The Medicare Plan Store

Making sense of Medicare
and talking about what you need to know about your health care choices.

Medicare Enrollment in the Age of COVID-19

Life goes on, even during this period (and who knows how long it will last?) of social distancing and work-from-home brought on by the now-infamous coronavirus. Those of us born in 1955 are still going to turn 65 this year, coronavirus or not! What to do about it? What has changed, what is new?

Julie Carter recently wrote an enlightening article explaining how those eligible to enroll can do so either by online application, via phone (1-800-772-1213 from 7 AM to 7 PM, Monday through Friday), or through the mail. Planning is essential, as it may take the SSA up to 21 days to process a Medicare application.

Medicare Part B. The article also mentions: “People applying for Medicare Part B due to a loss of employment or group health coverage will also need to complete form CMS-L564 (Request for Employment Information). Currently, some beneficiaries are experiencing difficulties gathering this paperwork. SSA seems to recognize these challenges, but clarity is needed on how the agency plans to alleviate this administrative burden during the emergency period.”

The Social Security Administration (SSA) has an FAQ page to answer Coronavirus questions. Read the entire article here »

Get Medicare Answers

1. Where can I find information on Medicare supplement insurance in Ohio?
A. If you are receiving Social Security, you will receive a consumer guide in the mail from The Ohio Department of Insurance. Read it online.
2. What is the difference between Medicare and Medicaid?
A. Medicare is federal health insurance for people age 65 or older, under 65 with certain disabilities and any age with End Stage Renal Disease (permanent kidney failure) requiring dialysis or a kidney transplant. Medicaid is a medical assistance program for low-income people and jointly funded by the federal government and the states.
3. Is Medicare free?
A. To qualify for Medicare you must have contributed to it through U.S. payroll taxes for at least 10 years (40 quarters) before turning 65. For this fact alone, it’s not free. However, many people do not pay a premium for Part A. Part B is not free. When Medicare started in 1965, Part B was $3 per month. Today’s monthly premium is $104.90 or higher! Advantage plans and supplemental insurance add to the cost.
4. What is an Advantage plan?
A. Medicare Advantage plans (Part C) are part of the Medicare Program but run by private insurance companies. With Medicare Advantage plans you generally get all your Medicare-covered health care through that plan. Coverage can include prescription drug coverage or extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs. You may have to use the plan’s network doctors and hospitals to get services. You don’t need to buy a Medigap policy when you have an Advantage Plan. These plans may require a monthly premium in addition to your Part B premium.
5. Am I eligible for Medicare?
A. Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you are not yet 65, you might also qualify for coverage if you have a disability or have End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

Most people on Medicare pay a premium for Part A. However, you can get Part A at age 65 without having to pay premiums if:
  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to get Social Security or Railroad benefits but you haven’t yet filed for them.
  • You or your spouse had Medicare-covered government employment.
  • If you are under 65, you can get Part A without having to pay premiums if you have:
    • Received Social Security or Railroad Retirement Board disability benefits for 24 months.
    • End-Stage Renal Disease and meet certain requirements.
  While you do not have to pay a premium for Part A if you meet one of these conditions, you must pay for Part B if you want it.
6. How do I enroll in Medicare?
A. If you began receiving Social Security income prior to age 65 or you receive Social Security disability income, your enrollment is automatic. Everyone else must apply for Medicare through the Social Security office.
You can apply online.
7. How long do I have to enroll?
A. If are just now turning 65, you have a total of seven months to enroll beginning three months before the month of your 65th birthday and ending three months after the month of your 65th birthday. If you apply before your birth month, your Medicare coverage should start on the first day of your birth month.
8. What happens if I miss the enrollment period?
A. If you don’t enroll in Medicare during your initial seven-month enrollment period, you must wait to apply during the next general enrollment period (January through March each year and the effective date will be July 1). You may also owe a 10 percent penalty on your Part B premium for each year you delay Part B.
9. Who can help me understand Medicare?
A. We can! There are other resources through The Ohio Senior Health Insurance Information Program (OSHIIP) 1-800-686-1578. Whatever you do, we recommend that you talk to someone who can ask the right questions, come to understand your circumstances, needs and budget, and recommend a plan that is right for you.
10. Why do I need Medicare supplement insurance?
A. Original Medicare does not pay all medical expenses. A Medicare supplement policy fills most of Medicare’s coverage gaps. You have options.
11. Does Medicare cover care in a nursing home?
A. Medicare does not cover long-term care in a nursing home. However, you may be covered for short stays in a skilled-care facility. You must meet certain pre-entrance requirements in order to qualify for benefits. If you’re eligible, Medicare will cover skilled care for the first 20 days and a certain amount each day for days 21-100. After 100 days per benefit period, Medicare pays nothing.
12. Does Medicare cover home health care?
A. Yes, but only if your doctor orders part-time skilled care and you are homebound. If you meet Medicare’s requirements for home health care, it is paid at 100 percent.
13. Will Medicare pay for hearing aids, dentures, eye exams, eyeglasses, etc.?
A. No. Coverage is available through stand-alone insurance plans or through most Medicare Advantage plans.
14. Who qualifies for Medicaid?
A. Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers.

Medicare Plan Tips

Do you have the right plan? Shopping for health insurance is difficult even for those who are generally comfortable with financial affairs.

7 TIPS FOR CHOOSING PART D

  1. Compare plans for the specific drugs you use and recheck every year.
  2. Premiums are projected to rise each year, so be sure you receive value.
  3. Pay attention to copayment and coinsurance. It’s the combination of copays and premiums and the deductible that impacts the total cost.
  4. Over half of Part D plans (53%) charge a deductible, but that could change next year.
  5. Compare the medications you need to the formulary and make sure a pharmacy near you is compatible with the plan. If you sign up for a plan that requires you to fill all your prescriptions at a specific pharmacy, you could end up paying more.
  6. Don’t delay signing up when you’re first eligible, or go 63 days or more with prescription drug coverage or it may cost you more.
  7. The Part D “donut hole” is gradually closing for those spending $3,310 in prescription drug costs, but most Part D plans offer no gap coverage now, and those that do provide only generic brands. Do the math.

7 TIPS FOR CHOOSING AN ADVANTAGE PLAN

  1. Call your doctor to see what plan they accept, and which one they recommend.
  2. Look at the plan’s entire cost, not just the premiums and deductibles. Compare out-of-pocket maximums plus copays and coinsurance for doctor visits, tests, specialists, etc. (Remember, if you are enrolled in an advantage plan, you are not eligible for a Medigap supplement policy.)
  3. Check the plan’s drug formulary — the list of prescription drugs covered — to be sure the meds you take are covered or that you don’t have to try less expensive drugs first.
  4. Check to see whether your extra benefits are covered, like dental, vision, and hearing — if these benefits are important to you.
  5. Some plans limit you to using in-network doctors only, so find out what’s covered if you have an emergency outside your network area.
  6. Make sure the doctors in the plans you’re considering are located near you, and check to see if hospitals, home health agencies and skilled nursing facilities are nearby too.
  7. If you have coverage from a former employer, check with the benefits manager to be sure signing up for an Advantage plan won’t void your retiree coverage.

What is Medicare?

Medicare is a federal health insurance program for people 65 and older and certain younger people with disabilities and people with End-Stage Renal Disease (ESRD). 

Medicare will likely cover you for more years than any other medical plan you have ever had.

MEDICARE PARTS: 4+

Parts A and B are considered Original Medicare. Part A is free and Part B has a monthly premium ($104.90 in 2013) which is either deducted from your Social Security check or paid quarterly if not collecting Social Security.

Part A covers hospital benefits and Part B covers physician services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment.

Official Name Commonly Called Cost /
Payment
Coverage
Type
Part A Original Free Hospital care
Part B Original Deducted from SSA check Medically-necessary and/or preventive services
Part C Advantage Commercially available Parts A & B provided by a private insurer
Part D Prescription Drugs Optional extra with Part C Prescription drugs
Supplement Medigap Commercially available Uncovered expenses, e.g., copayments, coinsurance, and deductibles
Learn more about Supplemental Plans »

To learn more about Medicare in general, we suggest MedicareMadeClear.com or simply contact us.

Know Your Medicare Options

Most people simply stick with their current coverage. And that’s fine if your current plan gives you the coverage you need at a reasonable cost, covers your medications, and provides access to high-quality care in locations convenient for you.

Questions to ask yourself during Medicare’s Open Enrollment Period:

  • Has my health changed in any major way this year?
  • Has my financial situation changed in any major way?
  • Am I taking any new or different medications?
  • Have my premiums increased?
  • Have my copayments increased?
  • Is my doctor still in the plan?
  • Are the medications I’m taking still in the plan?
  • Is my preferred pharmacy still in the plan?

If any of your answers cause concern, you should take a look at other plans to see whether they better meet your needs and budget.

Look closely though. For example, if prescription coverage has increased, before you choose another less expensive plan, be sure that plan still covers the medications you take.

Contact

Wish to get in touch? We’d love to work with you.

The Medicare Plan Store
5643 Cheviot Road, Suite 3
Cincinnati, OH 45247

(513) 451-8131

Fax: (513) 451-0094

facebook share LinkedIn logo

Disclaimer

When you call the number listed on this website, you will be directed to a licensed insurance sales agent or broker.

This website is a solicitation of insurance. By providing us with your contact information, you agree that an authorized representative or licensed insurance agent/producer may contact you by telephone, email or mail to answer your questions or provide additional information about Medicare Advantage, Part D or Medicare Supplement Insurance plans.

© 2011–20 The Medicare Plan Store, LLC. All trademarks, logos and other marks appearing in this website are the property of their respective owners. | ActiveCanvas