Medicare Page #2 - Benefit Options 4 U

Medicare and Medicare Supplement

Tips and Resources for Applying for Coverage……..

Turning Age 65 – Individuals who have recently reached the age of 65 are advised to enroll in both Part A and Part B, automatic Part A enrollment is not guaranteed. You must enroll in Part B,

Initial Enrollment Period (IEP) 7-month period: Begins three months before your 65th birthday, including your birth month and ends three months after.
Example: If your 65th birthday is in January, submitting your application between October thru May, will be helpful in Avoiding a late enrollment penalty.

Delayed Part B – You may delay Part B enrollment until a later date, for one of the following reasons:

You are still working and covered by an employer or spouses group plan (20 or more employees); or retired and covered by your spouse’s group plan.
Retired, covered by a Retiree Group Healthcare Plan
You are covered under a Union plan
Military – Active duty or covered under VA
When you are ready to enroll, you will have, an 8-month Special Enrollment Period (SEP), begins the month group plan terminates, which ends on the 8-months, in short, you have 8 months from the date coverage is loss to enroll in Part B.

Considerations Before Delaying Part B Coverage Enrollment until After Age 65

Small group coverage provided by employers with fewer than 20 employees is not considered Group Coverage

In the event of a sudden loss of coverage, (i.e., due to layoff), you may experience a break in coverage. COBRA and/or Healthcare.gov may are not considered as Group Coverage.

In order to mitigate, a break in group coverage, when at all possible, that you do not cancel your group plan until you have been approved for Medicare.

^{NOTE: Please be aware that after Age 65, as far as Medicare eligibility, any break in coverage, where you are not enrolled in a group plan, (20 Employees or more) can and result in Late Penalties, for Part A, B and D. -These are not 1-time penalties, but life-time penalties.}

Ready to Apply for coverage

Whether you are Turning Age 65, Disabled or Older and Delayed enrolling in Part B until Retirement and now you are ready to apply for coverage, you will need to apply for coverage through the Social Security Administration.

START YOUR APPLICATION-ELECTRONICALLY: Click here Ready to sign up for Part A & Part B | Medicare, you will be re-directed to the official SSA/Medicare System to complete the necessary steps. Once on the site, where you may:

Completed and submit the application online OR
Download it, print, complete and submit it via fax or In-Person at a local Social Security Office, the SSA/Medicare System site will provide with all the information needed to complete the application.

LOCAL APPLICATION ASSISTANCE: You may also, schedule an appointment at your local Social Security Office for assistance, to locate an office near you, please phone: (800) 772-1213.

Check Your Application Status

It can take an average of 3-months from the date the application is submitted, and sometimes even longer before your application is approved. You can access the system and check on your Application Status, click on this link, Check application or appeal status | SSA, to be directed to the SSA system, to see if you have been approved.

Medicare Plan Options – Select a Plan

There are Basically 3 Types of Medicare Products available to choose from:

Original Medicare

Also called Traditional Medicare

Part A – Hospital and Part B – Doctors Office Visits, Lab Work, Preventative services, Diagnostic tests, Medical Equipment, some Transportation

Ability see any doctor within the USA, that accepts Medicare.

No referrals required to see a Specialist, No Network requirements.

Does not provide coverage Prescription Drugs, Dental, Vision Hearing Services or Long-Term Care.

Medicare Advantage

Approved plans offered by private health insurance carriers

Offered as an alternative to Original Medicare.

Covers both Part A and Part B

Some plans cover Part D – Prescription Drug or can be designed without.

Provides Comprehensive coverage, many plans include Dental, Vision, Hearing and also RX coverage.

Medicare Supplement

Also knows as Medigap

May be purchased in addition to Original Medicare, it covers services that are not covered under Original Medicare.

Pays out of pocket costs, that Medicare does not pay, such as deductibles, copayments.

Like Medicare, Medigap does not cover Part D- Prescription Dental, Vision, Hearing Services.

Now that you have been approved for both Part A** and Part B**, you can then choose a Healthcare Plan.

Ready to Select Your Plan?

Need Help? Let’s talk.

Engage in a chat

Annual Enrollment/Special Enrollment Period

Medicare Annual Enrollment Period (AEP) begins on 10/15 thru 12/07 each year.

During this time, beneficiaries can make changes to their Medicare coverage, such as switching from Original Medicare to a Medicare Advantage plan, changing their drug plan, or selecting a different carrier.

Certain life events, changes in providers due to contracting issues between the provider and carrier, plan modifications may from time-to-time lead to interruptions in your healthcare. In these situations, individuals may be eligible to make a change to their coverages during a Special Enrollment Period. The following list is some examples of situations, that may qualify under the Special Enrollment Period (SEP):

The list below is not exhaustive; there are other situations as well:

Newly eligible individuals within their Initial Enrollment Period, either having recently turned 65 and are enrolled in both Part A** & Part B** or enrolled in Part A** at age 65, but who has now retired, (no longer working) and has recently been approved for Part B**.
Moved or relocated outside of your current plan’s service network
Recently approved for Medicaid** or PACE**
Loss of Medicaid** or PACE**
A change in coverage that occurs through no fault of your own, such as when the carrier modifies the contract, may affect your ability to access benefits.
Recently moved out of an institution (Nursing home or Rehabilitation hospital), after a long-term stay.

Regardless of whether you are new to Medicare or Participating in Medicare for Years and experiencing a disruption in utilizing your coverages. We can help you.

Need Help? Let’s talk.

Engage in a chat

ACA Marketplace Coverage-What is it?

Once you have been approved for both Part A** and Part B**, you can then choose a Healthcare Plan, you have choice between 3 Basic options:

Original/Traditional Medicare Only – with or without Part D** – Prescription Drug Plan

Pros to this option

Wide provider access – May see any Provider (Doctor or Hospital) within the US and its territories, as long as the provider accepts Medicare.
No Referral

Cons to this option

Limited coverage for certain services: does not cover routine dental, vision, or hearing care, and generally excludes long-term care, most prescription drugs (Part D is separate), and routine physical exams
No Referral is required
High out-of-pocket costs, higher coinsurance on hospital stays, doctor office visits,
No Part D- Prescription Drug Coverage – Must enroll in a Standalone Part D plan, which adds to additional monthly premiums

Original/Traditional Medicare – with a Medicare Supplement with or without Part D** – Prescription Drug Plan

Helps pay for Doctor’s Office visits, Lab work, Outpatient services.

Medicare Advantage Plan -with or without Dental, Vision and/or Part D** – Prescription Drug Plan

Approved plans offered by private health insurance carriers

Offered as alternative to Traditional Medicare**
Covers both Part A** and Part B**
May also, be designed to cover Part D*- Prescription Drugs Benefits or RX can be carved out.
May also be structed to cover Dental, Vision and Hearing Benefits

Regardless of whether you are new to Medicare or Participating in Medicare for Years, if you have questions regarding a Medicare Advantage Plan, Medicare Supplement Plan or a Part D – Prescription Drug Plan, we can help you. Call us at the number above, or click on the attached Form and we will reach out to you.

Contact Us

_{Medicare/Medicaid Disclaimer: 65 Benefit Options 4 U is an independent, non-government entity and is does not work with Federal Medicare or Medicaid Program. We provide Medicare Advantage, Medicare Supplement, and other healthcare plans designed for senior citizens and, in certain circumstances, individuals with disabilities. References to (**Original Medicare—including its components Part A, Part B, and Part D—, PACE as well as Medicaid) on this site are provided solely for informational purposes or as a major qualifying criteria for participation or enrollment in select products, such as Medicare Advantage or Medicare Supplement plans that may require prior approval under Federal Medicare and/or Medicaid Programs. Please note that 65 Benefit Options 4 U does not administer or process applications for Federal Medicare or Medicaid Programs. Due to the complexities involved in obtaining Medicare and/or ACA/Individual Healthcare benefits, we strive to offer general guidance regarding the application process. However official applications for Federal Medicare or State Medicaid Programs must be completed and submitted directly to the respective offices.}
_{TPMO Statement: We do not offer every plan that may be available in your area. We represent all the major healthcare organizations which depending upon your zip code may offer several products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.}

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