role of Medicare in these qualifying conditions so you can have the best coverage including Medicare Advantage, Medicare Supplements, or Part D plans.

ESRD Medicare Coverage

ESRD Medicare coverage can provide coverage for permanent kidney failure that requires dialysis or a kidney transplant. To be eligible, you must be diagnosed with end-stage renal disease (ESRD) and qualify for SSDI (Social Security Disability Insurance) or Social Security retirement benefits/railroad retirement benefits based on your work history.

Original Medicare covers a kidney transplant, hospital inpatient dialysis, and outpatient dialysis from free-standing facilities and hospitals. However, Medicare does not cover surgeries or services leading up to dialysis. Fortunately,  Chronic Special Needs Plans (CSNPs) can help. CSNPs are a type of Medicare Advantage plan for people with chronic health conditions – like ESRD! This is an excellent option if you are looking for more coverage beyond Original Medicare.

For more information on ESRD Medicare Coverage, click here or fill out this form to get in contact with a licensed agent to learn about enrolling in a Special Needs Plan.

ALS Medicare Coverage

If you have been diagnosed with ALS, also known as Lou Gehrig’s Disease, you will be automatically enrolled in Original Medicare (Part A and B) the first month you receive Social Security Disability Insurance (SSDI) or a railroad disability annuity check.

ALS Medicare coverage includes hospital, hospice, skilled nursing, and home health services through Part A. Preventative services, mental health, lab tests, x-rays, emergency transportation, and medical equipment are covered through Part B.

Once you are enrolled in Original Medicare, you are eligible to enroll in a Medicare Advantage or Part D plan. Medicare Advantage plans offer additional health benefits like hearing, dental, and vision coverage. Part D plans provide prescription drug coverage. Plus, you may be eligible to enroll in a Medicare Supplement plan. These plans work alongside Original Medicare and can cover coinsurance, copayments, and deductibles.

Want to learn more about Medicare Advantage, Part D, and Medicare Supplement plans that are available to you? Click here to get in contact with a licensed agent.

Other Qualifying Disabilities

You are automatically enrolled in Original Medicare (Part A and B) after you have received Social Security disability benefits for 24 months or have certain disability benefits from the RRB for 24 months. If you qualify, you will get your red, white, and blue Medicare card in the mail 3 months before your 25th month of disability.

The following is a list of qualifying impairments with relevant examples.

• Musculoskeletal disorders (back injuries and joint/bone dysfunction)
• Cardiovascular conditions (heart failure and coronary artery disease)
• Senses and speech issues (vision and hearing loss)
• Respiratory illnesses (COPD, cystic fibrosis, or asthma)
• Neurological disorders ( cerebral palsy and epilepsy)
• Immune system disorders (HIV/Aids, lupus, and rheumatoid arthritis)
• Mental disorders (PTSD, Schizophrenia, autism, and anxiety)
• Skin disorders (cellulitis and dermatitis)
• Digestive tract problems (Crohn’s disease, hepatitis, and liver disease)
• Kidney problems (ESRD and genitourinary problems)
• Cancer (Breast cancer, prostate cancer, etc.)
• Hematological disorders (sickle cell disease, hemophilia, and bone marrow failure)

Please note, each condition and qualifying situation is unique, and we can not guarantee qualification or coverage. If your impairment is not on this list, you may still be eligible for disability benefits under other SSA guidelines.

I’m Disabled and Don’t Have Insurance. Can I get Medicare Now?

Sometimes. If you have a qualifying disability, like ALS or ESRD, you may be able to get Medicare now. Alternatively, if you receive SSDI (Social Security Disability Income) for at least 25 months, you can get Medicare.

How to Enroll in Coverage Beyond Original Medicare

Health costs can quickly add up. It’s great that Original Medicare is available with qualifying disabilities to people under 65, but what about coverage beyond Original Medicare? Medicare Advantage, Medicare Supplements, and Part D plans can add additional benefits and help you save on out-of-pocket costs.  However, different states have different laws and some plans may not be at the best possible rate. A licensed agent is your best bet to compare your different options and enroll in the coverage you need at the price you want. Call us today at 844-431-1832 or fill out this form to get in contact with a licensed agent.

Medicare Advantage Supplemental Benefits

Did you know Medicare Advantage plans have tripled in enrollment since 2003? This means more than one-third of beneficiaries are enrolled in an MA plan in 2019! The increase in enrollment has lead to new benefits like telehealth, non-emergency transportation, and gym memberships like SilverSneakers®. Research shows that the top three Medicare Advantage supplemental benefits that cause beneficiaries to switch to an MA plan are vision coverage, OTC allowances, and healthy behavior rewards.

Medicare Vision Coverage

Nearly 90% of people over the age of 65 wear glasses. Plus, one in three older adults suffers from some form of vision-reducting eye disease like glaucoma, macular degeneration, cataracts, or diabetic retinopathy. Fortunately, Medicare Advantage plans may include vision coverage and help you cut back on out-of-pocket costs.

What eye care does Medicare cover?

Generally, Medicare does not cover eye exams or glasses. This means that if you are only enrolled in Original Medicare (Part A and B) you will have to pay 100% of your costs, including the fees to have your frames fitted. However, if you had cataract surgery to insert an intraocular lens, Medicare Part B may pay for corrective lenses. This can include a pair of glasses or contacts, but you must get them through a Medicare supplier.

Medicare will cover the corrective lenses even if you had the cataract surgery before enrolling in Medicare. Plus, both lenses may be covered if you only had cataract surgery on one eye. If your situation applies, you will pay 20% of the Medicare-approved costs after reaching your Part B deductible. If you want upgraded frames, you will be required to cover the additional cost.

Are you looking for more coverage? Medicare Advantage plans can add additional benefits like routine eye checkups, eye exams, glasses, and contacts. To learn more about how to get vision coverage through a Medicare Advantage plan, click here.

Medicare OTC Pharmacy Allowance

The average American makes 26 trips per year to buy over-the-counter (OTC) products. What if we told you that some of the expenses from these trips could be covered? Well, great news! Some Medicare Advantage plans offer a monthly OTC pharmacy allowance.

What is a Medicare Advantage OTC card?

A Medicare Advantage OTC card can be used to purchase most OTC products and medications. The average allowance is $50-$100/month for most providers. Once you exceed this balance, your card is no longer valid until it is reloaded the next month. If you do not spend the monthly balance in its entirety, you may lose any remaining allowance.

Eligible products and medications may vary through your plan provider, but common eligible items include acne aids, cough, cold, and flu medications, antibiotic creams, denture products, bandages, digestive aids, ear care, first-aid kits, orthopedic support, sleep aids, and wart removal. However, chapstick, soaps, deodorant, dietary supplements, mouthwash, perfume, and teeth whitening products are generally not covered.

To learn more about how to get OTC pharmacy allowance through a Medicare Advantage plan, click here.

Healthy Behavior Rewards

Original Medicare does not incentivize healthy behavior, but some Medicare Advantage plans will! Research shows that 93% of people will change their behavior if they are rewarded. This is a win-win for everyone involved.

Healthy behaviors can include utilizing your annual wellness visit, losing weight, and smoking cessation. Incentives can include sweepstakes or direct rewards like gift cards and discount coupons. Some plans may utilize a “point” system that can be claimed at a later date for rewards.

Get Medicare Advantage Supplemental Benefits

Vision coverage, OTC allowances, and healthy behavior rewards are just a few of several Medicare Advantage supplemental benefits. Are you interested in joining the 20.4 million beneficiaries who are enrolled in MA? Our agents can contract with nearly every carrier in your state! This means that you can enroll in the MA plan that best fits your needs and budget. Call us at 844-431-1832 or fill out this form to arrange a no-cost, no-obligation appointment with an agent in your area.

The Shocking Truth: Does Medicare Cover Vision Care?

Nearly one in three older adults over the age of 65 suffer from some form of vision-reducing eye disease. These diseases include glaucoma, macular degeneration, cataracts, and diabetic retinopathy.

As you age, your risk for these diseases increases. However, Original Medicare does not include a comprehensive vision benefit. Understanding Medicare vision coverage allows you to protect your aging eyes and save money in the long run.

Does Medicare cover vision?

Your vision is important, and we want to help you understand what Original Medicare (Part A and B) does and does not cover. If you have any additional questions, you can fill out this form, and a licensed agent will get back to you.

Does Medicare cover eye exams and glasses?

Generally, Medicare does not cover eye exams or glasses. This means that if you are only enrolled in Original Medicare (Part A and B) you will have to pay 100% of your costs, including the fees to have your frames fitted.

However, if you had cataract surgery to insert an intraocular lens, Medicare Part B may pay for corrective lenses. This can include a pair of glasses or contact lens, but you must get them through a Medicare supplier.

Medicare will cover the corrective lenses even if you had the cataract surgery before enrolling in Medicare. Plus, both lenses may be covered if you only had cataract surgery on one eye.

If your situation applies, you will pay 20% of the Medicare-approved costs after reaching your Part B deductible. If you want upgraded frames, you will be required to cover the additional cost.

Does Medicare cover eye care?

Routine eye exams, also known as refraction tests, are not covered by Medicare. However, if you have diabetes, your eye exam may be covered. Glaucoma tests and macular degeneration tests are often covered too.  If you want coverage for eyeglasses, contacts, and exams, you should consider Medicare Advantage plans.

Medicare Advantage and Vision Coverage

Medicare Advantage plans must cover, at a minimum, the same benefits as Original Medicare. Medicare Advantage plans are growing in popularity because they can offer vision, hearing, and dental coverage.

Benefits will vary by plan, but an MA plan can cover routine eye exams, eyeglasses, contacts, and fittings. There are a few different types of MA plans, but if you are looking for vision coverage, a Medicare Advantage PPO is a good option. These are ideal because even though there is a network you should stick to, you have the freedom to see other providers.

You may not get as much coverage as you would by seeing in-network providers, but at least you have the option to visit a multitude of eye doctors. Want to learn more? Fill out this form, and we are happy to answer any of your questions.

Glaucoma Treatment

Glaucoma is the cause of roughly 20% of blindness in the US. Most glaucoma cases occur in people over the age of 65. Glaucoma occurs when there is a build up of pressure in your eye. The pressure damages the major transmitter from your eye to your brain, also called the optic nerve.

There are a few different kinds of glaucoma based on how the pressure is accumulated into your eye. The main type of glaucoma is open-angle glaucoma and accounts for 90% of cases.

To treat glaucoma, your eye doctor may recommend eye drops to help relieve pressure. Another option is medication, usually a pill, that can work alongside eye drops to relieve the pressure.

The eye drops are typically used as short-term relief while the medications aim to work long-term and attack the parts of your eye that are contributing to the disease. The last resort to combatting glaucoma is surgery.

Is glaucoma testing covered by Medicare?

Part B covers a glaucoma screening once per year for those who are considered high-risk. You are considered high risk if one of the following applies:

• You have diabetes
• You have a family history of glaucoma
• You are African American and 50+
• You are Hispanic American and 65+

You will pay 20% of the cost for the screening after you reach your deductible. If you get the test in an outpatient setting in a hospital, you may also have a copayment.

Age-Related Macular Degeneration Treatment

Age-Related Macular Degeneration (AMD) is the leading cause of severe vision loss in adults over 50. Caucasians have a higher risk of developing AMD and it is more common in women than men.

AMD occurs when there are changes to the macula (a small portion of the retina). There are two different types of AMD – “dry” and “wet”.

There is no treatment for “dry” AMD because the tissue in the macula becomes extremely thin and eventually stops working. “Wet” AMD occurs when the blood vessels leak fluids under the macula. If detected early, “wet” AMD can be treated with laser surgery.

Is Macular degeneration covered by Medicare?

Part B covers certain tests and treatments related to macular degeneration. This includes injection-based drug treatments. If you have age-related macular degeneration, you may be covered. If you are eligible, you will pay 20% for outpatient services after you reach your deductible.

Cataract Treatment

All of our eyes have a natural lens. The lens bends light rays that are directed at our eyes to help us see. The lens should be clear. If you have a cataract, the lens is cloudy. This makes your vision look blurry or hazy.

Prescription glasses can be used to correct your vision if the cataract is minor. However, sometimes glasses aren’t enough and cataract surgery is the most effective treatment. The operation involves removing your clouded lens and replacing it with a clear, artificial lens.

What does Medicare pay toward cataract surgery?

Medicare will only cover your cataract surgery if a doctor says it’s medically necessary. Medicare will also cover the related doctor visits after surgery. Unless you have a Medicare Supplement plan, you will be responsible for certain costs including deductibles, copayments, and coinsurance. To learn more about Medicare Supplement plans, send us a message!

Diabetic Retinopathy Treatment

Diabetic retinopathy occurs when the tissues in your retina are affected by blood vessels from high blood sugar. It is the most common eye disease among people with diabetes.

The vision loss from diabetic retinopathy is often irreversible, but early detection can reduce your risk by 95%. Treatment can include blood glucose management through a healthy diet, surgery, and medications like blood vessel growth inhibitors and steroids.

Does Medicare cover diabetic retinopathy?

As we mentioned, Medicare does not cover routine eye exams. However, Part B will cover an annual vision exam to check for diabetic retinopathy if you are enrolled in Part B, have diabetes, and the test is approved by an approved Medicare provider.

Other Vision Coverage Options

If you don’t want Medicare Advantage, you can purchase separate vision plans for seniors and Medicare eligibles. Vision policy premiums vary but are based on your age, health, and family history (disease risk). Most vision plans start at around $15 per month, but yours may be different. You may be able to save money by purchasing a vision plan that is combined with another benefit, like dental.

Private vision plans for seniors and Medicare eligibles and Medicare Advantage vision coverage both usually include annual exams, discounts for surgeries and services, and a specific allowance for glasses and contact lenses. Allowances will vary based on the plan you choose.

Losing Eyesight? Get Coverage!

If you are losing eyesight, now is the time to get vision coverage. Even if you have the healthiest eyes, Medicare Advantage plans can help you become the healthiest version of you.

Beyond vision coverage, they can also include dental and hearing coverage. Plus, some may offer fitness classes like SilverSneakers®! Our licensed agents can help you find the perfect plan that fits your needs and budget. Call us at 844-431-1832 or click here to get in touch with an agent!

Medicare for Diabetics and Diabetes Management

Diabetes is one of the largest health issues facing America and affects over 12 million older adults. In fact, the World Health Organization estimates that diabetes will be the seventh leading cause of death by 2030. The risk of developing diabetes increases with age, so it’s important to understand the role of Medicare and diabetes management.

Medicare for Diabetics and Medications

If you are diabetic, or even pre-diabetic, your doctor may prescribe you medications like:

• Metformin
• Glucophage
• Glumetza
• Sulfonylureas
• Meglitinides
• Thiazolidinediones

Original Medicare (Part A and B) does not cover prescription drugs. If you are diabetic, you could end up having a high out-of-pocket cost for your medications. A Part D plan is a great alternative to help you save money and get the coverage for medications you need.

You can enroll in a Part D plan on top of your Original Medicare or purchase a Medicare Advantage plan. Medicare Advantage plans can offer benefits like prescription drug coverage, hearing, vision, or dental coverage and even things like meal delivery and transportation to doctor appointments or the pharmacy.

Does Medicare cover insulin?

Insulin can be divided into Original Medicare will only cover insulin that is needed for an external insulin pump and may be covered as Durable Medical Equipment.

Without insurance, the most popular form of insulin (Lantus) can cost over $500. According to GoodRx, the average copay for Lantus is $37.50-$67.70 with insurance.

Original Medicare does not cover other forms of insulin including pens, syringes, or needles. If you need other forms of insulin, a Part D plan or a Medicare Advantage plan with a prescription drug benefit can help!

What does Medicare cover for diabetics?

Medicare Part B covers diabetes self-management training (DSMT) for those who were recently diagnosed. Part B will also cover:

• Blood sugar monitors
• Blood test strips
• Lancet devices
• Lancets
• Orthotic shoes or inserts
• External insulin pumps

However, there may be limits on how much or how often you can get these supplies.

Medicare Part D covers diabetes supplies including:

• Syringes
• Needles
• Alcohol swabs
• Gauze
• Inhaled insulin devices

Diabetic Supplies Delivered Directly to Your Door

You can get your diabetic supplies delivered directly to your door. However, you have to use an approved Medicare mail-order supplier if you want to utilize your Medicare coverage. If you prefer to purchase your supplies in a store, Medicare will cover the costs if you buy them at a Medicare-enrolled store or pharmacy.

Types of Diabetes and Symptoms

If you are diagnosed with diabetes, it means that your body struggles to process the sugars in the foods you eat. As a result, your blood sugar levels rise. This means your body cannot produce enough insulin (or produce it in the right way) depending on which type of diabetes you have.

Type 1

Type 1 occurs when your pancreas cannot produce insulin (a hormone produced in the pancreas which regulates the glucose in your blood). It is typically developed at a young age and accounts for less than 10% of cases. If you have type 1, you will need to balance your blood sugar with insulin doses through a shot, pen, or pump. You will also need to pay close attention to the foods you eat and your daily activity level

Warning signs and symptoms of type 1 diabetes include:

• Going to the bathroom more frequently
• Being thirstier
• Having mood changes
• Struggling to see or other vision problems
• Feeling fatigued
• Losing weight without a change in diet or exercise

Type 2

Type 2 is the most common type of diabetes and accounts for 90% of diabetic patients. On the bright side, it is the most preventable and treatable form of diabetes. Unlike type 1, people with type 2 can produce insulin, just usually not enough. This means insulin shots, pens, or pumps may not be needed. Instead, you can monitor your blood sugar and manage insulin levels through medication.

The warning signs and symptoms of type 2 are very similar to type 1, they just take longer to develop. These symptoms include frequent urinating, thirst, mood changes, vision issues, fatigue, and unexplained weight loss. Some symptoms can take several years to surface which means regular check-ups and monitoring your blood sugar levels is crucial, especially if you are diagnosed with prediabetes.

Another sign of type 2 is prediabetes. If you are prediabetic, you probably have high blood sugar, and your body will start to reject insulin slowly. However, your blood sugar levels are not high enough to be considered type 2 diabetic just yet. Eating better, exercising, and losing weight can help prevent the development of type 2 diabetes in the future.

Effects of Diabetes

All types of diabetes should be taken seriously as they can have severe complications and effects on your body. Without proper treatment and management, diabetes can lead to the following health issues:

Heart Disease

Diabetes can raise your blood pressure and cholesterol. Nearly 75% of people with diabetes suffer from some sort of heart-related condition. This can include heart attacks, stroke, coronary heart disease, and many more.

Kidney Damage

Your kidneys are full of small blood vessels. Diabetes can damage these vessels, which impacts your kidney’s overall function. According to the National Kidney Foundation, 30% of type 1 diabetes patients will experience kidney failure.

Hypoglycemia

Hypoglycemia is when your blood sugar levels reach a dangerously low level. These low levels can result in falls, seizures, or even cause you to enter a coma.

Nerve Damage

High blood sugars can make it difficult for your blood vessels to take blood to certain parts of your body. If blood does not get to certain nerve endings, they can be partially or permanently damaged.

Eye Damage

Blurry vision is a warning sign of diabetes. This is because the blood vessels attached to your retinas are getting damaged. If diabetes is left untreated, this condition could worsen.

How to Test for Diabetes

If you have a body mass index over 25, are older than 45, or have been diagnosed with prediabetes, you should be tested for diabetes annually. The most common tests are as follows:

Glycated Hemoglobin (A1C) Test

This blood test shows your average sugar levels for the past 2-3 months. It measures the percentage of sugars attached to hemoglobin (an oxygen-carrying protein in red blood cells). The higher level of blood sugars equates to the higher number of hemoglobin with attached sugars. Two A1C tests of levels greater than 6.5% indicate diabetes. One A1C test between 5.7% and 6.4% indicates prediabetes. Anything under 5.7% is normal.

Random Blood Sugar Test

A random blood sugar test is exactly that – random. There is no fasting and it does not matter when (or what) you last ate. A blood sugar level of 200 mg/dL or higher indicates diabetes.

Fasting Blood Sugar Test

This test requires you to fast overnight. The next morning you take a blood sugar test. Sugar levels less than 100 mg/dL is normal. Anything between 100 and 150 mg/dL indicates prediabetes. If you take two separate tests at different times, and the results are over 126 mg/dL, you may have diabetes.

Oral Glucose Tolerance Test

This test requires you to fast overnight and check your blood sugar levels the next morning. Directly after, you will drink a sugary liquid. Over the next two hours, you will check your levels again. A level of less than 140 mg/dL is normal. After two hours, a level between 140 and 199 mg/dL indicates prediabetes, and anything over 200 mg/dL indicates diabetes.

How to Prevent Diabetes

You can’t change your genes, age, or past behavior, but you can take control of other factors, including:

Exercise: Did you know losing 10 kg (about 22 pounds) over a ten year period can lower your risk of diabetes by 33%? You should aim to get 30 minutes of exercise at least five days a week. If you haven’t been active, start slowly and work towards an overall goal.

Diet: A diet that is high in nutrients and low in glycemic loads are great for preventing diabetes. Green vegetables, beans, nuts, seeds, and fruit can help maintain your blood sugar. However, foods with added sugars, refined grains, and trans fats can have the opposite effect. Avoid fried foods and red meats when possible. Try a healthy soup!

Stress Less/Sleep More: When you are sleep deprived or have unusual sleep patterns, you increase your risk of obesity. As we previously mentioned, obesity plays a large factor in developing diabetes. Stress can impact your sleep schedule and make you toss and turn in the night. Plus, stress releases several hormones that increase your blood sugar. Pay attention to your sleep patterns and stress levels and visit a doctor if you have continued issues.

Diabetes and Medicare Coverage

Diabetes costs America more than $327 billion every single year. If you are diagnosed with diabetes, you may have high out-of-pocket costs. As we mentioned, Part D and Medicare Advantage plans can help save you money and provide the benefits and coverage you need. If you have any questions, or interested in enrolling in a Part D or MA plan, fill out this form or call us at 844-431-1832.

Pneumonia in the Elderly: Causes, Treatment, and Prevention

According to the Centers for Disease Control and Prevention, more than three million Americans develop pneumonia each year. As you age, your risk of developing this infection increases.

Pneumonia can cause serious complications in older adults and can even be fatal. Take this time to educate yourself on the causes, symptoms, treatment, and prevention of pneumonia in the elderly.

What Is Pneumonia?

Pneumonia is an infection that results in the inflammation of air sacs in one or both of your lungs. The tiny sacs fill with fluid and disrupt the process your lungs use to create oxygen. As a result, you may have difficulty breathing. If left untreated, vital organs may not receive enough oxygen, bacteria can enter your bloodstream, and fluid can surround your lungs.

There are two main types of pneumonia – bacterial and viral.  Bacterial pneumonia occurs when your immune system is weak from illness, poor nutrition, or age, and bacteria infiltrates your lungs.

If you smoke, abuse alcohol, have a respiratory disease, or have recently had surgery, you have a higher risk because your immune system is weakened. Viral pneumonia is caused by a virus, most commonly the influenza (flu) virus, and is responsible for roughly one-third of all pneumonia cases. Both types can range from mild to life-threatening.

What Causes Pneumonia in Elderly Patients?

According to the American Lung Association, there are more than 30 different bacterias, viruses, and fungi that lead to pneumonia. When pneumonia starts to spread through your lungs, your white blood cells will attack the germs. The area will become inflamed.

What Are the Symptoms of Pneumonia in Elderly Patients?

Bacterial and viral pneumonia have different symptoms, and can often be confused with bronchitis or the flu. Bacterial pneumonia can make your temperature rise as high as 105 degrees and cause excessive sweating, a high heart rate, and heavy breathing. Your lips and nails may develop a blue tint from the lack of oxygen. Other bacterial symptoms include:

• Green, yellow, or bloody mucus
• Fever
• Loss of appetite
• Low energy
• Chills
• Chest pain when breathing or coughing
• Shortness of breath

On the other hand, the initial symptoms of viral pneumonia have the same symptoms of the flu. Within 36 hours, you may see a small amount of mucus and you may also see a blue tint on your lips. Other viral symptoms include:

• Headaches
• Muscle pain
• Weakness
• Worsening cough
• Shortness of breath

Pneumonia in Elderly Recovery Time

The average healthy person can recover from pneumonia in one to three weeks, but depending on your immune system, recovery can last weeks or even months.

Coughing is the primary way to get the infection out of your body, and it takes a lot of your energy. Once you clear the infection, it can still take several more weeks to regain your strength.

Pneumonia in Elderly Survival Rate

Pneumonia can form very quickly and can rapidly spread to other parts of your body.  The disease puts your immune system into overdrive and your body cannot create enough oxygen for your vital organs. Pneumonia can also worsen the symptoms of your other ailments, like heart disease.

Pneumonia in Elderly With Dementia

Dementia usually refers to a decline in mental ability that seriously impacts a person’s everyday life. Short-term memory loss and confusion and are most common when dementia results from an injury or an infection such as pneumonia.

According to the Alzheimer’s Association, the symptoms of dementia can be different in every person. However, a person may have dementia if two or more of the following functions are impaired significantly:

• Memory
• Ability to communicate
• Ability to focus and pay attention
• Reasoning and judgment
• Visual perception

Pneumonia in Elderly With COPD

People with chronic lung disease may be more susceptible to pneumonia. The combination of COPD (chronic obstructive pulmonary disease) and pneumonia is particularly dangerous because it presents an increased risk of respiratory failure, which means that your body can’t get enough oxygen or can’t successfully remove carbon dioxide.

If you have COPD and think you might have symptoms of pneumonia, be sure to call your doctor right away.

Pneumonia Treatment

A doctor can determine if you have pneumonia through physical exams, chest x-rays, blood tests, CT scans, and other tests. Depending on the severity and type of infection there are several treatment options. Most cases can be treated at home with a combination of antibiotics, hydration, fever control, and rest.

However, some cases may require hospitalization. If hospitalized, you will likely receive fluids and antibiotics through an IV as well as breathing treatments and oxygen therapy.

Your risk of being admitted increases if you have another serious medical problem, more severe symptoms, or if you have been taking antibiotics at home and are not recovering.

Can Pneumonia Heal on Its Own?

Pneumonia cannot heal on its own. It’s important to start treating your symptoms as soon as possible. You can treat your symptoms at home, but visiting a doctor and getting antibiotics is highly recommended, especially for older adults and children.

Pneumonia Prevention

Pneumonia in the elderly along with pneumonia in other adults and children can oftentimes be prevented by practicing healthy habits including:

• Washing your hands regularly — especially after blowing your nose, using the restroom, or eating.
• Avoiding smoking
• Eating a healthy diet
• Exercising regularly

Since the flu is a common cause of pneumonia, get your flu shot! Did you know Medicare pays for your annual flu shot? Read more about preventing the flu here.

Pneumonia Vaccine

Another form of pneumonia prevention is the pneumococcal vaccine. This can help protect you from bacterial pneumonia and is recommended for anyone over the age of 65.

There are two vaccine types, PCV13, and PPSV23. You and your doctor can work together to help determine which type is best for you. However, please note, the vaccination is not guaranteed to prevent the infection entirely, but it can drastically lower your risk. Your Medicare plan can cover the cost.

Pneumonia and Your Medicare Plan

Practicing a healthy lifestyle is one of the best ways to keep your immune system strong. Medicare Advantage plans can make sure you’re living the healthiest life possible. These plans may offer additional benefits beyond Original Medicare like routine physical exams and a monthly allowance for over the counter products and medications!

We have licensed agents across 38 states who are contracted with all the major carriers! This means they can answer your questions and enroll you in a plan with an honest and unbiased approach. If you have any questions or are interested in arranging a no-cost, no-obligation appointment, call us at 844-431-1832 or fill out this form.

How to Sign Up for Medicare

An estimated 70 billion baby boomers are nearing retirement, and over 10,000 boomers are turning 65 every single day. If you’re new to Medicare, we can help you understand how to sign up for Medicare and answer your questions about coverage, benefits, qualifications, fraud, and privacy.

How to Sign Up for Medicare

If you currently receive Social Security benefits, you’ll be automatically enrolled in Medicare Part A when you turn 65. You will need to opt into B, and it will be automatically deducted from your monthly Social Security check. However, if you do not receive Social Security benefits, you will need to enroll yourself. You can enroll in Original Medicare (Parts A and B) online, by phone, or by visiting your local Social Security office.

Do you have to sign up for Medicare when you are 65?

The standard age for Medicare eligibility is 65. However, this does not mean you are required to enroll on your 65th birthday.

If you wish to enroll in Medicare when you become eligible, you can enroll anytime during your initial enrollment period. This period begins three months before your 65th birthday and ends three months after. If you choose to postpone enrollment, you may be subject to a late-enrollment penalty. This can result in a 10% Part B premium increase for every year you were eligible but did not enroll. Plus, you will have an additional penalty of 1% the national based Medicare Part D monthly premium for each month you did not enroll in prescription drug coverage.

Medicare Coverage and Benefits

Original Medicare consists of Parts A and B. Part A covers inpatient hospital fees, hospice care, and home health services. Part B covers doctor services, outpatient care, and physical therapy. Most beneficiaries receive Part A for free, but pay a monthly Part B Medicare premium. Beyond Original Medicare, there are Parts C and D, Medicare Advantage and prescription drug plans.

What is Medicare Advantage (Part C)?

Medicare Advantage plans, sometimes referred to as “Part C,” are available through private insurance companies. They cover the same benefits as Original Medicare, but most offer extra benefits like vision, hearing, dental, and even fitness programs like Silver Sneakers.

Medicare Advantage plans have one monthly premium, and you only pay for the services you use rather than paying a higher cost upfront.  You may want to enroll in Medicare Advantage instead of Original Medicare alone. If MA is not right for you, consider Medigap.

What is Medigap?

If you are enrolled in Original Medicare, you are eligible to purchase a Medigap plan, otherwise known as Medicare Supplements. These plans help pay some of the costs that Original Medicare does not cover – your copayments, coinsurance, and deductibles. Most Medigap plans do not cover additional benefits like vision, hearing, dental, and prescription drugs. They are sold by private insurance companies. You can search Medicare Supplement Plans here.

What is Medicare Part D?

You may have noticed by now that Original Medicare (Parts A and B) does not include prescription drug coverage. Even though it isn’t included in your initial plan, you will encounter penalty fees if you do not purchase a prescription drug plan during your initial enrollment period.

Part D plans will have a formulary or list of qualifying prescription drugs. The list is usually divided into tiers according to cost. Keep in mind that your out-of-pocket drug costs will vary according to the plan you choose. Costs will also depend on your premium, deductible, copayments, and coinsurance.

How do I compare Part D plans?

The best way to compare Part D plans is to contact a licensed agent in your area. We happen to have thousands of agents across 38 states! Plus, our Medicare Part D Plan Finder Checklist can help make sure your needs and wants regarding Part D coverage are clear. The checklist has six short sections and shouldn’t take long to complete.

Does Medicare offer free preventive services?

Once you’ve had Medicare Part B for at least 12 months, you are eligible for a zero-cost yearly Medicare wellness exam. The purpose of this wellness visit is to work with your doctor to identify any concerns and to develop a plan for staying healthy. In addition to the annual wellness exam, there are a number of additional services, screenings, and vaccinations covered at no cost including:

• Annual flu shot
• Alcohol screening
• Bone mass measurements
• Cardio screening
• Colorectal screening
• Diabetes screening
• Hepatitis screening
• HIV screening
• Lung, prostate, and cervical cancer screenings

Medicare Eligibility

Turning 65 is certainly the most common way to qualify for Medicare, but there are a handful of other ways to qualify. You may also qualify for Medicare if you are under 65, have received Social Security Disability Insurance (SSDI) for more than 24 months or if you are diagnosed with either Lou Gehrig’s disease or ESRD.

What are the different Medicare enrollment periods?

Initial Enrollment Period

Every Medicare beneficiary will have an IEP, or Initial Enrollment Period, during which they are eligible to enroll in Medicare. Your IEP will begin three months before you turn 65 and will end three months after, giving you a total of a seven-month enrollment period. For example, if your birthday is April 1, your IEP will last from January 1 through August 1.

General Enrollment Period

The General Enrollment Period runs from January 1 to March 31 every year. This is when, if you missed your IEP, you can enroll in Medicare for the first time. Your coverage will begin in July. If you decide that you would like to enroll in a Medicare Advantage or prescription drug plan, you can do so from April 1 through June 30. The reason for that time gap is that you cannot enroll in Medicare Advantage or Part D until you have Original Medicare.

Annual Enrollment Period

AEP occurs from October 15 through December 7 of each year. This is when you have the ability to review and change your existing Medicare Advantage Plan or Medicare Part D Plan.

Special Enrollment Period

You can either have a SEP for a set period of time, or you can have a lifelong SEP. A SEP allows you to enroll in a new Medicare plan or make changes to your current coverage outside of the normal enrollment periods. If you qualify for a SEP, you should take advantage of your ability to get yourself into a better plan. To see if you qualify for SEP, click here.

Open Enrollment Period

Medicare Open Enrollment 2019 will run from January 1 through March 31. During this time, you can switch between:

• One Medicare Advantage plan to another Medicare Advantage plan
• A Medicare Advantage plan with prescription drug coverage to Original Medicare with Part D prescription drug coverage
• Medicare Advantage to Original Medicare only, with the option to add a prescription drug plan

Do I qualify for Medicare’s Extra Help Program?

The LIS, or Low-Income Subsidy program, is a federal prescription drug plan discount program often called “Medicare Extra Help.” LIS helps Medicare beneficiaries who do not qualify for Medicaid but still need help paying for prescription drugs. Plus, those with LIS have a special enrollment period and can change plans at any time!

To have LIS, you must have a Part D or Medicare Advantage plan. LIS can help cover late enrollment penalty fees if you enroll in Part D or Medicare Advantage too late. It also helps with coverage issues if you enter the Medicare donut hole.

LIS qualifications are based on income and assets. The limits change every year, but a licensed agent can help you with eligibility information. Thousands of seniors & Medicare eligibles out there don’t even know that they are eligible! We can help. Click here to get in contact with an agent.

Medicare Fraud and Privacy

It’s important to keep your personal information protected. Your Medicare number is just as valuable as your bank account and social security number. It’s important to understand the appropriate steps to replace a lost Medicare card and to watch out for common Medicare scams.

How do I replace a lost Medicare card?

If you need to replace a lost Medicare card, visit Social Security’s website, call Social Security at 1-800-772-1213, or visit your local Social Security office. Please note, it can take up to 30 days for your card to be mailed to you. If you have moved or have a different address, you need to report this information to Social Security before they can send you a new card.

What are common Medicare scams?

Ransom
Some people will call and act like they are a relative of yours. They will claim to be injured or in trouble. Try to call that relative first rather than believing the random caller.

Fake Telemarketing 
Real telemarketers will not ask for your Medicare number. Plus, they cannot call without your permission.

Fake charities
Some telemarketers may lie and say they are from a charity and ask for money. Never give out your financial information over the phone.

“Can you hear me?”
If you answer the phone and someone asks if you can hear them, hang up immediately. This is a common scam where your response is used to make it sound as though you were agreeing to something.

Who can help answer other Medicare questions?

If you have any other questions or concerns about Medicare and related coverage options, please do not hesitate to contact us. Our licensed agents are contracted with the major carriers in your state and can answer these questions with an unbiased and honest approach. To get in contact, fill out this form, or call us at 844-431-1832.