We understand that selecting health insurance after age 65 can be confusing. There are many options to select. Our Creative Benefits Senior Care Team has the knowledge and expertise to help you choose the best Medicare plan to cover your individual needs. Contact our Senior Care Team to set up a consultation to identify the appropriate affordable coverage.
Our Services Include;
- Medicare Supplements
- Medicare Advantage Plans
- Prescription Drug Coverage Plans
What is Medicare?
Medicare Part A covers hospitalization and Medicare Part B covers your daily medical coverage and doctor visits. Medicare Part D is the Prescription Drug Plans (PDP’s).
Medicare Supplement insurance plan helps cover the gaps in coverage that are left unpaid after traditional Medicare pays its portion of your health care expenses. A Supplement (also known as Medigap) is coverage that you can add to your Medicare Parts A and B. For this reason, these plans are often referred to as Medigap plans. In order to purchase a Medicare supplement policy you must be enrolled already in Medicare Part A and Part B.
Medicare Supplement Insurance: Is a policy that provides coverage for medical or health needs that are not covered by Medicare. A Medicare policy is needed to get this insurance, however. While Medicare is a government program, Medicare Supplement Insurance is provided by private companies. It is also known as Medigap. Only those who already have either Medicare A or Medicare B coverage can avail themselves of Medicare Supplement Insurance.
Medigap usually covers co-payments, deductibles, and healthcare outside the US.Medigap policies are similar across states, with the exception of a few specific state carve outs.
Medicare Advantage Plans: Medicare Advantage Plans are health plans approved by the federal government and run by private companies. These plans are sometimes referred to as Medicare Part C. Medicare Advantage Plans offer equal benefits to traditional Medicare plans while also providing extra benefits such as prescription drug coverage, dental and vision benefits, and etc. For this reason, advantage plans are not supplemental insurance.
An Advantage Plan also known as Part C is an alternative to Original Medicare Part A and B. The Medicare Advantage plan replaces the individual’s Original Medicare and the carrier will now manage your Medicare Part A and Part B. Unlike, traditional Medicare most advantage plans have provider networks.
There are ten types of Medigap plans, each plan comes with its own set of benefits. The plans benefits are standardized by law; which means that the benefits of any plan you choose will be the same regardless of what company you purchase it from. However, it is important to note that the rates are not standardized so your premium will vary depending on the insurer you purchase it from.
Some Advantage plans will also cover prescriptions, while others won’t. The Medicare Advantage plans have the same benefits offered as Medicare Part A and Part B. As a trade-off for lower premiums, many Advantage Plans may offer a smaller network of doctors less coverage outside of their coverage area.
Prescription Drug Coverage: Traditional Medicare Parts A and B does not include coverage for prescription drugs. However, Medicare requires all persons enrolled to have creditable prescription drug coverage also known as Part D, it is important that you enroll in a prescription plan when you are first eligible to avoid any late enrollment penalties. To enroll in Medicare Part D, you must be eligible for and enrolled in Original Medicare Parts A and B.
You can obtain prescription drug coverage by enrolling in a standalone plan which is also known as a PDP’s. Some Medicare Advantage plans also include coverage for prescription drugs, these plans are also referred to as MAPD’s.
Thinking About Switching Plans? Give us a call to discuss your options.
Key Dates: There are 2 separate enrollment periods each year: Open Enrollment Period for Medicare Advantage and Medicare Prescription drug coverage that allows individuals to go from Medicare to a Medicare Advantage Plan or from a Medicare Advantage Plan back to Original Medicare.
In addition, they can add or drop a Prescription Plan. This takes effect on October 15-December 7. The Medicare Advantage Open Enrollment Period allows you to switch Medicare Advantage Plans (with or without drug coverage) and you can drop the Medicare Advantage and return to Original Medicare. This takes effect from January 1 – March 31.
What if I am still covered by my employer’s health insurance plan?
If your employer has 20 or more employees you do not need to sign up for Part B since the group plan will be the primary insurer. If your company has fewer than 20 employees, you would need to enroll in Part B as Medicare is your primary insurer.
Choosing a Plan that’s right for you: There are several types of Medicare Supplements available in the marketplace. A Creative Benefits Insurance professional can help you select the coverage that’s right for you.
Original Medicare + Medicare Supplement: Know the Facts!
When you choose to stay with Original Medicare (Part A and Part B) and add additional “gap” coverage with a Medicare Supplement, there are several things you should be aware of first!
- Original Medicare doesn’t cover prescription drugs, which means your Supplement plan doesn’t either. Therefore, you will need to enroll onto a Prescription Drug Plan (PDP). If you choose not to enroll into PDP, then after 63 consecutive days without this type of coverage in force, the Social Security Administration (SSA) will assess a penalty for you to pay. This penalty will only be paid once you are enrolled into a PDP plan and will be tacked on top of the PDP premium cost. Should you be required to pay the penalty, you will receive a letter from SSA letting you know what amount.
- Medicare Supplement carriers reserve the right to increase premiums. If an increase of premium is assessed against you it will take effect on the anniversary of the policy, and you would receive a letter in the mail detailing the amount of the increase. If you are unhappy with the increase in premium you do have the right to apply for a supplement with a different carrier (one that would be less expensive), however outside of your IEP you will be required to undergo medical underwriting meaning your plan could be declined or rated up. If you plan to apply for a supplement plan with a new carrier, do not disenroll from your current before you are approved with the new supplement plan. Disenrolling before you know if you have been approved could be detrimental if you are declined or are rated-up as a high-risk insured.
- Original Medicare does not cover Dental or Vision. If you would like to have this coverage in force, you can purchase it at any time of the year as a standalone plan. It’s important to remember however, that if you have a current Dental plan that has been active for a years’ time, and you switch when you disenroll from the current plan you may not have to endure the typical 12month waiting period on catastrophic services (dental) whereas if you wait and time lapses in between dental plans you could be subjected to this waiting period.
Medicare Advantage Plans (MAPD): Medicare Advantage (Part C) combines Part A & Part B coverage into one plan. Many come with built-in prescription drug coverage. Select plans that don’t have drug coverage allow you to add a standalone Part D plan.
When you choose a Medicare Advantage there are things that you should know first:
- Medicare Advantage plans are required to include the same benefits that you get from Original Medicare and often provide more benefits beyond.
- Medicare Advantage plans can provide additional benefits like dental and vision, fitness memberships, transportation to doctor’s appointments, and more. Review your plan’s Summary of Benefits and Evidence of Coverage to know all of the benefits available to you in your Medicare Advantage plan.
- There is a difference between Medicare Advantage Prescription Drug plans (MAPD) and Medicare Advantage (MA) only plans. MAPD offers a prescription drug plan attached and the MA does not! MA plans typically exist for veterans who receive prescriptions from the VA hospital.
- It is not typical at all, however if a Medicare Advantage plan receives 5 stars, it can be enrolled into throughout the year! If you have a 5-star rated plan available in your zip code and want to enroll into it, call us to help you through enrollment.
- Medicare Advantage plans can change from year to year, so it’s very important that you review the updated Summary of Benefits and Evidence of Coverage, to be aware of how these changes will affect you. We can help you manage these changes.
- There are two other types of Medicare Advantage plans. Chronic Special Needs Plan (CSNP): a Medicare Advantage plan for people with chronically disabling conditions of the heart, of the lungs (only some states) and or have diabetes. The other type is called Dual Special Needs Plan (DSNP): a Medicare Advantage plan for people who are dually eligible for Medicare and Medicaid. If you believe you may qualify for a CSNP or DSNP plan, reach out and discuss with your local Creative Benefits agent as you may have a Special Enrollment Period to work with!