New to Medicare

Your Medicare Journey Starts Here

As you are quickly finding out, Medicare has a lot of moving parts. These include various enrollment periods, benefit plan options, penalties and costs.

You are probably asking yourself how do you organize all this information?

Here is where we come in.  By following our PATH℠ process, you will be able to make informed decisions regarding when to enroll in Medicare Parts A and B, which plans to select to complete your Medicare benefits, how to coordinate your coverage to prevent gaps, and finally, how to avoid any penalties.

Let’s get started!

Let's Prepare You For Your Transition to Medicare

The first step of a journey is always the most important one. That’s why “P,” for “Prepare,” is the initial and most crucial step in our PATH℠ process.  

With basic information, such as your 65th birthday or the day you are retiring, we can successfully map out your timeline and the required steps for a stress-free, on-time enrollment into Medicare.

As we navigate the PATH℠ process together, you will find yourself empowered with the knowledge and confidence to make the right decisions regarding your Medicare benefits.

Medicare Basics

Below are the fundamentals that you need to know as you begin your Medicare journey.

Medicare is a federal health insurance program that is administered through the Centers for Medicare and Medicaid Services (CMS). Since 1966, it has been providing important health insurance coverage to individuals over the age of 65, as well as those with certain qualifying disabilities.

This program is often referred to as Original Medicare, with two main components:

✓  Part A: Inpatient hospital and skilled nursing services

✓  Part B:  Outpatient services, doctor visits, durable medical equipment, and some preventive care

While Original Medicare provides comprehensive health insurance coverage, it does not complete your insurance benefits.

You might need to consider supplemental insurance:

✓  Part C (Medicare Advantage)

✓  Part D (Medicare Prescription Drug Coverage)

✓  Medicare Supplement (a secondary payer to Original Medicare)

Learn More About Medicare Basics 

Medicare has a number of requirements to be eligible for enrollment:

 You are 65 years or older

You are a US citizen or legal resident (an alien lawfully admitted for permanent residence and has been living in the United States for 5 consecutive years prior to applying for Medicare)

You are also eligible for Medicare enrollment if:

You have a qualifying disability at any age

You have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s Disease)

Knowing when to enroll in Medicare is equally as important as choosing your Medicare benefits.  Specific enrollment periods were created to accommodate various life events and changes.  

Below are the five most common life events that create an enrollment period into Medicare:

  You’re turning 65 – Initial Enrollment Period

  You’re working past 65 – Special Enrollment Period

  You missed your initial enrollment into Medicare – General Enrollment Period

  You want to change your Medicare benefits – Annual Enrollment Period

  You experience a life change while enrolled in Medicare – Special Enrollment Period

Identifying your applicable enrollment period is crucial as it will determine when and how you apply for your Medicare benefits.  It is important that you understand that, in most scenarios, enrollment into Medicare or changing Medicare benefits is not automatic. Get the facts so you can avoid penalties and delays in coverage.

Learn More About Medicare Enrollment Periods

For most, turning 65 is the first time you are eligible for Medicare. If you are enrolling in Medicare because you are turning 65, you would apply during your Initial Enrollment Period (IEP), which is a 7-month window that surrounds your 65th birth month.

Applying during you IEP allows you to also complete your Medicare benefits by adding a Part C (Medicare Advantage) or a Medicare Supplement and a Part D plan.

→ Learn more about your IEP 

Today, more and more people are deciding to work past their 65th birthday and delay enrolling into Medicare.  If you decide to work past 65, there are important details regarding your employer coverage that will determine your ability to remain on your current health plan, or if you need to apply for Medicare Parts A and/or B.

→ Learn more about Working Past 65 

Your total out-of-pocket costs related to Medicare will vary based on where you live, the plans you select, and your income.

When calculating your costs for Medicare, you will have expenses associated with Medicare, such as Part B premiums, Part B IRMAA premiums, and Part D IRMAA premiums. You can also incur premiums associated with Medicare Part C, Part D and Medicare Supplement. Lastly, when you use your Medicare benefits, whether under Original Medicare, Part C or Part D, you may encounter deductibles, copays, and coinsurance.

When considering costs, it’s important to calculate not only your monthly premiums, but also your maximum out-of-pocket expenses in case of a significant medical event during the year.

Learn More About Medicare Costs

After enrolling in Original Medicare, there are additional decisions that you need to make. While Parts A and B provide comprehensive health insurance coverage, it does not complete your insurance benefits.

There are two options to consider when completing your Medicare benefits.

Option 1 – Original Medicare with a Medicare Supplement and Part D plan. The first option involves making Original Medicare your primary payer for medical claims. With this choice, you would receive care from providers contracted with Medicare, and they would bill Medicare for services. To cover the gaps in Medicare Parts A and B, you would add a Medicare Supplement plan to your benefits. Lastly, you would also need to include a stand-alone Part D plan to fulfill your prescription drug needs.

Option 2 – Part C (Medicare Advantage). The alternative to the first option is selecting a Medicare Advantage plan. These all-in-one plans, covering Parts A, B and D, are approved by CMS and operated by private companies. These plans usually come in HMO, PPO, POS, PFFS and MSA formats. Medicare Advantage plans offer the same benefits as Original Medicare, but can provide additional benefits above what Original Medicare offers.

Tip:  Before enrolling in any plans, it is important to check:

  if your doctors participate in the network

  if your prescriptions are covered (on the formulary)

 what your out-of-pocket costs are for anticipated care

Learn More about Plan Options

Need Help Navigating Medicare?

Our licensed Medicare insurance agents are here to walk you through this process step by step.
   Contact us today to start your PATH℠ journey with us!

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