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Your Guide to Health Insurance & Discounts

Frequently Asked Questions (FAQ)

Have a question? Here as some answers. Below is a list of healthcare frequently asked questions to help you increase your understanding.

 Part A: helps pay for inpatient stays at hospitals, short-term nursing facilities, home health services, and even hospice care.

 Part B: helps pay for doctors’ services, outpatient care, diagnostic tests, preventive care, and some medical equipment.

●  Part C (Medicare Advantage): an alternative coverage option to original Medicare that allows you to receive your Medicare benefits through one plan. These plans cover Part A and Part B services, and most include Part D drug coverage. Many Part C plans also provide extra benefits that are not included with Original Medicare. 

●  Part D: helps cover the cost of outpatient FDA-approved prescription drugs.

Medicare covers some but not all healthcare costs. Depending on which plan you choose, you may need to pay premiums, deductibles, copayments, and coinsurance. The cost of these payments may change from year to year.

Yes. Medigap and Medicare Supplement Insurance are the same thing. This type of policy, which is sold by private insurance companies, can help pay some of the out-of-pocket costs that Original Medicare (Part A and Part B) doesn’t pay.

Yes. There are healthcare resources available for people with a lower income. You can explore some options below.

● Medicaid
Medicaid is a federal program that funds medical assistance for specific individuals and families in all states. Medicaid is the largest source of funding for medical and health-related services for people with limited income. Find out more by calling Centers for Medicare and Medicaid Services’ toll-free number: 1-877-267-2323

● State Health Insurance Assistance Programs
State Health Insurance Assistance Programs provide free, unbiased health insurance information for Medicare-eligible individuals. Learn more by calling the State Health Insurance Assistance Program National Technical Assistance Center: 1-877-839-2675.

● Health Resources and Services Administration (HRSA) Information Center
The HRSA information center provides resources and referrals on health care services for low-income, uninsured patients. You can find out more through the HRSA website or by calling:1-877-464-4772

Medicare has different time periods for when you can enroll in Medicare or Medicare-related coverage options, and for when you can make Medicare coverage changes. These enrollment windows occur during different times of the year and have specific rules around eligibility requirements and actions you can take. 

●  Initial Enrollment Period (IEP) – Three months before you turn 65, you enter your Medicare Initial Enrollment Period (IEP). Your IEP lasts a total of 7 months. It includes the three months before your turn 65, the month of your 65th birthday and the three months after. During this period, you can enroll in Medicare Parts A, Part B or both – also known as Original Medicare – and you can also choose to enroll in a Medicare Advantage (Part C) or a stand-alone Medicare Part D prescription drug plan. Be sure to enroll in Medicare on-time as Medicare Part A, Part B and Part D have late enrollment premium penalties that could quickly add up.  

●  General Enrollment Period (GEP) – If you missed your Initial Enrollment Period, you get another opportunity to enroll during the General Enrollment Period (GEP).  This enrollment window in open from January 1 – March 31 each year. During this period, you can enroll in Medicare Part A, Part B or both (also known as Original Medicare). Your coverage will begin on July 1 of the same year.  You may also be eligible to next enroll in a Medicare Advantage plan or a stand-alone Medicare Part D prescription drug plan between April 1 and June 30 of the same year.

● Special Enrollment Period (SEP)

-  If you work past 65 or have health insurance through a spouse's employer, you may be able to delay enrolling in Medicare. In this situation, Medicare gives you a Special Enrollment Period (SEP) of 8 months. Your SEP begins after you lose the employer coverage or leave your job, whichever happens first.  During these 8 months you can enroll in Medicare Part A and Part B (also known as Original Medicare). But it's important to note, you will have only the first 2 months of your SEP to enroll in a Medicare Advantage (Part C) plan or a stand-alone Medicare Part D prescription drug plan without penalty.

- Medicare also offers a special enrollment window to address special circumstances or life events. This Special Enrollment Period (SEP) is different from the one for people working past 65 and it is designed only for individuals who have Medicare coverage and who experience a qualifying life event, such as moving to a new state or county where their current coverage is not available.  This SEP lasts 2 months, and during this time, you can enroll in a new Medicare Advantage plan or a stand-alone Medicare Part D prescription drug plan. You can alternatively decide to drop your Medicare Advantage plan and return to Original Medicare (Medicare Part A and Part B only), in which case you can then enroll in a stand-alone Medicare Part D plan.

●  Annual Enrollment Period (AEP) – Formerly known as the Open Enrollment Period, this period is open every year from October 15 – December 7. During this Medicare Annual Enrollment Period, you can join, switch or drop a Medicare Advantage plan, or a stand-alone Medicare Part D prescription drug plan.  If you choose to drop your Medicare Advantage plan, you will return to Original Medicare (Medicare Parts A and B only) and lose any drug coverage or other health benefits the Medicare Advantage plan provided. If you return to Original Medicare, you can enroll in a stand-alone Medicare Part D plan for prescription drug coverage. Any changes you make will take effect January 1 the following year.

● Medicare Advantage Open Enrollment Period – This is a new enrollment window Medicare opened up in 2019. This window is only for people who are currently enrolled in a Medicare Advantage plan.  It runs from January 1 - March 31 each year and during this time, Medicare Advantage plan members can switch to a new Medicare Advantage plan or drop it and return to Original Medicare (Parts A and B). If you return to Original Medicare, you can also add a stand-alone Medicare Part D prescription drug plan during this time.
 

Sources: Center for Medicare and Medicaid Services and Medicare.gov. 

 

 

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