What Is The Medicare Advantage Plan Initial Coverage Election Period:
Most beneficiaries are first eligible to enroll in a Medicare Advantage plan during the Initial Coverage Election Period. Unless you delay Medicare Part B enrollment, this enrollment period takes place at the same time as your Initial Enrollment Period , starting three months before you have both Medicare Part A and Medicare Part B and ending on whichever of the following dates falls later:
- The last day of the month before you have both Medicare Part A and Part B, or
- The last day of your Medicare Part B Initial Enrollment Period.
If youre under 65 and eligible for Medicare due to disability, your IEP will vary depending on when your disability benefits started.
Factors That Affect Original Medicare Out
- Whether you have Part A and/or Part B. Most people have both.
- Whether your doctor, other health care provider, or supplier accepts assignment.
- The type of health care you need and how often you need it.
- Whether you choose to get services or supplies Medicare doesn’t cover. If you do, you pay all the costs unless you have other insurance that covers it.
- Whether you have other health insurance that works with Medicare.
- Whether you have Medicaid or get state help paying your Medicare costs.
- Whether you have a Medicare Supplement Insurance policy.
- Whether you and your doctor or other health care provider sign a private contract.
How To Sign Up For Medicare Supplement Insurance Plans: When Can I Enroll
Medicare Supplement insurance plans are voluntary, additional coverage that helps fills the gaps in coverage for Original Medicare. The best time to enroll in a Medicare Supplement insurance plan is during your individual Medigap Open Enrollment Period, which is the six-month period that begins on the first day of the month you turn 65 and have Medicare Part B. If you decide to delay your enrollment in Medicare Part B for certain reasons such as having health coverage based on current employment, your Medigap Open Enrollment Period will not begin until you sign up for Part B.
During your Medigap Open Enrollment Period, you have a guaranteed-issue right to buy any Medigap plan sold in your state. This means that insurance companies cannot reject your application for a Medicare Supplement insurance plan based on pre-existing health conditions or disabilities. They also cannot charge you a higher premium based on your health status. Outside of this open enrollment period, you may not be able to join any Medigap plan you want, and insurers can require you to undergo medical underwriting. You may have to pay more if you have health problems or disabilities.
Do you have more questions? Connect with any of our licensed insurance agents to discuss a Medicare plan that may be right for you.
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Medicare Advantage Plan Types
Medicare Advantage plans generally have networks of providers that accept their plan. That network might be just in one or two counties or occasionally we see them include a whole state. You agree to treat with those providers according to the plans rules.
The most common types today Health Maintenance Organizations and Preferred Provider Organizations . Standard HMO plans require you to see only providers in their network, except in emergencies. This is more restrictive than a PPO plan, so we often find that Medicare HMO plans costs less than Medicare PPO plans, but not always.
Theres one other type of plan too.
In some areas, you may find plans called Medicare PFFS plans. These usually have a small network with a feature that allows doctors outside the network to treat you. You must notify the doctor up front about your coverage, and he can treat you if he is willing to accept the plans payment terms and conditions.
This made PFFS plans popular with folks that like to travel, such as RV groups.
However, a few years back Medicare began phasing out PFFS plans in any counties where at least two HMO or PPO providers were operating. We dont find as many available these days.
Enrolling In Medicare Part D
The first opportunity for Medicare Part D enrollment is when youre initially eligible for Medicare during the seven-month period beginning three months before the month you turn 65, or during the seven-month period beginning three months before your 25th month of disability.
In both of these cases whether youre turning 65 or are eligible for Medicare because of a disability you likely have the option of selecting a Medicare Advantage plan that includes Part D prescription drug coverage, and using that in place of Medicare A, B, and D
If you enroll in Medicare during the period, you can enroll in Part D between April 1 and June 30.
If youre enrolled in a Medicare Advantage plan and use the Medicare Advantage open enrollment period to switch to Original Medicare, youll also have the option to sign up for a Part D plan to supplement your Original Medicare coverage.
Suggested reading: Seven rules for shopping Medicare Part D plans
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Medicare Supplement Plan G: How It Works
In order to purchase a Plan G, you must be signed up for Medicare Part A and B. If you have a Medicare Advantage Plan, you cannot purchase a Medicare Supplement.
After you decide you want the Part G plan, you pay the private insurance company of your choice a monthly premium. This premium is separate from the Medicare Part B premium.
Your Plan G policy only covers yourself. If your spouse or partner wants supplemental coverage, he or she will also need to purchase a plan.
Any Plan G is guaranteed renewable even if you have health problems. In other words, the insurance company cant drop you from the plan. The only stipulation is that you must pay your premium on time.
Does Medicare Cover The Shingles Vaccine
En español | Unlike some common vaccines, like those for the flu, hepatitis B and pneumonia, shingles shots are not covered under Medicare Part B, the component of original Medicare that includes doctor visits and outpatient services. Part A, which deals with hospital costs, doesnt cover shingles shots either.
Medicare coverage for Shingrix and Zostavax, the two commercially available shingles vaccines, is provided only if you are enrolled in a stand-alone Part D drug plan or a Medicare Advantage plan that includes Part D drug coverage.
Medicare requires Part D plans to cover the shingles vaccine, so if youre enrolled in Part D, you shouldnt have difficulty obtaining the shot. Most require a copayment, which can vary widely from plan to plan.
And if you havent yet met your plans deductible for the year, youll likely pay the full price. For Shingrix, the newer vaccine, that averages around $190, according to GoodRx, a website and app that tracks prescription prices.
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Is Part B Needed
Medicare Part B is optional, but there are penalty fees for signing up after the initial enrollment period. Its important to note that Part B can help pay for care thats not covered by your VA benefits. So, while its not a requirement, it is good to enroll once you qualify.
If you are going to sign up for a Medicare Advantage plan or Medicare Supplement plan you need to have Medicare Part B in place first.
Does Medicare Pay For Shingles Shots
Heres the quick answer
Surprisingly, Original Medicare doesnt cover the shingles vaccine, even though it covers other vaccines like the flu vaccine and pneumonia shot.
On the other hand, Medicare Part Dor a Medicare Advantage plan that includes Part D coveragetypically does cover the vaccine.
The devil is in the details
Every Part D plan is different, so your copay for a shingles vaccine could vary from one insurance plan to another. For this reason, its always good to check your plans formulary to see which vaccines they cover and which tier those medications fall under.
Part D covers a lot more than the shingles vaccine, providing coverage for prescription medications. If you need the shingles vaccine and prescription drug coverage, see our guide on how to find the best Part D plan for you, orlearn more about Part D first.
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Medicare Advantage Vs Medigap
People who only have Medicare Parts A, B, and D may incur sizable bills not covered by Medicare. To close these gaps, recipients can enroll in some form of Medigap insurance or in a Medicare Advantage plan .
One important thing to know about Medigap: It only supplements Medicare and is not a stand-alone policy. If your doctor doesn’t take Medicare, Medigap insurance will not pay for the procedure.
Insurance agents are not allowed to sell Medigap to participants of Part C, Medicare Advantage.
Medigap coverage is standardized by Medicare but offered by private insurance companies. According to, Patrick Traverse, founder of MoneyCoach, Mt. Pleasant, S.C.,
“I recommend that my clients purchase Medigap policies to cover their needs. Even though the premiums are higher, it is much easier to plan for them than what could be a large out-of-pocket outlay they might have to face if they had lesser coverage.”
Do I Need Medicare Part D If I Don’t Take Any Drugs
If you are healthy and donât take prescription medicines, you might be asking yourself if having a Medicare Part D Drug Plan is necessary.
Part D plans cover prescription drugs, so it may not seem like an obvious choice. However, not enrolling in a Part D plan may cost you more money in the long run, either through late enrollment penalties or through unexpected and expensive prescription costs.
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What Does Medicare Supplement Insurance Cover
Because Medicare doesnt cover at 100%, you must pay a portion of your medical expenses. Your portion includes deductibles, co-payments, and excess charges. An excess charge occurs when doctors accept original Medicare Part B, but they do not accept assignment. When this happens they can charge you an additional 15% over the Medicare approved rate.
Some booklets indicate that Medicare Supplement Plans cover items not covered by Medicare. But personally, I think its misleading. Medicare Supplement plans typically dont cover services that original Medicare doesnt cover.
Ill give you an example. Medicare doesnt cover hearing aids. So because of that, your Medicare supplement plan wont cover it either, unless its an Innovative or Extra plan. Ask your broker if you have access to one of these plans.
What Is Medicare Extra Help
Extra Help is a federal program that helps pay for out-of-pocket costs related to Medicare prescription drug coverage. Extra Help is also known as the Medicare Part D Low-Income Subsidy
The assistance that Medicare Extra Help may provide includes:
- Help paying Part D premiums
- Lowered out-of-pocket costs of prescription drugs
- An annual Special Enrollment Period to enroll in a Part D plan or switch to a new one
- Elimination of Part D late enrollment penalties
You automatically qualify for Extra Help if you are enrolled in Medicaid, Supplemental Security Income or a Medicare Savings Program.
You may still qualify for Extra Help if you are not enrolled in any of those programs but still have income and assets below a certain limit.
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Would A Medicare Advantage Plan Be Better Than A Medicare Supplement Plan
If you find the monthly premiums too high for a Medicare Supplement, then you might want to look a Medicare Advantage Plan instead. The low-to-no monthly premium plans are common around major metropolitan areas and less common in rural areas, where seniors may be better suited for a Medicare Supplement plan instead.
The biggest caution we give seniors considering a Medicare Advantage plan is to look at the maximum out-of-pocket cost and ask yourself, if something happened to you, would it break the bank to come up with that kind of money? Another thing to watch for is that Medicare Advantage Plans are constantly changing, so every year, seniors need to double-check to make sure all their doctors still accept their plan, and their plan still accepts all their medications .
Who Can Join A Medicare Advantage Plan
To join a Medicare Advantage Plan, you must be enrolled in Medicare Parts A and B. Some of the plans may have a monthly premium in addition to your Medicare Part B premiums which you must continue to pay. You must live within the plans service area. Also, in most situations if you have been diagnosed with End-Stage Renal Disease you cannot join a Medicare Advantage Plan. Plan benefits can change from year to year . There are generally only certain times of the year you can join a Medicare Advantage Plan. The Annual Enrollment Period runs from October 15-December 7th. This is the time of year to compare your options and change your plans if desired. There may be other times to enroll as well. Some examples might be when you first enroll in Medicare or if you qualify for a special election period. Its important to understand how your plan works before you join.
Do you have more questions about Medicare Advantage Plans? Were here to answer all your questions.
Do you need help with Medicare, insurance and healthplans? Explore your options with Allina Health Aetna, Blue Cross/Blue Shield of Minnesota, Medica and UCare. We work with you to find the best plan for your needs and budget. Contact us today to get started.
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Which Vaccines Does Medicare Cover
Medicare covers most vaccines. Some are covered by Part B, and some are covered by Part D.
Getting the vaccines you need is one of the most important things you can do for your health and for the health of those around you. Vaccines are your first line of defense against a number of infectious diseases. If you dont get sick, then you cant infect your loved ones, your friends or others in your community.
Three: Which Medicare Supplement Insurance Should You Choose
Medicare Supplement Insurance helps cover the out-of-pocket health care costs you can incur with Original Medicare Part A and Part B and hospice and home health care services. There are 10 standardized plans and premiums are regulated by the states. Massachusetts, Maine and WIsconsin have their own standardization. What you pay in monthly premiums can depend on where you live, what coverage you get and how old you are. You can learn more in this guide on comparing and selecting plans, with a side-by-side comparison of the different policies.
As you explore your options, keep in mind one caveat. During open enrollment, its easy to move from one Medicare Advantage plan to another, change your stand-alone Part D prescription plan or move from traditional Medicare to Medicare Advantage.
What is more complicated, however, is moving from Medicare Advantage to Original Medicare. Thats because, in all but four states, if you dont sign up for a Medigap policy within six months of the time Medicare Part B begins, insurers can deny you coverage based on preexisting conditions, such as asthma, heart disease, diabetes or a pending surgery.
This can significantly change the cost structure of your coverage.
Knowing what types of Medicare choices are available can help you determine which plan is right for your healthcare needs.
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Choosing Traditional Medicare Plus A Medigap Plan
As noted above, Original Medicare comprises Part A and Part B . You can supplement this coverage with a stand-alone Medicare Part D prescription drug plan and a Medigap supplemental insurance plan. While signing up for Medicare gets you into Parts A and B, you have to take action on your own to buy these supplemental policies.
Medicare Supplement Plan G What You Need To Know
June 13, 2017 By Garrett Ball
If youre turning 65, youve probably heard of Medicare Supplement Plan G. But, if youre looking for a good Medicare supplement, you might feel like youre drowning in a bowl of alphabet soup.
There are a lot of different Medigap plans Medigap is another term for Medicare supplement and it can be hard to determine which plan suits your needs and your budget.
Weve found that the Plan G is generally the best coverage at the best price, which explains why its the 2nd most popular supplement in the nation.
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Why Might I Need A Medicare Advantage Plan
The type of Medicare coverage that works best for you is your decision. Here are some of the ways Medicare Advantage plans might appeal to some beneficiaries:
Medicare Advantage plans: scope of benefits
Medicare Advantage plans often offer more benefits than Medicare Part A and Part B. Many Medicare Advantage plans offer additional benefits which may include one or more of the following :
- Medicare Part D prescription drug coverage
- Routine vision care
- Routine dental care
- Gym membership and/or other wellness programs
You might find a Medicare Advantage plan that provides the benefits you want. And you might appreciate the convenience of getting all of your health-care coverage in a single plan rather than dealing with multiple insurance companies.
Its important to note that if you pay a premium to your Medicare Advantage plan, its not the only premium youll need to pay. You still need to pay your monthly Medicare Part B premium as well, no matter what Medicare Advantage plan you might sign up for.
Medicare Advantage plans: maximum out-of-pocket costs
Medicare Advantage plans: HMO, PPO, HMOPOS plans
If you had group health insurance coverage under an employer or union plan, you might be familiar with health plans such as health maintenance organizations , preferred provider organizations , and HMO point-of-service plans. Similarly, some common types of Medicare Advantage plans include HMOs, PPOs*, and HMOPOS plans.
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