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Does Medicare Cover the Cost of Hip Replacement Surgery?

An estimated 2.5 million Americans have undergone total hip replacements. Conditions such as osteoarthritis and rheumatoid arthritis can cause the hip joint to wear down so much that a hip replacement may be the only course of action to improve your mobility.

The total cost of hip replacement surgery can be staggering if you don’t have help from insurance. How much does a hip replacement cost with insurance?

A total hip replacement costs anywhere from $32,000 to $45,000, based on general coverage guidance from The total cost usually includes everything from the surgeon’s initial evaluation to post-operation hospital care.

Increases in year-to-year costs are small under stable economic conditions. There was only a small increase in hip replacement 2019 costs compared to medicare hip replacement 2018 costs.

If you’re one of the millions of Americans who needs a hip replacement, you may wonder, “Does Medicare cover hip replacements?” Yes, but you have to meet certain eligibility requirements, and you may still have some out-of-pocket costs even with Original Medicare.

You may also be asking, “How much does Medicare pay for hip replacement surgery?” The good news is that it will cover at least some of all types of costs.

Find Medicare Plans | Medicare Plan Finder
Find Medicare Plans | Medicare Plan Finder

How Much Does Medicare Pay for Hip Replacement Surgery?

Cost of Hip Replacement Surgery | Medicare Plan Finder
Cost of Hip Replacement Surgery with Medicare | Medicare Plan Finder

The likelihood of needing hip replacement surgery increases with age. Seniors 65 and older, people with ALS or ESRD, or people who have received SSDI for at least 25 months qualify for Medicare.

Original Medicare (Parts A and B) will help cover the cost of hip replacement surgery if your doctor determines it’s medically necessary because other treatments have failed. The answer to how much Medicare pays for hip replacement surgery will depend on whether it is medically necessary and what types of coverage you have.

Medicare Hip Replacement Costs With Medicare Part A

Medicare Part A is hospital insurance. This Medicare coverage helps pay for a semi-private room, meals and nursing care during your stay.

Part A will only cover a private room if your doctor says it’s medically necessary or it’s the only room available.

Medicare hip replacement reimbursement includes skilled nursing care after your surgery. Part A helps cover the first 100 days of in-patient care including physical therapy.

The Medicare Part A deductible can apply, and you may be responsible for copays or coinsurance.

Part B Coverage for Hip Replacement Surgery

Medicare Part B will help cover medical expenses such as doctor’s fees for the initial evaluation and post-op visits, surgery in an outpatient surgical facility, and outpatient physical therapy.

You may be responsible for paying the Part B deductible, which was $185 in 2019, and 20% of the Medicare-approved costs. Medicare Part B may also cover your post-operative durable medical equipment (DME) such as a cane or in-home grab bars.

Medicare Durable Medical Equipment
Medicare Durable Medical Equipment

Medicare Part D Coverage

Original Medicare does not cover post-op prescription drugs, but Medicare Part D includes prescription drug coverage. Your doctor may prescribe blood thinners to prevent clotting or painkillers to take during your recovery.

You can use Medicare Part D or private health insurance plans to cover prescription drugs.

Rx Discount Card | Medicare Plan Finder
Rx Discount Card | Medicare Plan Finder

Will Medicare Help Pay for a Knee Replacement?

Medicare Part A and Medicare Part B each cover a different aspect of joint replacement surgery. Medicare Part C will cover knee replacement, including both knees at once, only if your doctor considers it necessary.

Medicare Part D prescription drug program will cover the cost of painkillers, antibiotics, and anticoagulants required for the surgery.

What Medicare Advantage and Medicare Supplements Cover

Private insurance plans offer Medicare Advantage (MA) plans, and they are a great way to get all of the Part A and Part B benefits along with some unexpected offerings such as meal delivery, non-emergency transportation, vision and dental insurance.

Certain MA plans even cover prescription drugs! You will pay a monthly premium with MA plans, but some are as low as $0. Coverage varies depending on your location and the plans available, so look for a qualified professional to help you sort through the plans in your area and find the right one.

Medicare Supplement (Medigap) plans pick up where Original Medicare leaves off. Like MA plans, private insurance companies offer Medigap plans.

The difference is that Medigap Plans only cover your financial responsibilities such as coinsurance and deductibles. You cannot have both a Medicare Supplement and a Medicare Advantage plan at the same time, so it’s important to find out which one is best for you.

Medicare Supplement Insurance plans work with Medicare Part A and Medicare Part B to cover out-of-pocket costs for Medicare hip replacements.

Post-Hip Replacement Surgery Costs

Does medicare cover rehab after hip replacement? Yes. Sometimes, after hip replacement surgery, you may need some help.

For example, throughout your recovery, you might need orthotic devices or other equipment to help you get around. Medicare may cover those devices if your doctor says that they are medically necessary.

Some Medicare Advantage plans may provide extra coverage, and Medicare Supplement plans may cover your copayments for devices.

You also might be interested in Medicare Advantage plans that have an OTC or over-the-counter benefit. This can help offset some of your costs related to pain medication and other items you need to pick up from your pharmacy for your recovery.

Additionally, some people may need physical therapy to recover from surgery or other hip injuries. Medicare Part B may cover your physical therapy by as much as 80%, as long as it is deemed medically necessary.

Why You Might Need a Hip Replacement

Several conditions can cause the hip to deteriorate to the point of needing surgery including:

Hip replacement surgery can restore the hip joint and full range of motion. The type of replacement you receive depends on the doctor’s recommendation and your general health.

The surgery may use a cemented or uncemented prosthesis to connect the replacement parts to the healthy bone after the unhealthy cartilage is removed. The entire recovery process can take three to six months.

Understanding the Hip Replacement Procedure (Orthopedic Hip Arthroplasty)

Hip arthroplasty, also known as total hip replacement, is a common orthopedic procedure. During the surgery, your damaged bones and some soft tissue are removed.

The hip joint is replaced with an implant, which can be ceramic, plastic, or metal.

In a traditional replacement, a 10-12 inch incision is made on the side of the hip. In less-invasive procedures, the incision may only be three to six inches.

Some people may not be eligible for a minimally invasive procedure. Be sure to ask your doctor if you aren’t sure what your procedure will be like.

Man Discussing the Cost of Hip Replacement Surgery With His Doctor | Medicare Plan Finder
Man Discussing the Cost of Hip Replacement Surgery With Medicare With His Doctor | Medicare Plan Finder

Medicare Hip Replacement Scenario

To better understand how everything works together, let’s take the real-world example of a 75-year-old man who has osteoarthritis.

He’s been working with his doctor to manage his symptoms, and things have been going well. One day, the man takes a nasty fall and breaks his hip. This man’s Medicare hip replacement process involves several steps:

  1. He doesn’t go to the hospital right away because the bruising around his hip looks like one of his routine injuries. The man makes another doctor’s appointment, and his doctor takes X-rays and determines the man will need a hip replacement.
  2. His doctor will determine if the man is healthy enough for surgery, and then the doctor refers the man to an orthopedic surgeon. Until this point, everything falls under Medicare Part B.
  3. The man decides to have his surgery in an outpatient facility. He’s responsible for his deductible if he hasn’t met it, or the out-of-pocket maximum for his plan.
  4. The surgery is successful, so he has physical therapy appointments so he can recover as quickly as possible. The man has a Medicare Advantage Prescription Drug plan, so he collects his blood thinners and painkillers for only a small copayment at the pharmacy.
  5. Along with prescription drugs, the man’s surgeon prescribes a cane and grab bars to help the man perform daily tasks. The man’s MA plan also covers those items, because his doctor determined they are medically necessary.

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A comprehensive Medicare plan can help cover the cost of hip replacement surgery. If you need help finding coverage, we can help! Call us at 833-438-3676 or contact us here today.

Contact Us | Medicare Plan Finder
Contact Us | Medicare Plan Finder

This post was originally published on May 15, 2019, and updated on March 24, 2020.

Does Medicare Cover Alcohol Rehab and Substance Abuse? (Updated for 2020)

Substance abuse costs the US more than $740 billion every year. Those costs are related to crime, healthcare, and lost productivity at work.

Overcoming addiction is a lot of work, and it takes a team of mental health and medical professionals to keep you on the right path. You might know that Medicare will pay for doctor visits for illness and injuries, but what you want to know is, “Does Medicare cover alcohol rehab?”

Medicare does cover many of the costs related to alcohol rehab and treatment if your provider says those services are medically necessary. You must get treatment at a Medicare-approved facility or from a Medicare-approved provider, and that provider must create a care plan.

Addiction Treatment for Seniors and Medicare Eligibles

Outpatient Addiction Counseling | Medicare Plan Finder
Outpatient Addiction Counseling | Medicare Plan Finder

Treatment for addiction is a lot like treatment for any other disease. It starts small, often with preventive measures, and will progress according to the doctor’s recommendations.

Medicare pays for alcohol and substance abuse treatment for both inpatients and outpatients. Substance use disorders are drug addictions that influence a person’s thoughts, feelings, and behaviors.

These disorders aren’t just limited to illicit drugs, such as Cocaine, Ecstasy, GHB, Hallucinogens, and Heroin, among others. They can also include misuse of legal drugs like nicotine, marijuana, or alcohol as well as legal medications like fentanyl (Duragesic), hydrocodone (Vicodin), or oxycodone (OxyContin).

The American Society of Addiction Medicine (ASAM) divides treatment into five levels of care. Here’s how they relate to Medicare:

Level 0.5, Early Intervention
Education and prevention for people who are at risk of developing an addiction fall under this level. Medicare can cover a conversation with your doctor about a prescription drug that may be habit-forming.

Level 1, Outpatient Treatment
This level of addiction treatment refers to nine hours or less of weekly counseling services or recovery. Outpatient mental health services fall under Medicare Part B and certain Medicare Advantage (MA or Part C) plans.

Level 2, Intensive Outpatient and Partial Hospitalization

These treatment programs are categorized as having more than nine hours of counseling services a week, and/or short inpatient hospital care. Medicare Part A pays for hospital stays of up to 60 days. After 60 days, you will owe coinsurance.

According to the American Addiction Centers, “Part B covers partial hospitalization (PHP), which is an outpatient treatment” that a hospital or mental health center provides. A PHP provides more intensive treatment than standard outpatient programs.

A doctor must say that PHP is medically necessary, and your treatment plan must include at least 20 hours of treatment per week.

PHP services can include:

  • Individual and group therapy
  • Occupational therapy
  • Family therapy
  • Patient education
  • Activity therapies that are not chiefly recreational
  • Therapeutic drugs that can’t be self-administered
  • Medically necessary diagnostic services for mental health

Level 3, Inpatient Treatment

The next level involves up to 90 days in a rehab facility with a focus on behavioral therapy and staying away from substances. Medicare Part A covers the first 60 days of psychiatric hospital stays.

Days 61-90 will cost most people $335/day.

According to the American Addiction Centers, you can receive up to 190 days of treatment at a specialty psychiatric hospital, but no more. That is a lifetime limit. You may be able to receive treatment under Medicare Part A at:

  • Acute care hospitals
  • Critical access hospitals
  • Inpatient rehab centers
  • Long-term care hospitals
  • Inpatient care as part of a qualifying research study
  • Mental health care

Level 4, Medically-Managed Intensive Inpatient Services

People whose long-term addictions have caused them physical harm need this level of care. It not only involves drug and alcohol counseling but also access to nursing care, prescription drugs, and other medical services

Medicare Part A covers limited home health care, and Medicare Part D and certain Medicare Advantage (Part C) plans cover prescription drugs.

Medicare Coverage and Overdoses

In the event that you or someone you love suffers an overdose, Medicare covers some treatments. For example, most Medicare Part D plans cover Narcan, the drug used to reverse the effects of an opioid overdose.

Typical co-pays for most people with Part D and certain Part C plans for Narcan range from $19-$144.

Medicare Part A is hospital insurance, and it will cover your hospital stay, but not all services fall under Part A. Ambulance transportation is under Part B, and so is doctor observation until you are “officially admitted” into the hospital.

The Centers for Medicare & Medicaid Services (CMS) cover mental health treatment. Medicaid is a federal and state program to help you with your medical costs if you have limited income.

Mental health treatment services are based on screening, brief intervention, and referral to treatment (SBIRT). This is an evidence-based approach used in public health for early interventions and treatment services.

It’s designed to help someone at risk for a substance abuse disorder or who already has a substance abuse disorder.

For instance, after this comprehensive evaluation protocol, someone addicted to heroin might be administered methadone to reduce the intensity of withdrawal symptoms. If this patient does not benefit from outpatient treatment, then inpatient psychiatric care is another option. Such residential treatments provide a space for treatment, sleeping, bathing, recreation, and dining.

Addiction is a disease, and with the right treatment plan, it can be managed. A qualified professional can guide you through the thousands of Medicare plans out there and help you find one that will suit your needs.

Does Medicare Cover Opioid Treatment?

In 2020, the Medicare program includes paying for Opioid Treatment Programs (OTP). The Medicare-enrolled opioid treatment program is comprehensive, consisting of periodic assessments, intake procedures, toxicology testing, individual therapy, group therapy, and counseling for substance use.

It also includes FDA approved opioid treatments and medication-assisted treatment (MAT) medications as well as the dispensation and management of MAT medications. A search for “opioid treatment programs near me” will show you a map of addiction treatment centers in your neighborhood.

SAMHSA Helpline to Find Treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline is a free, confidential service you can use 24 hours a day, seven days a week to find treatment for substance abuse disorders. You reach the helpline at 1-800-662-HELP (4357) or use SAMHSA’s online treatment finder tools.

What Is the SAMHSA Helpline?

The SAMHSA National Helpline offers assistance in finding local treatment facilities, support groups, and community-based organizations. You can also request free publications and other information.

Will My Medicare Plan Cover This Service?

The referral service is free. When you call, ask the representative to refer you to a facility that accepts Medicare. If you have a Medicare Advantage plan, ask your health insurance carrier for a list of participating healthcare providers.

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Providers

Medicare’s Physician Compare website is a great resource for finding addiction treatment in your area. Click here to get started.

You’ll reach a page that allows you to enter your zip code and what type of medical practice you want to find. We chose 37209, which is the zip code for our corporate offices in Nashville, TN.

For the practice type, we chose “addiction medicine.” Once you’ve entered that information, click “search.”

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 1 | Medicare Plan Finder
How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 1 | Medicare Plan Finder

That will lead you to a list of local practices that specialize in addiction treatment. You can use the contact information to call the facilities and compare their services, or you can use’s tool.

To use the tool, click on the practices you want to compare. For our purposes, we only chose the top three practices on the list.

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 2 | Medicare Plan Finder
How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 2 | Medicare Plan Finder

Then click “Compare” at the bottom of the page.

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 3 | Medicare Plan Finder

Then you will come to a page that allows you to view practice contact information on one screen. You can also look at the practices’ full profiles and get directions to each location.

How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 4 | Medicare Plan Finder
How to Find Approved Medicare Alcohol Treatment and Drug Rehab Step 4 | Medicare Plan Finder

Prevalence of Substance Abuse in Older Adults

Older adults (defined as 65 and older in the United States) most commonly abuse alcohol, but many also abuse prescription and illegal drugs. The percentage of older adults who met the criteria for having an addiction problem was 11.7 percent.

Drug abuse in adults older than 65 years is mainly limited to alcohol despite the prevalence of so many illicit drugs and mood-altering prescription drugs.

Substance Abuse in the Elderly: Unique Issues and Concerns

The elderly population accounts for 25% of the prescription drugs sold in the US, and this population faces unique issues when it comes to substance abuse. Because addiction symptoms look like other common senior health disorders such as dementia, diabetes, and depression, addiction often goes ignored.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), drug addiction in adults over 60 years primarily arises from alcohol and prescription drugs. This creates a risk of harmful interactions between the two.

Medicare Help for You or Someone You Love

If you or someone you love struggles with drug or alcohol addiction, you don’t have to face it alone. A licensed agent with Medicare Plan Finder may be able to help you find a Medicare plan with the right care team to lead your or your loved one’s recovery.

To set up a no-cost, no-obligation appointment with an agent call 844-431-1832 or contact us here today.

Contact Us | Medicare Plan Finder
Contact Us | Medicare Plan Finder

This post was originally published on April 22, 2019, and updated on March 6, 2020.

Does Medicare Cover Dental Implants?

Sometimes plaque and tartar can build up to the point where the accumulation irritates the gums. The irritation can result in tooth loss. A dentist might recommend a dental implant to solve the problem.

If you’re one of the many people who need dental implants and you have Medicare insurance, you probably have a lot of questions such as, “What are dental implants,” and, “Does Medicare cover dental implants?”

What Are Dental Implants?

A dental implant is an artificial tooth with a titanium post that’s surgically attached to the jaw. About 450,000 people have dental implants every year.

Medicare Advantage Dental Appointment | Medicare Plan Finder
Does Medicare Cover Dental Implants? | Medicare Plan Finder

Original Medicare and Medicare Advantage Dental Coverage

Original Medicare (Part A and Part B) does not cover dental implants or routine dental care. However, private insurance policies called Medicare Advantage (MA) plans can offer coverage for additional services Original Medicare does not, including dental services.

If you need dental insurance, an agent with Medicare Plan Finder can work with you to find a MA plan in your area that offers dental coverage. Some plans also offer coverage for vision, hearing and even fitness classes along with all of the services that Original Medicare covers.

Some people may find that their Medicare Advantage plan does not cover all of their dental needs. Those people may need additional dental coverage from private policies called commercial dental insurance plans to cover major procedures such as dental implants.

Medicare Advantage | Medicare Plan Finder

Does Medicare Supplement Cover Dental Implants?

Medicare Supplement (Medigap) plans can help pay for financial items such as copays and coinsurance that can come with Original Medicare.

Unlike Medicare Advantage plans, Medigap policies do not offer additional benefits. That means that a Medicare Supplement plan will not pay for routine dental care or dental implants. You cannot have both a Medicare Advantage policy and a Medigap plan at the same time, so it’s a great choice to learn the difference between the two.

A licensed agent with Medicare Plan Finder can help you determine what you need, and what’s available in your area. To learn more, call 1-844-431-1832 or click here to use our Medicare Plan Finder tool!

Medicare Plan Finder Tool

Does Medicaid Pay for Dental Implants?

Medicaid is both federally and state-funded. The program helps people who qualify to pay for their health insurance. Every state has different rules about dental coverage. While most states provide at least emergency dental services for adults, not all states provide comprehensive dental coverage.

If you qualify for Medicaid and have questions about what services your state covers, contact your local Medicaid office.

Elderly Dental Problems and Their Solutions

Tooth loss is not an inevitable part of aging, but many seniors can develop diseases which can make dental implants or other solutions a necessity. Conditions that affect older adults include dry mouth, gum disease, and oral cancer.

Dry Mouth

Many medications that treat common senior conditions have dry mouth as a side effect. Dry mouth can lead to cavities, which ultimately lead to gum disease. If you have dry mouth as a medication side effect, talk to your doctor about what drugs you take and the dosages.

Your doctor may change your prescriptions or recommend over-the-counter oral moisturizers or drinking more water. In order to further prevent cavities, your dentist may apply fluoride treatments.

Gum Disease

Periodontal, or gum disease results from bacteria in plaque irritating the gums. The gums become swollen and are more likely to bleed. Periodontal disease is widespread among older adults because it’s often painless until it becomes severe and many people don’t have regular dental exams.

If gum disease goes untreated, the gums can recede from the teeth and form spaces that can collect food particles and more plaque. Advanced periodontal disease can destroy the gums and the bones and ligaments that support the teeth. Your dentist can treat or help you prevent gum disease, so it’s important that you have regular check-ups.

Oral Cancer

Oral cancer is an uncontrollable growth of invasive cells that causes damage to the mouth, tongue, and throat. It can be life-threatening if it’s not treated early. Along with regular dental visits, you can prevent oral cancer by avoiding tobacco or heavy alcohol use.

Other risk factors include a family history of cancer, excessive sun exposure and having HPV. About 25 percent of oral cancer cases are people who don’t smoke or who only drink occasionally. Treatment for oral cancer involves surgery to remove the cancerous cells, or radiation and chemotherapy.

Does Medicare Cover Dentures or Other Alternatives to Traditional Dental Implants?

Dental Exams | Medicare Plan Finder
Dental Exams | Medicare Plan Finder

Some people may not be able to receive dental implants. For example, if your jaw cannot support an implant, a dental specialist will have to find an alternative. Dental implant alternatives include:

  • Bridges: This alternative uses artificial teeth supported by crowns that attach to the natural teeth to solve the dental issue.
  • Full or Partial Dentures: Full dentures are a dental implant alternative for people who have lost most of their natural teeth. They are removable artificial teeth secured to a support piece in the mouth. Partial dentures are for people who have most of their natural teeth still, and they attach to natural teeth with metal clasps.
  • “Teeth in a Day”: Traditional dental implants require a lengthy recovery period that can last up to two years. “Teeth in a Day” is a procedure that uses computer-guided technology to find the best placement for implants and accurately insert new posts in an hour.

Medicare does not cover alternatives to dental implants, but certain Medicare Advantage plans or private dental insurance plans might.

Dental Health for Seniors

If you take care of your teeth, you can avoid many of the issues that contribute to tooth decay, gum disease and tooth loss. A strong oral hygiene routine includes:

  • Brushing twice daily with fluoride toothpaste
  • Flossing between your teeth every day to remove plaque
  • Limiting alcoholic beverages
  • Refraining from smoking or chewing tobacco
  • Regular dental visits even if you have no natural teeth or you have dentures
  • Visiting your doctor or dentist if you experience abrupt changes in taste or smell
  • Working to control diabetes, which will decrease the risk of gum disease and other conditions

Many older adults will need assistance with everyday grooming and self-care. If you’re a caregiver, you can help the people you care for avoid gum disease by flossing and brushing their teeth every day and bringing them to their dentist visits.

Let Us Help You Find Dental Plans That Cover Dental Implants

Even though Medicare does not cover dental implants, the right Medicare Advantage plan or commercial dental insurance plan can help pay for the treatments your dentist recommends. Call 833-438-3676 or contact us here to arrange an appointment with a licensed agent.

Contact Us | Medicare Plan Finder

This post was originally published on June 12, 2019, and updated on January 7, 2020.

7 Important Things You Never Knew About Medicare

What is Medicare? Most people are familiar with short answer: Medicare is a federal health insurance program that covers people over the age of 65, people with certain disabilities, or those who suffer from either ESRD (end-stage renal disease) or ALS (Lou Gehrig’s Disease).

While this is probably the easiest way to explain Medicare, most people don’t know how complicated it can be once you dive below the surface. Here we’ve broken down the 7 most important facts about Medicare that you may have never heard before!

1. There are multiple parts of Medicare

Perhaps the biggest misconception about Medicare is that it’s one gigantic program. In truth, what we refer to as Medicare actually has four distinct components, or “parts.” You might hear some different names used but usually these parts will be designated as A, B, C, or D.

The Original Medicare program consists of Part A and Part B. Part A primarily covers inpatient hospital care, while Part B handles outpatient services like doctor visits. These two components of Original Medicare represent the basic coverage that is available to you when you turn 65. 

Part C, often called Medicare Advantage plans, are offered by private health insurance companies. These allow recipients of parts A and B to also receive benefits like dental, vision, and prescription drug coverage depending on the plan they choose.

Medicare Advantage | Medicare Plan Finder
Medicare Advantage | Medicare Plan Finder

Part D, sometimes called a prescription drug plan (PDP), offers prescription drug coverage to beneficiaries enrolled in Medicare. These are offered by private insurance companies as an addition to the Original Medicare benefits, as Original Medicare does not include any drug coverage. 

To see these different Medicare plans explained in even more detail, check out our more in-depth blog here on finding the best types of Medicare plans for you in 2020!

2. You can’t enroll whenever you want

Unfortunately, Medicare is not a program you can just enroll in at any time. It’s true that you are eligible for Medicare when you turn 65, but unless you qualify for automatic enrollment, you will need to sign up during one of the five designated enrollment periods

The Initial Enrollment Period (IEP) is usually your primary opportunity for Medicare enrollment. If you are aging into the program, this IEP begins three months before your 65th birthday and extends to three months after, giving you seven months in total to enroll.

There is actually a second IEP, sometimes called IEP2, available for those who are eligible for Medicare before they turn 65, such as those with disabilities. This period also lasts seven months and gives these beneficiaries an opportunity to make changes to their plan. 

The General Enrollment Period (GEP) is offered for first-time Medicare enrollees who did not join during their IEP. This period occurs every year from January 1 to March 31. Coverage applied for during this period begins on July 1st.

The AEP, or Annual Enrollment Period, starts every October 15 and runs until December 7. This period provides an opportunity for those already enrolled in Medicare to make changes to their coverage, such as adding a Part D plan or converting your Original Medicare to a Medicare Advantage plan.

Special Enrollment Periods (SEPs) allow Medicare beneficiaries to make changes to their coverage outside of AEP. During these periods, people who are enrolled in a Special Needs Plan or who have recently lost a job can add to or switch their coverage. Check out the handy graphic below to see if you qualify for one of these SEPs.

medicare special enrollment period | Medicare Plan Finder
Special Enrollment Period | Medicare Plan Finder

In 2019, a new enrollment period was introduced, called the Open Enrollment Period, or OEP. This period lasts from January 1 to March 30, and lets those who enrolled in Medicare Advantage during AEP make changes in their coverage without having to wait for the next AEP.

3. You may have to pay if you delay

If you do miss your IEP, you may have to pay penalties when you finally do enroll. The amount you will pay and the duration you will have to pay depends on which part of Medicare you enroll in and how long you waited.

The Part A penalty is incurred if you do not qualify for free, automatic enrollment and you fail to sign up for it when you are eligible. This penalty will be added to your premium to the tune of 10%, which you will have to pay for twice the number of years that you neglected to sign up.

If you enroll late in Part B, your premium will go up by about 10% for every year you were eligible but didn’t sign up. You will then have to pay this increased premium for the entire time you have Medicare Part B. You may also have to pay a penalty if you do not enroll in a Part D plan within the first three months that your Parts A & B are active. However, some of these penalties may be avoided if you qualify for a Special Enrollment Period.

4. Original Medicare only covers 80%

Once you are finally enrolled, you might wonder: “How much does Medicare cover?” The unfortunate truth is that it will not fully cover your medical expenses. Parts A & B will only cover up to 80% of the cost of Medicare-covered services, leaving you to pay the remaining 20% coinsurance. 

This might not be too much trouble for routine doctor visits, but in the case of a medical emergency or hospital stay, the amount you pay out-of-pocket can skyrocket quickly. To cover that last 20%, consider purchasing a Medicare Supplement plan to add on to your Original Medicare coverage.

5. Original Medicare doesn’t cover dental, hearing, or vision

Many people might not realize that Medicare covers very little in the way of dental and hearing expenses, and virtually nothing when it comes to vision. Part A will sometimes pay for specific dental services if you have to get them while you are staying in a hospital, but will not pay for cleanings, fillings, dentures etc.

Medicare will sometimes cover diagnostic hearing exams if your physician orders it as part of their treatment, but will not cover hearing aids under any circumstances. For vision coverage, your options with Original Medicare are even more limited, as it will not pay for eye exams, glasses, or contact lenses.

There are some options that can provide vision, hearing, and dental coverage for seniors. A DVH (or Dental, Vision, Hearing) plan can be purchased to add to your Original Medicare benefits, or you might look to a Medicare Advantage policy to consolidate all of that coverage into one plan. 

If you think Part C might be the best coverage option for you, click here or give us a call at 844-431-1832 to have a licensed agent help you compare Medicare Advantage plans!

6. Original Medicare will not cover you abroad

Aside from a few very specific circumstances, Medicare Parts A and B will not cover your health care while you are traveling outside the United States. Medicare Part D plans are also invalid once you are more than 6 hours away from a U.S. port.

But there are some Medicare coverage options available for foreign travel, primarily in the form of Medicare Supplement (Medigap) plans.

7. Supplement plans have the same coverage, different cost

Medicare Supplement, or Medigap, insurance can be used to cover the out-of-pocket costs you may have to pay with Parts A and B. Insurance carriers offer many different types of Medigap plans, often sorted alphabetically, but they all must follow the same government regulations. 

This means that Plan F from one carrier must provide the same benefits as Plan F from another carrier. Below is a quick breakdown of all the benefits covered by the different Medigap plan types.

2020 Medicare Supplement Comparison Chart
2020 Medicare Supplement Comparison Chart

Once you have found a Medigap plan type that meets your needs, you must consider the price. Insurance carriers must cover what is mandated by the government guidelines, but may charge very different rates for that coverage.

To find the best price, reach out to one of our licensed agents here or at 844-431-1832 to have them run a personalized quote, or use our Medicare Plan Finder Tool to compare all the plans offered in your state and county!

3 Easy Steps to Making New Friends After Retirement

It’s always tough adjusting to big life changes and, as we get older, those changes seem to come faster and faster. Retiring, moving to a new city, or the death of a spouse can all be overwhelming and foster social withdrawal and isolation. 

In fact, a recent survey of retirees showed that 11% of those questioned said they felt lonely and isolated, and almost half of those had recently moved to a new home. The AARP estimates that 42.6 million Americans over age 45 suffer from loneliness, which has been established as a risk factor for early illness and death, especially among seniors.

Fortunately, staying social is easier than ever in our modern age. Read on and learn some awesome methods for making and maintaining new friendships!

1. Follow Your Passions To Find Friends

It’s not easy knowing how to make friends when you are older. Stanford researchers have even suggested that baby boomers are withdrawing from social relationships more than any other group. 

But finding new friends doesn’t have to be a guessing game. Just ask yourself a few simple questions: what do you like to do? What are you passionate about? What would you like to learn more about? Finding people with mutual interests and passions is the best place to start forging new friendships.

Social Networking for Seniors

More than ever, technology is helping us form and sustain new friendships. A quick Google search will bring you to senior friendship sites like Silversurfers or Buzz50, which feature forums and chat rooms tailored to older adults. 

You can also find countless senior social media groups on platforms like Facebook, which have an increasingly large userbase over the age of 55. Here you can get connected with people online or even find a group that meets in real life. You can look for clubs, classes, or other hobby groups in your area and you’re sure to meet other like-minded social seniors.

2. Getting Out and About

In the social media age, congregating with people who have shared interests can be done from the comfort of your own home. But if you’re feeling cooped up, there are countless ways to meet new senior friends while staying active!

Senior Meetups

A senior meetup is a great place to meet seniors in your area that share your interests or passions. You may find these meetups at churches, gyms, retirement communities, or other places senior citizens hang out. There are even dedicated websites like, which connect you to in-person events based on your location and preferred activity. This helps provide a built-in ice breaker, as you can discuss your common interests.

If you are into photography or arts & crafts, find a workshop at a senior community center where you can advance your skills. If you enjoy cooking but are getting bored of the same old recipes, join a cooking class like the ones offered at Sur La Table. If you’re more of an outdoorsy type, there are groups that go for nature outings. Or you may prefer to find a group that gets together simply to eat, drink, and socialize.

Volunteer Opportunities for Seniors

Another great solution for the social isolation elderly people face is volunteering. This can be a great way to form social connections and do something good for others at the same time. 

Organizations like Senior Corps offer programs that allow retirees to mentor young people, be a companion to other seniors who are less mobile, or share their expertise in community projects like building housing.

The AARP also has a program called the AARP Foundation Experience Corps, where those over the age of 50 can tutor young children to help improve their reading comprehension. This mentoring has an impressive impact on the students, improving their literacy skills by up to 60%.

Senior Fitness Classes

Working up a sweat is a tried-and-true strategy for staving off some of the side effects of isolation, such as depression and anxiety. But it can also be a terrific way to meet new people! 

Active older adults can join a senior fitness program to help keep an exercise routine and chat with other seniors looking to stay in shape. Many of these programs, like Silversneakers®, may be covered by your insurance. If you have Medicare and are considering purchasing a Medicare Advantage plan to cover fitness programs, click here or give us a call at 844-431-1832 to speak with a licensed agent.

Medicare Advantage | Medicare Plan Finder
Medicare Advantage | Medicare Plan Finder

3. Get To Know Your New Friends

Once you have made some new acquaintances, it can be difficult to form a closer bond. Plus, as we get older, we usually have less interest in maintaining superficial or casual relationships. Getting organized and keeping to a routine can help tremendously in developing old and new friendships alike.

Keep A Schedule To Stay In Touch

The best way to uphold and develop a relationship is to keep in contact on a regular basis. As your social group grows, start a calendar.

A well-organized calendar can ensure you never miss a meetup or social event that you want to attend. You can also use your calendar to keep track of birthdays and anniversaries. A simple “happy birthday” can go a long way in strengthening a burgeoning friendship.

Just as modern technology can help us meet new people, it can also help us stay in touch with friends and family alike. On social media platforms like Facebook, you can stay engaged with your social groups, old and new, by liking or commenting on statuses and pictures, as well as posting a few of your own! Emails and phone calls can also keep you in the loop with new friends.

Whichever way you choose to find your new social group, remember that forming long-lasting bonds takes time. If a new acquaintance does not respond to your efforts, try not to take it personally. There are plenty more people out there looking for the same connections you are. Keep searching and don’t get discouraged!

5 Common Types of Mental Illness In The Elderly

Most of today’s senior citizens grew up in a time when mental illness was almost never discussed in public. Over the years though, the stigma around mental health has largely eroded and conversations about mental health often dominate the national discourse. 

As mental illness becomes less taboo, its far-reaching impact on society is coming more into focus. For example, the effects of mental illness in seniors are studied much more closely than ever before.

Common Types of Mental Illness In Seniors

With this more extensive research, it’s easier to see what mental health issues are common in the elderly population. The most prominent issues in senior mental health are:

1. Depression

Depression is often cited as the most endemic mental illness in the elderly population today. Many older adults may shrug depression symptoms off as simply “feeling down,” meaning it often goes undiagnosed and may be even more pervasive than the research suggests. 

There are many risk factors that specifically contribute to depression in the elderly. Retiring from work can cause strong feelings of boredom or listlessness, and the death or illness of a spouse can leave many stressed and sorrowful. 

Not only can depression exacerbate the symptoms of other chronic health issues, it is also noted as a symptom of more severe mental disorders like dementia. This means seniors and their loved ones must be vigilant in watching for these depression symptoms:

  • Feelings of sadness, hopelessness, or emptiness
  • Lack of motivation or interest in previously enjoyed activities
  • Trouble concentrating and decision making
  • Thoughts of suicide or self-harm

2. Anxiety

Anxiety disorders can take many different forms, such as obsessive-compulsive disorder (OCD), panic disorder, or generalized anxiety disorder. These are usually characterized by intense fear or nervousness over issues most would consider normal, routine aspects of everyday life – locking doors or finding a parking spot, for example.

Like depression, anxiety in older adults is extraordinarily common and is often underdiagnosed. Older adults are especially prone to ignoring this illness, perhaps because the conventional medical wisdom of previous decades downplayed psychiatric symptoms if no physical issues existed.

It is important to note however, that some physical symptoms such as restlessness or fatigue may accompany anxiety, further confusing a potential diagnosis. Be on the lookout for these symptoms of anxiety in the elderly:

  • Irrational, obsessive, or catastrophic thoughts
  • Isolating behavior and withdrawal from others
  • Irritability or agitated moods
  • Fatigue and muscle soreness

3. Bipolar Disorder

Bipolar disorder is usually diagnosed in younger people, whose moods can swing quickly from elation to depression. If this diagnosis is made when the person is an older adult, it is referred to as late onset bipolar disorder and it is more likely to manifest as agitation.

Diagnosing bipolar disorder in seniors is made even more difficult by the misinterpretation of symptoms. Many of the warning signs of late onset bipolar disorder might be dismissed as simply the natural effects of aging. Furthermore, some symptoms may resemble the side effects of certain medications, like antidepressants and corticosteroids.

As the population steadily increases, the number of cases of late onset bipolar disorder is expected to rise along with it. Professional help should thus be sought if you or those close to you observe any of these bipolar symptoms in adults:

  • Agitation and irritability
  • Hyperactivity or distractibility
  • Loss of memory, judgment, or perception

4. Schizophrenia

Similar to bipolar disorder, schizophrenia is a condition usually diagnosed in younger individuals. Late onset schizophrenia is the terminology used when this disorder is observed in patients over the age of 45. 

Schizophrenia is characterized by a broad range of symptoms, from the so-called “negative” symptoms, like loss of interest or enthusiasm in activities, all the way to delusions and hallucinations. While late onset schizophrenia is less common than the early onset variety, older sufferers are more likely to experience these severe symptoms.

Currently, doctors are unsure what causes late onset schizophrenia and why it is different from its other forms. Some have theorized that it is a subtype of the disorder which is triggered by life events. Regardless, it is vitally important that seniors and their loved ones keep an eye out for these late onset schizophrenia symptoms:

  • Delusions or hallucinations
  • Disorganized speech or behavior
  • “Negative” symptoms (absence or lack of interest in normal behaviors)

5. Dementia

Though it is classified separately from mental illnesses by the medical community, dementia is still a disorder that severely affects mental health. There are many different stages and forms of dementia but the most common incarnation is Alzheimer’s disease, which affects around 3 million people over age 65. 

Alzheimer’s and other forms of dementia can develop from the natural cognitive decline that happens as we age, drawing a startling link between aging and mental health. All demographics should make mental health a priority but seniors especially should watch for these dementia symptoms:

  • Disorientation or confusion (forgetting dates, years etc.)
  • Decrease in memory
  • Decline in ability to communicate 
  • Mood swings and emotional issues

Treatment & Medication

Mental illness treatment can involve inpatient or outpatient care.

Mental illness treatment can be a tricky process and it begins with a proper diagnosis of the condition’s type and cause. To do this, your doctor may administer several different types of tests, from cognitive and psychiatric evaluations to brain scans and lab tests. 

Several different mental conditions have symptoms that overlap and make them difficult to diagnose without extensive medical experience. Once the condition is properly diagnosed, a doctor may suggest one of these common forms of mental illness treatment.

Outpatient Care

The most common forms of outpatient mental illness treatment are based around medication or psychotherapy, often used in conjunction. The efficacy of these treatments varies from person to person and sometimes multiple treatment options must be attempted before an effective one is found.

For depression and anxiety disorders, pharmacological methods of treatment usually utilize antidepressants. These can be prescribed in addition or as an alternative to psychotherapeutic approaches like “talk therapy.” The Anxiety and Depression Association of America (ADAA) also suggests regular exercise and a balanced diet as ways of staving off these common mental illnesses, stressing the link between brain and gut health.

The primary medications used in treating bipolar disorder and schizophrenia in seniors are classified as antipsychotics, usually prescribed at a lower dosage than people diagnosed at a younger age. For non-drug treatments of more severe cases, inpatient care is often required for proper rehabilitation. 

For the treatment of dementia in the elderly, no cure is currently known. But the symptoms can be managed and the Alzheimer’s Association recommends a non-drug approach before attempting medication. These can begin with something as simple as changing the environment of those with dementia to remove obstacles and promote a general ease of mind. 

If these non-drug approaches are not effective, certain types of medications like cholinesterase inhibitors and memantine may be prescribed to temporarily relieve some symptoms. Other approaches may include the use of antidepressants or anxiolytics, depending on the specific behaviors and symptoms that manifest.

Inpatient Care

With the more serious mental illnesses widely seen among seniors, outpatient care may not be an option. Those suffering from bipolar disorder or dementia may not be able to maintain their daily functions on their own and must turn to medical services that can attend to their needs 24 hours a day. 

For example, the most common form of therapy for conditions like schizophrenia is a psychosocial approach, where a team of doctors, nurses, social workers and other professionals work in close contact with the patient to monitor their symptoms, both mental and physical, and help them maintain social skills and daily activities.

In these severe cases of mental illness, the accessibility of quality inpatient care has been shown to be a determining factor in recovery. The psychosocial interactions common in inpatient care are now considered to play a necessary role in a comprehensive intervention plan, as isolation can intensify many of the symptoms of these conditions.

What mental health services does Medicare cover?

Medicare can help pay for your mental health care.

When faced with one of these potentially life-changing illnesses, it is important to know what exactly is covered by your health insurance. Depending on the condition and its severity, some patients may need an extended stay in a hospital, which can quickly skyrocket the cost of care. Fortunately, Medicare covers many mental health services.

Medicare Part A Coverage

The types of mental health coverage offered differ depending on which elements of Medicare you are covered by. Medicare Part A covers inpatient care, or the medical services you receive while staying in a hospital. The out-of-pocket costs not covered are the same regardless of the type of hospital, general or psychiatric.

Medicare measures your use of hospital facilities using benefit periods. These benefit periods are tallied in increments of 60 days, beginning on the day you’re admitted to a hospital and ending when you haven’t used any hospital services for 60 consecutive days.

If your stay is in a general hospital, there is no limit to the amount of benefit periods Medicare will cover. In a specialized psychiatric facility though, Part A will only pay for up to 190 days of inpatient care during your lifetime.

For further information on how the co-payments break down, check out this handy graphic or see our more in-depth article here.

2020 Medicare Part A Copayments
2020 Medicare Part A Copayments

Medicare Part B Coverage

Medicare Part B will cover most of the cost associated with outpatient mental healthcare. This primarily includes any doctor visits that may relate to your mental health, including appointments with psychiatrists, psychologists, nurses, and social workers. 

Therapy and counseling may or may not be covered depending on if the doctor accepts Medicare assignment. Finding a therapist who takes Medicare is now easier than ever, using tailored search tools like the one developed by Psychology Today, available here.

After you meet your Part B deductible, Medicare will cover 80% of their approved amount to the doctor or therapist. This leaves a 20% copay that will have to be paid out-of-pocket. For some, this may still be too expensive and that’s where Medicare Advantage, Supplement, and Part D plans can help!

Medicare Advantage, Supplement & Part D Coverage

There are several types of supplemental coverage that can help pay for Medicare mental health benefits. 

Part D plans, for example, offer coverage for prescription drugs which are not covered by original Medicare. For the year of 2020, these plans will have an annual deductible of $435 but, since they are provided by private insurance, there is some variation in the deductible, which may be waived, reduced, or charged upfront.

Medicare Advantage plans, also referred to as Part C, can offer far more benefits than parts A and B alone, including prescription drugs, dental and vision coverage, and group fitness classes tailored to seniors. 

Medicare Advantage | Medicare Plan Finder
Medicare Advantage | Medicare Plan Finder

Alternately, you may choose to apply for a Medicare Supplement plan, which provides additional financial benefits to help with mental health-related costs like copayments and deductibles. There are up to ten distinct types of Medicare Supplement plans (designated alphabetically from A – N). Each plan may differ in coverage and price. 

Medicare Supplements | Medicare Plan Finder
Medicare Supplements | Medicare Plan Finder

Whatever supplemental coverage you are looking for, it is best to seek the help of a licensed agent who can fully explain the details of each plan and find one that works best for you or your loved one. To contact one of these professionals directly for free, no-strings-attached information, fill out this form or give us a call at 844-431-1832 and get covered today!

$0 Premium Humana Honor Plans for Veterans

Humana is one of the biggest Medicare Advantage carriers, with over 8.4 million members across all 50 states (plus D.C. and Puerto Rico). They’ve been active for over three decades! New this year, Humana is providing a “Humana Honor” Medicare Advantage plan. 

Uniquely, though it is “available to anyone eligible for Medicare” who lives in the service area, this Medicare Advantage plan is designed to complement VA (Veteran’s Affairs) coverage. Many veterans think they have no use for Medicare Advantage (or even Medicare at all) due to their VA coverage, but a plan like this could be a game-changer. 

Do you Need Medicare if you have VA Coverage?

For some people, the VA may provide all the coverage you need. But, if you can get additional coverage at no extra cost, why not take it?

Plus, even though there are 1,921 VA facilities across the country, wait times can be a problem. You can use this tool to find out what your local wait times are, but you might not need to if you have additional coverage. If you also have Medicare (and if you have Medicare Advantage), your network can be expanded to many more local doctors and other medical facilities, where you may have an easier time getting an appointment. 

Plus, the VA does not automatically provide dental coverage to all veterans. You can purchase it through the VADIP (VA Dental Insurance Program), but you might not need to. If it makes sense for you and if it is available in your area, you can instead enroll in a Humana Honor or other Medicare Advantage plan that includes a dental benefit. 

What’s Great About Humana Honor?

Humana’s new Honor plan includes

  • $0 premiums + a Part B give back (Part B premium reduction)
  • Closing VA coverage gaps
  • Broad network, including urgent care facilities
  • Dental coverage

Humana Honor is available as 17 different plans available in 28 states: 

  • Alabama 
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Delaware
  • Florida
  • Georgia
  • Idaho
  • Illinois
  • Indiana
  • Kansas
  • Louisiana
  • Maryland
  • Michigan
  • Mississippi
  • Missouri
  • Nevada
  • New Mexico
  • New York
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • South Carolina
  • Tennessee
  • Utah
  • Washington

How to get Humana Honor Medicare Advantage

There are a few ways you can enroll in Humana plans, but we recommend speaking with a licensed agent. An agent can help you sort through all your options and make sure that the plan you like is truly the best plan for you. It is free to speak with a licensed agent regarding your healthcare, so it can only help! 

You can speak to a agent by calling 844-431-1832 during business hours or clicking here

Humana Taking Care of Veterans

Humana has strong relationships with (and is the national Medicare plan carrier for) the VFW (Veterans of Foreign Wars) and AMVETS (American Veterans). Infact, Humana partnered with the VWF’s “Uniting to Combat Hunger” campaign and helped raise money for over 500,000 veteran meals. 

Humana has also contributed over one million dollars to the Entrepreneurship Bootcamp for Veterans with Disabilities, an organization that serves post-9/11 veterans. They also sponsor the Washington, D.C. Rolling Thunder Motorcycle Run during Memorial Day weekend, as well as the Wounded Warrior’s “Warrior Games.”

Additionally, Humana’s administration has hired over 4,500 veterans and veteran spouses since 2011. 

Whether you like Humana’s Medicare Advantage plans or not, you have to give them props for their work with veterans and veteran families!

We’re proud to offer Humana plans through our insurance brokers and are excited to be a part of providing veterans with the care they deserve.

How to Switch From Medicare Advantage to Medigap

Medicare Advantage and Medigap are similar in some ways but very different in others. If you’ve enrolled in a Medicare Advantage plan and you don’t like it, you may think switching Medicare plans and enrolling in Medigap is a great idea. It’s important to understand the differences between the two, so you can make the best choice. 

What is Medicare Advantage?

Medicare Advantage, also called Medicare Part C, is a type of private Medicare plan. When you first enroll in Medicare, you’ll start with Medicare Part A (the part that covers hospital care), and then most people will enroll in Medicare Part B (the part that covers doctor’s appointments). 

Medicare parts A and B are limited, so adding Part C can give you additional benefits like:

  • Long-term care
  • Specialized care
  • Dental
  • Vision
  • Hearing
  • Physical fitness
  • Prescription drugs

No two Medicare Advantage plans are the same. In fact, there are several different types. You’ll have to look at what you’re eligible for and decide which benefits you need most and how much you’re willing to spend.

Medicare Part C doesn’t always mean spending more money, though. Some plans might even have $0 premiums!*

*Even with a $0 Medicare Advantage premium, you’d have to continue paying your Part B premium.

What is a Medigap plan?

Medicare Advantage plans sound fantastic, but some people will find that Medigap plans work best for them. Medigap coverage is what can “fill the gap” between what Medicare covers and what you owe out of pocket. These plans are also called “Medicare Supplement” plans because they supplement your existing Medicare Part A and Medicare Part B coverage.

Some Medigap plans may provide a few extra “perks,” but generally speaking, they do not provide additional health benefits in the same way that Medicare Advantage plans do. Instead, supplemental insurance covers your Medicare Part A and Medicare Part B deductibles, copayments, coinsurance, etc.

You’re probably thinking, “great!” I’ll just go ahead and get Medigap and Medicare Advantage. However, you can’t have both. That decision can be tough, but it all comes down to how much you’re able to spend each month and whether or not you can afford a medical emergency. For example, Medigap premiums tend to be a bit higher than Medicare Advantage, but if you’re in the hospital all the time, it might pay off. 

Can I switch from Medicare Advantage to Medigap?

If you enroll in a Medicare Advantage plan and decide that a Medigap plan might be better, you can switch – but there are a few things you’ll need to keep in mind.

Mainly, Medigap plans come with medical underwriting. In other words, you can be denied for pre-existing conditions. Meanwhile, you will never be denied or charged more for a Medicare Advantage plan based on your preexisting conditions. There are two times when your preexisting conditions won’t affect your Medigap enrollment: when you’re enrolling in Medicare for the first time, and if you are forced out of your current plan and need to find a new one quickly. That rule is called “guaranteed issue rights.”

You’ll also have to keep in mind that if you had a Medicare Advantage plan with prescription drug coverage and you want to switch to Medigap, you will lose your prescription drug coverage. The only way to have a prescription benefit with Medicare Supplements is to also invest in a Part D (prescription drug) plan. 

One of the many benefits to Medicare Advantage is that most of your benefits will be rolled into one plan, whereas if you have Medigap, you may have to seek alternative plans for your prescription drugs, dental, vision, etc. 

Can I switch from a Medigap plan to an Advantage plan?

Just like switching from Medicare Advantage to Medigap, switching from Medigap to Medicare Advantage is possible, but there are some things to be aware of. 

One of the first things you’ll notice when you switch plans from Medigap to Medicare Advantage is that your copayments might rise. This will all depend on what plans you have. For example, if you had Medigap Plan G (which covers Part B copayments), and then you switched to a Medicare Advantage PPO plan that had a $20 copayment for doctor visits, you might feel like your costs are rising. However, your Medicare Advantage plan might have a lower premium than your Medigap plan did, making your overall costs lower.

Confused? Your insurance agent can walk through these numbers with you before you switch plans to help you decide which type of plan is truly best for you. 

Is it better to have Medicare Advantage or Medigap?

The question should read, “Is it better for ME to have Medicare Advantage or Medigap?” That may not be the answer you were looking for, but it is different for every person. What you may see as disadvantages of Medicare Advantage might be great for someone else. Common Medicare Advantage disenrollment reasons, like trouble finding a doctor in-network or the lack of one very specific benefit, may not apply to you. 

While Medicare Advantage usually provides more covered benefits, Medigap can result in lower hospital bills and lower overall out-of-pocket costs.

Your decision should be based on your health history, your budget, and the quality of plans available in your area. Try sitting down and writing a pros/cons list for Medicare Advantage vs. Medigap, like this: 

Medicare Advantage: 

Pros: Prescription drug coverage can be included

Cons: Stricter network

Medicare Supplements:

Pros: Copayments can be covered

Cons: Higher premiums

Add in any items specific to you, like a specific benefit that you need or a specific cost that you are worried about. Then, circle the items that are most important to you. Whichever column has the most circled items is likely the best option for you. 

Why should I switch Medicare plans?

There are plenty of reasons to switch Medicare plans. Everything from network size to costs and benefits can be a factor. 

You may want to switch Medicare plans if:

  • Your plan doesn’t cover all of your healthcare needs.
  • The premiums are too high.
  • Your favorite doctors are not in-network.
  • The costs are not worth the benefits you’re receiving.
  • A better plan becomes available in your area.
  • You become eligible for a cheaper or more specialized plan.

When can I switch from Medicare Advantage to Medicare Supplement?

Unfortunately, switching Medicare plans is not always easy. If you have a Medigap plan, you can switch to another Medigap plan at any time. However, if you already have Medicare Advantage and want a new Medicare Advantage plan, or if you have Medigap but want to switch to Medicare Advantage, you’ll have to wait for one of three* Medicare Advantage enrollment periods:

  • Annual Enrollment Period: October 15 – December 7 of every year, applies to all Medicare beneficiaries, any change is allowed
  • Special Enrollment Period: Applies only to those with specific circumstances, such as a special medical or financial need, and allows enrollments at specific times outside of AEP and OEP
  • Open Enrollment Period: January 1 – March 31 of every year, allows those with Medicare Advantage to make one switch to a different Medicare Advantage plan or drop coverage

*The fourth Medicare Advantage enrollment period is when you first become eligible for Medicare and is called the Initial Enrollment Period. This is when you would enroll in Medicare Part A and Part B for the first time and can choose to also enroll in Medicare Advantage (or Medicare Supplements and Part D). 

When can I switch from Medicare Advantage to Medigap without losing guaranteed issue rights?

The guaranteed-issue rights for Medigap state that you cannot be denied coverage based on a preexisting condition if you enroll:

  1. When you first become eligible for Medicare, or
  2. When you lose your current coverage for reasons beyond your control

Additionally, identifies a few specific circumstances that can grant you guaranteed issue rights, including:

  1. Your Medicare Advantage plan leaves your service area, or you move out of the plan’s service area.
  2. You have Part A and Part B, and now your employer coverage is ending.
  3. You joined either a Medicare Advantage plan of PACE (Programs of All-Inclusive Care for the Elderly) upon turning 65 and decided to switch within the first year.
  4. You switched from Medigap to Medicare Advantage and want to switch back within less than one year.
  5. Your policy’s company mislead you or broke a rule.

When You Can Change Medicare Advantage Plans

If you don’t want to switch between Medigap and Medicare Advantage and you simply want to disenroll from a Medicare Advantage plan or switch to another, you can do that during one of the Medicare Advantage enrollment periods. 

CMS added the Medicare Advantage disenrollment period in 2020 to give beneficiaries another chance to switch without having to wait a full calendar year. This Medicare disenrollment period is actually the “Open Enrollment Period” lasting from January 1 through March 31. You are only eligible if you already have Medicare Advantage.

If you’d prefer to switch from Medigap to Medicare Advantage or make any other types of changes, you can do that during the annual election period in the fall, which is sometimes referred to as “Medicare open enrollment,” though it should not be confused with the Open Enrollment Period. 

If you qualify for a Special Enrollment Period (SEP), you can make changes outside of the traditional enrollment periods. Common reasons that you might qualify are if you moved to a new plan service area (or your plan leaves your service area, you move into or out of a long-term care facility, you are also eligible for Medicaid, or you have a medical condition that qualifies you for a Special Needs Plan.

Can I Change my Medicare Advantage Plan If I Move?

You can (and may have to) change your Medicare Advantage plan if you move. Medicare Advantage plans are confined to specific service areas. Some are confined to specific counties or zip codes, while others are state-wide. If you leave that service area, you will need to change plans. 

Additionally, moving to a new service area grants you a Special Enrollment Period. That means that from the date that you are officially living in the new area, you will have 60 days to switch Medicare Advantage plans. If you wait too long, you will have to wait until the Annual Enrollment Period rolls around again. 

Switching Medicare Advantage Plans with Pre-existing Conditions

If you have preexisting conditions and want to switch into a new Medicare Advantage plan, you do not have to worry about medical underwriting. Medicare Supplement (Medigap) plans are the only type of Medicare plan that may require medical underwriting. Original Medicare (parts A and B), Prescription Drug Plans (Part D), and Medicare Advantage plans (Part C) all cannot deny you coverage based on your health history. 

How to Switch Medicare Plans: Step by Step

When you think you’re ready to switch Medicare plans, follow these steps to ensure a successful switch: 

  1. Review your current benefits and make notes about what you like and what you don’t like about your current plan.
  2. Find out if you qualify for Medicaid, Social Security Disability Income, Medicare Savings Programs, or Low-Income Subsidies (all things that can help you save money on your Medicare coverage).
  3. Use this Medicare plan finder tool to find out what plans are available in your area that meet what you’re looking for.
  4. Meet with an insurance agent who can help you fill out your application correctly and answer all your questions (for no additional fees).

Tips for choosing a Medicare plan

Choosing a Medicare plan is a very personal process. Your Medicare coverage goes beyond copayments and deductibles. It can determine how prepared you are for emergencies, it can affect the quality of care you receive, and it can alter your lifestyle based on the benefits included.

Some people might find that traditional Medicare (parts A and B alone) is all they need, but most people will likely want to look for a prescription drug plan or some other benefits as well. No two health plans are the same. Some are very simple, covering basic needs and prevention, and others are complex, offering unique benefits like gym memberships and meal delivery. 

When choosing your Medicare coverage, keep the following tips in mind:

  1. What works for your spouse or friend may not work for you.
  2. Always make sure your favorite doctors are in the plan network before you enroll.
  3. Before selecting a prescription drug plan, verify that the prescriptions you need are covered.
  4. Remember to look at all costs: premiums, copayments, deductibles, and coinsurance. It’s easy to get excited when you see one low number, but everything together can add up.
  5. It doesn’t cost you anything to meet with an insurance agent who already understands the plans. They might even be able to help you save money.

We Can Help You Decide Which Coverage You Need

Changing your Medicare plan from Medicare Advantage to a Medicare Supplement is a big decision. Our licensed agents are highly trained, and they can help you find the plans available in your area. Your agent can discuss the pros and cons of MA and Medigap and help you make the decision that best fits your needs. To set up a no-cost, no-obligation meeting with an agent, call 1-844-431-1832 or contact us here today. 

Home Health Tests Seniors Should Try

We’re all aware we should make an effort to regularly see our physicians. But we also know that life tends to get in the way. 

Especially for seniors, transportation and cost can often prevent routine doctor visits. However, just because you can’t get to your doctor’s office, doesn’t mean you have to stay in the dark about your health. There are quite a number of tests that you can perform without ever leaving home!

Tests You Can Do At Home Today

The range of at-home tests and testing methods varies widely. Some require expensive medical equipment only available through a supplier and with a prescription, while others require only a pen and paper. Here are some tests that you can do today with little to no supplies

SAGE Test for Dementia

The Self-Administered Gerocognitive Exam, or SAGE, was devised by researchers from the Wexner Medical Center at Ohio State University. SAGE can help detect early warning signs of cognitive impairment and memory loss in less than 15 minutes.

The test has several components and several forms, all of which can be viewed and downloaded at the Wexner Medical Center’s website. These include sections on orientation, language, memory and visuospatial awareness.

The most well-known element of the SAGE is known as the clock drawing test. All you need to do is get out a pen and paper and draw a picture of a clock, with the hands reading 3:40. Then compare your drawing to a real clock to see how you scored.

If your circle is closed, give yourself a point. If all twelve numbers are accounted for and in the right place, you get two more points. If your hands are in the correct position as well, you passed with flying colors. A score of any less than three points, however, might be an indication that you should see your physician for further screening. This test is sometimes performed without the rest of the exam, though it is usually recommended to perform the entire SAGE test for dementia detection.

Medicare 101 Course
Free Medicare 101 Course

Window Test for Vision Loss

Our eyes take a lot of abuse these days from the onslaught of screens and artificial lighting. It’s even more severe as we get older and the natural, age-related loss of vision begins to take effect. If you experience some trouble reading, give yourself this informal at-home eye exam to judge whether or not you should seek an eye care professional.

First, sit across the room from a large window or door so that you can see all the lines of the frame around it. Cover one eye and focus on the window or door frame with your open one for 30 seconds. Then repeat with the opposite eye. The horizontal and vertical lines of the frame should be clearly visible with no missing or hazy areas. If the edges of the frame seem distorted or warped, this may indicate macular degeneration, a disease that is currently the leading cause of irreversible vision loss in people over 60.

Cushion Test for Peripheral Arterial Disease

The cushion test can be performed without even getting out of bed! It can help detect blocked arteries in your legs and feet, a condition known as PAD, or peripheral arterial disease. Those with high blood pressure or diabetes, both common among seniors, are especially at-risk for this disease. 

To perform this test, lie on a bed and elevate your legs with pillows or cushions until they are resting at a comfortable 45-degree angle. Keep them there for one minute, then sit up and swing your legs over the side of the bed so that they hang at an angle of 90 degrees. If either or both of your legs turn pale when elevated and take several minutes to return to their normal shade after sitting up, you may need to consult your physician with the results from this peripheral artery disease test.

Phalen’s Maneuver for Carpal Tunnel

We are an increasingly computer-savvy society and people of all ages are typing more than they used to. Extended periods of typing are strongly associated with carpal tunnel syndrome, a painful condition caused by a pinched median nerve in the wrist, but many other activities like driving can bring on these symptoms as well. Furthermore, people over 55 years old are at a much higher risk and those over 65 are more likely to have cases that are severe.

Phalen’s maneuver is a test devised to diagnose carpal tunnel at home and has been shown to be surprisingly effective. To see for yourself, press the tops of your hands together with your fingers pointing toward the floor and your elbows extended. If you can, hold this position for a full minute. If you feel an unpleasant sensation, such as prickling, tingling, or burning, you may likely have carpal tunnel and should consider preventive measures.

Check out this video from Physiotutors on YouTube that explains how to perform the Phalen test:

Testing With Medical Equipment

Some at-home health tests will require special instruments to fully gauge the results. While many of these items can be freely obtained from online and brick-and-mortar retailers, some require ordering through a medical supplier with a doctor’s prescription. Below, we will detail some of the testing you can do at home with the help of specially-designed medical equipment.

Blood Sugar Test

For the 12 million seniors living with diabetes* (about 25% of those over the age of 65), monitoring blood sugar levels is an near-constant concern. Luckily, this is something that can be checked at home or on-the-go using a blood glucose monitor, or glucometer. These can be found online or in pharmacies in the form of kits, which include testing strips, needles (called lancets), and the glucometer itself. 

Read about Medicare coverage for Diabetes!

To test blood sugar at home, you will need to insert a test strip into the electronic monitor and prick the side of your finger with the provided lancet. Gently apply pressure to that finger until you see a drop of blood form, then touch it to the edge of the test strip. In just a few seconds, you will have an accurate metering of your current blood sugar levels, no matter where you are.

Blood Pressure Test

Along with heart rate, breathing rate, and body temperature, blood pressure is one of the four most significant vital signs that our bodies produce. High blood pressure can be caused by countless factors like high cholesterol, stress, and even fear, and affects almost 70% of adults between the ages of 65 to 74. Monitoring blood pressure accurately is vitally important, as symptoms may not manifest until these levels are dangerously high. Doctors maintain accuracy by using large, costly machines but there are ways to test blood pressure at home with minimal equipment.

The quickest and most accurate results will come from automated, electronic blood pressure monitors that come with an upper arm cuff. Many different brands of at-home blood pressure cuff exist and can be found at pharmacies or similar retailers. The directions for use may change from model to model but there are certain rules that apply no matter what brand you use, including placing the cuff directly on the skin, placing the feet flat on the floor, elevating the arm to chest height, and avoiding smoking or drinking for 30 minutes before testing.

At-Home Lab Tests

Another popular method of in-home health testing comes in the form of test kits that can be ordered right to your door. These vary widely, not only in terms of what is being tested, but also in the method of sample collection. Some services will send a team of professionals to administer and retrieve your test, while others will only send instructions and require you to send your samples back in the mail for results. These can be purchased to test for a wide range of conditions, including food sensitivity, hormone testing, DNA testing, and other at-home blood tests.

Medicare DME Coverage

Medical equipment may be needed for certain tests.

Durable medical equipment, or DME, is a designation that Medicare uses to classify coverable medical equipment that can be used in the home. This benefit might be used to cover the cost of equipment to aid in the at-home testing we have already covered. The covered equipment can range from crutches and canes to CPAP devices and hospital beds, though it all must come from a Medicare-approved medical supplier.

Medicare-Approved Glucose Meters

Blood sugar monitors and test strips are usually covered under Medicare Part B as durable medical equipment for home use with a doctor’s prescription. You may be able to rent or buy a glucometer but Medicare will only provide coverage if both your physician and the supplier are both enrolled and participating in Medicare. Be sure to clarify this with your doctor and equipment supplier, as some may be enrolled but not “participating” and may not accept the cost of assignment.

Read more about durable medical equipment Medicare coverage.

Does Medicare Cover Blood Pressure Monitor?

Medicare Part B may cover the cost of a blood pressure monitor or ambulatory blood pressure monitoring (ABPM) device but only under very specific circumstances. Part B will cover a blood pressure monitor and stethoscope for those who receive blood dialysis treatment in their home and will pay for the rental of an ABPM device for patients who have exhibited “white coat hypertension,” a phenomenon where nervousness in clinical settings causes artificially high blood pressure readings. 

For those with Medicare Part C, or Medicare Advantage, all the benefits of Parts A & B will be covered but may also include additional benefits and expanded coverage. Contact your insurance company to find out if your Part C plan covers blood pressure monitors or glucometers.

If you don’t have a Medicare Advantage plan, give us a call at 844-431-1832 or contact us online to speak with a licensed agent and find a plan that can address your healthcare needs!

2020 Medicare Plan Finder: How to Find the Best Medicare Plan in 2020

It’s time to start thinking about what you want your Medicare coverage to look like next year. Did your current plan change? Did you develop a new health condition and need more coverage? Are you enrolling in Medicare for the first time? 

No matter your situation, the Annual Enrollment Period (AEP) runs from October 15 through December 7. If you used AEP to enroll, your plan became effective on January 1, 2020.

By now, you may have realized that there are hundreds of Medicare plans out there, all offering slightly different benefits at different costs. So how do you choose?


Which Medicare Plan is Best for me?

The best Medicare plan for 2020 is the one that fulfills your needs. To figure out which Medicare plan is best for you, ask yourself the following questions: 

  1. What specific medical services do I need coverage for (ex: lab tests, blood work, surgery, chemotherapy, dental, etc.)
  2. How much room do I have in my budget? Am I able to pay a little more to have more benefits?
  3. Do I qualify for savings (apply for Medicaid, Medicare Savings Programs, and LIS)?
  4. Would I rather pay more on a monthly basis and pay very little when I visit the doctor, or is it better to pay a small amount every month but risk having higher copayments?
  5. Who are the doctors and other providers who I want to be covered in my plan?
  6. What prescriptions do I need coverage for?

Start by Choosing a Type of Plan

There are four main types of Medicare plans to consider when you begin your Medicare plan search. Start by comparing Original Medicare, Medicare Advantage, Prescription Drug Plans, and Medicare Supplements. 

Keep in mind that you cannot have Medicare Advantage and a Prescription Drug Plan at the same time. You also cannot have Medicare Advantage and a Medicare Supplement plan at the same time.

Which plan or combination of plans works best for you?

  • Original Medicare: The original Medicare program. Comprises of Part A (hospital coverage) and Part B (medical coverage)
  • Medicare Advantage: A private plan that you can purchase once you have Original Medicare. Can add additional benefits such as hearing, vision, dental, fitness, etc. Can include a prescription benefit.
  • Prescription Drug Plans: Another type of private plan that you can purchase once you have Original Medicare. Usually only includes a prescription benefit.
  • Medicare Supplements (Medigap): Another type of private plan that you can have in addition to Original Medicare. Adds more financial coverage, like for copayments and deductibles.

You can choose from the following combinations: 

  • Original Medicare only
  • Original Medicare and a Prescription Drug Plan
  • Medicare Advantage
  • Medicare Advantage with Prescription Drug Coverage
  • Medicare Supplement
  • Medicare Supplement AND standalone Prescription Drug Plan
Different Types of Medicare Plans
Types of Medicare Plans

Original Medicare Only

Having Original Medicare only means you’ve enrolled in the government program, Medicare Part A and Part B, but you have not enrolled in an additional (private) plan. Parts A and B can cover some of your hospital and medical costs, but they do not cover prescription drugs and other additional benefits such as dental and vision. 

Original Medicare and a Prescription Drug Plan

If you don’t think you need any other medical benefits aside from what parts A and B cover, but you do need prescription drug coverage, you can enroll in a standalone prescription drug plan in addition to your Original Medicare.

Medicare Advantage

With a Medicare Advantage (MA) plan, you’ll still have to pay your Part B premium, but you can get other benefits. MA plans can include additional health benefits such as fitness program memberships, dental care, vision, and more. 

Choosing a Medicare Advantage Plan

So, did you decide to go with Medicare Advantage? Great! Now, there are a few types of Medicare Advantage plans that may be available for you. First, ask yourself whether or not you need a large network and whether the freedom to see any doctor is important to you. Then, read through these important differences:

  • HMO Plans (Health Maintenance Organization) – You’ll select one primary physician. In some cases, you may only receive coverage for that one doctor (unless he or she refers you to a specialist). Requirements may vary based on your plan.
  • HMO-POS Plans (Point-Of-Service) – You’ll select one primary physician, but you’ll have the freedom to visit any specialist in your network for your other needs. You will be charged a fee for visiting specialists.
  • PPO Plans (Preferred Provider Organization) – You can see any doctor, but your costs will usually be lower if you choose one that is in your network.
  • PFFS Plans (Private Fee-For-Service) – You will not need referrals or a primary physician, but you’ll have to pick a doctor that accepts your PFFS plan.
  • SNP (Special Needs Plans) – Designed for those who are eligible for both Medicare and Medicaid, live in a nursing home, or have a chronic illness or disability.
  • MSA (Medical Savings Account) – Works like a tax-free savings account for your medical bills. Medicare will deposit money into your HSA. You can use that account to pay for medical expenses.

Medicare Advantage with Prescription Drug Coverage

Some select Medicare Advantage plans come with a prescription drug benefit. This is important because you can’t have BOTH a Medicare Advantage plan and a standalone prescription drug plan. If you like the idea of Medicare Advantage but need prescription coverage, a “MAPD” or Medicare Advantage Prescription Drug Plan may be right for you. 

Medicare Supplement

Sometimes called “Medigap,” Medicare Supplement plans bridge the gap between your Part A and B costs and your out of pocket costs. For example, Medigap Plan A covers Part A* coinsurance and hospital costs, Part B coinsurance and copayments, up to three pints of blood, and hospice coinsurance and copayments. It does not offer additional health benefits, but it eliminates many of the costs that come with Part A and B. 

The best Medicare Supplement plan is the one that fits your needs at the time. For example, you might not need skilled nursing care when you first sign up for Medicare, so Plan A might work best for you. Eventually, your health condition may require more inpatient services and skilled nursing services, so Plan D may be a better fit.

*Be careful not to confuse Part A with Plan A

2020 Medicare Supplement Comparison Chart
2020 Medicare Supplement Comparison Chart

Medicare Supplement AND a Prescription Drug Plan

Medicare supplements do not offer any prescription coverage, but you are able to enroll in both a Medicare Supplement plan and a standalone Prescription Drug Plan at the same time. 

What is the Best Medicare Plan in 2020?

Everyone wants to know what the “best” Medicare plan is, but just like shopping for anything else, “best” can be subjective. If you were shopping for a vacuum cleaner, you’d probably search “best vacuum cleaners,” too, but what would you find?

We did that part for you, and we got about 228,000,000 results. You’re never going to sort through all those options, right?

Medicare search
Google search results for “Best Vacuum Cleaners”

When you really want to narrow down the best vacuum for your needs, you’re probably going to filter your search by price, capabilities, maybe even the size of the vacuum…any number of things that are going to narrow down your choices to what you really want to purchase.

While there probably aren’t 228,000,000 Medicare plans available to you, there are far too many for this to be a quick Google search! Like choosing the “best” vacuum, choosing the “best” Medicare plan for you requires some research.

Medicare Plan Finder Tool

Our Medicare Plan Finder tool compares plans from carriers in your area. You’ll have to tell us your birthdate and a few other things so that we can determine what you’re eligible for.

Medicare Plan Finder Tool
Medicare Plan Finder Tool

Once you’ve entered your information, you’ll see a graph showing you the names of the plans and the potential premiums you might owe for those plans. This is a great place to start your research.

We ran a sample search for a 76-year-old non-smoking woman in Nashville who wanted a low premium to show you what the results look like. Your online Medicare Plan Finder results may not look the same.

2020 Medicare Plan Finder Tool Search Results
Medicare Plan Finder Tool (These search results may not be an accurate representation of your search results)

New Tool

You may have heard the buzz about’s new plan finder tool. They’re offering a “new and improved” experience after getting complaints about their old tool. 

To use’s tool, you’ll need to enter your Medicare number and some other information. Then, you’ll see a graph of the plans available in your area.

Scour the Internet

We don’t recommend this option, but you could start your Medicare plan shopping experience with a quick Google search. However, watch what happened when we Googled “best medicare plan.” The first four search results are ads.

Best Medicare Plan Google Search
Google search results for “Best Medicare Plan”

The other thing you can try is going directly to the carrier websites, if you already know the name of a company you’d like to purchase from. However, keep in mind that those websites are only going to show you a select group of plans that they alone offer. You could be missing out on better plans from different carriers.

Meet With a Licensed Agent

Another option for Medicare plan research is to let a licensed agent do the work for you. 

Let’s go back to our vacuum cleaner example. Imagine if you had someone do all the vacuum research for you and then present you with only one or two options that meet your needs. Imagine if that service was free, and all you had to do was talk to the agent for a few minutes to hear about all the benefits. What if the vacuum didn’t cost anything different just because you bought it from the agent instead of Amazon. Wouldn’t you take that deal?

At, we have agents across 38 states that can help you sort through your Medicare options and narrow it down for you. The appointments are free and easy, and you won’t pay any more for your Medicare plan whether you buy it from a licensed agent or online by yourself.

The difference is that our agents are experienced and can tell you all the ins and outs of your plan options (maybe even more than what is advertised online)! 

Ready to get started? Give us a call at 844-431-1832 or click here to have an agent call you.

When Can You Enroll in Medicare in 2020?

Your enrollment periods will depend on a few factors, such as:

  • What type of coverage are you hoping to enroll in?
  • Are you over the age of 65?
  • Do you have a chronic condition or low income that qualifies you for a Special Enrollment Period?
  • Do you have a qualifying life event such as moving to a new state where different plans are available?
Medicare Enrollment Periods

Initial Enrollment Period

Your Initial Enrollment Period is the time you get started with Medicare coverage.

If you are eligible for Medicare due to age (you are over 65 or about to turn 65), your Initial Enrollment Period will last from three months before your 65th birthday through three months after.

Initial Enrollment Period Medicare
Initial Enrollment Period Medicare

If you qualify for Medicare for another reason, such as having a disability or chronic illness, your Initial Enrollment Period will be the month of your diagnosis.

Annual Enrollment Period

Once you’ve enrolled in Original Medicare (Parts A and B), you’re eligible for the Annual Enrollment Period. The AEP runs from October 15 through December 7 of each year. During this time, you can enroll in Medicare Advantage or Part D (prescription drug coverage).

Special Enrollment Period

There are two types of Special Enrollment Periods: Immediate/consequential and “long-term”. If you qualify for an immediate Special Enrollment Period, you typically have 90 days to make a change following a major life event. If you qualify for a “long-term” special enrollment period, you are able to change plans once per quarter for the first three quarters of the year (and during AEP, which falls during the fourth quarter of the year). Keep in mind that a SEP is never truly permanent, as you could lose your eligibility at any time due to a major life change.

To qualify for an “immediate” SEP, you must incur a major life change such as moving to a new service area that has different plans available (a different zip code), moving into or out of a medical facility, gaining or losing Medicaid eligibility, etc. You can also gain a SEP if your plan decides to leave the Medicare program

To qualify for a “long-term” SEP, you must be:

  • Eligible for Medicaid,
  • Eligible for a Medicare Savings Program,
  • Eligible for a Special Needs Plan, or
  • Eligible for LIS (Extra Help)

Other Enrollment Periods

Technically, there are two other Medicare enrollment periods as well.

The General Enrollment Period runs from January 1 through March 31 and is a time when people who missed their Initial Enrollment Period can sign up for Medicare parts A and B. The Open Enrollment Period also runs from January 1 through March 31 and is for those who selected a Medicare Advantage plan during AEP and changed their mind.

It’s important to make note of all the Medicare enrollment periods and which ones you are eligible for so that you don’t miss your chance to enroll!

Ready to get started? Give us a call at 844-431-1832 or click here to have an agent call you during your enrollment period.

This post was originally published on October 16, 2019 and was last updated on November 1, 2019.

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