Medicare is a federal health insurance program designed for individuals aged sixty-five and older, as well as for certain individuals under sixty-five with long-term disabilities or specific medical conditions such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease. Eligibility for Medicare is not based on current health status, and once you qualify, you are automatically enrolled.

Medicare Part A provides coverage for hospital stays, hospice care, and skilled nursing facility care. For most individuals, there is no cost associated with Part A, as it is considered an entitlement program. This means that you and your employer have already contributed to the program through payroll taxes while you or your spouse were employed.

Medicare Part B covers a range of medical services including doctor’s visits, services provided by doctors while in the hospital, ambulance rides, outpatient procedures, and durable medical equipment such as oxygen machines, CPAP devices, blood sugar monitors, and diabetic test strips. Additionally, Part B also includes coverage for a limited number of prescription drugs, which are typically high-cost medications.

We meticulously select our Medicare insurance partners, exclusively collaborating with ‘A’ rated, reputable, and well-established insurance companies known for their excellence in offering Medicare Advantage, Medicare Supplement, Medigap, and Medicare Part D plans. Our partnerships extend to companies serving in Illinois, Indiana, and Wisconsin, ensuring our clients have access to quality coverage options from trusted providers.

If you are eligible for Medicare Part B but choose not to enroll, you may face a late enrollment penalty. This penalty results in higher premiums for Part B coverage for the duration of your enrollment in the program. It’s important to note that this penalty persists for the rest of your life once you decide to enroll in Part B after your initial eligibility period.

Medicare Part C, also known as Medicare Advantage, is offered exclusively through authorized insurance companies. Unlike Original Medicare, which is administered by the federal government, Medicare Advantage plans are provided by private insurance companies. These plans come in various forms, with the majority falling under the category of ‘Medicare Advantage-Prescription Drug’ plans, offering coverage for both medical services and prescription drugs.

Medicare Part D is a prescription drug coverage program designed to assist with the costs of retail prescriptions, typically obtained from local pharmacies or through mail-order services. Unlike other parts of Medicare that cover medical procedures, Part D specifically focuses on providing coverage for prescription drugs. These plans are exclusively offered by insurance companies authorized to provide Medicare coverage.

What is the Medicare Part D Late Enrollment Penalty? The Medicare Part D late enrollment penalty is an additional amount permanently added to your Medicare drug coverage (Medicare Part D) premium. This penalty is imposed if you go without Part D or other creditable prescription drug coverage for a continuous period of 63 days or more after your Initial Enrollment Period for Medicare Part D ends.

Medicare Advantage plans with Prescription Drug (MAPD) provide coverage for both medical expenses and Medicare Part D prescription drug coverage. These plans fall under Medicare Part C and are combination plans, offering coverage for medical benefits provided by Original Medicare Parts A and B, along with Part D prescription drug coverage. It’s worth noting that around 45% of the sixty-seven million people enrolled in Medicare opt for this option.

Medicare Advantage plans typically operate within three main types of provider networks: Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), and HMO with Point-of-Service (HMO-POS). While there may be some variations and exceptions, these three network types are the primary structures used by Medicare Advantage plans.

Medicare Supplement plans, often known as ‘Medigap’ plans, are insurance policies designed to cover the deductibles, coinsurance, and copays that Original Medicare Parts A and B do not cover. These plans are exclusively offered by insurance companies. To be eligible for a Medicare Supplement plan, you must be enrolled in Original Medicare Parts A and B.

Are you considering switching from your Medicare Part D Prescription Drug + Medicare Supplement plan to an all-in-one Medicare Advantage plan during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year? While making this change is relatively straightforward, reverting back to your previous plan later on may pose significant challenges.

Can you purchase a Medicare Supplement plan outside of a special window when you turn sixty-five, or will you need to undergo medical underwriting? Unlike Original Medicare Parts A and B, Medicare Part D, or Medicare Part C (Medicare Advantage plans), Medicare Supplement insurance companies have the authority to deny you coverage based on your health status.

When does the AEP occur, and what does it entail in terms of the influx of marketing efforts from insurance companies promoting Medicare Advantage or Medicare Part D Prescription Drug Plans?

What options are available for individuals who miss the Annual Election Period (AEP), which ends on December 7 each year, and still wish to make changes to their Medicare Advantage plans?

If an individual opts to switch from a Medicare Advantage plan to a Medicare Part D Prescription Drug plan during the OEP, what implications does this have for their coverage?

When selecting a Medicare plan, it’s important to consider your medical needs and budget. It also helps to review how each plan compares in terms of prescription drug coverage and provider network options.

Whether you are still working or have retired, becoming eligible for Medicare is a significant milestone. Now is the time to review your benefits and take appropriate action