Specializing in Medicare Plans
Medicare Advantage, Medicare Supplement, Prescription Drug Plan
How Does Medicare Work?
Original Medicare is made up of two parts:
Part A provides your hospital insurance
Part B provides medical insurance for things like doctor visits and check-ups
When are you eligible for Original Medicare?
(Part A & Part B)
You’re at least 65 years old, or you’re under 65 and qualify on the basis of a disability or other special situation
You’re a U.S. citizen or a legal resident who lived in the U.S. for at least five consecutive years.
When can you Enroll?
Initial Enrollment Period
When you turn 65 or otherwise become eligible for Medicare, you’ll have your Initial Enrollment Period (IEP), Your IEP begins three months before and ends three months after the month of your 65th birthday ( a seven month window).
If you have employer or plan-sponsored coverage when you first become eligible, you won’t need to enroll until you retire or otherwise lose the coverage.
Prescription drug (Part D) coverage must be creditable or you may be subject to a Late Enrollment Penalty when you enroll in a plan with Part D benefits.
If you’re still working at age 65 and covered by your employer’s health insurance, then in most cases you don’t need to sign up for Part B yet.
Once you stop working, you’ll have a special enrollment period of eight months after your employment ends in which to sign up for Part B.
October 15th though December 7th
Open Enrollment Period
During Open Enrollment you can add, drop or switch your Medicare plan coverage.
The annual open enrollment period for Medicare is October 15th through December 7th.
This is the time each year when you can switch from original Medicare to a Medicare Advantage plan; change from your Medicare Advantage plan back to original Medicare; or switch from one Medicare Advantage plan to another.
Special Election Period
Some individuals may also qualify for a SEP depending on certain circumstance.
You may qualify for a Special Election Period if you:
Retire and lose your employer coverage
Move out of the plan’s service area
Receive assistance for the State
Have been diagnosed with certain qualifying disabilities or chronic health conditions
Understanding Your Needs
Question to Consider: Following are a few questions that may help you get closer to understanding your needs.
Are you in good health or do you have chronic conditions?
Which prescription drugs do you take regularly? How much do you spend?
What doctors do you you see regularly and for what kind of care?
How would you feel about seeing a new doctor?
How much do you travel and where?
Are you eligible for any health care coverage besides Medicare? Will you keep that coverage when you retire?
How much did you spend on health care last year? Do you expect similar costs this year?
How does health care fit into your budget? Will you need financial help to pay Medicare premiums?
How you answer the above questions can help determine which type of Medicare plan may be best for you.
Enrolled in Original Medicare
Live in the plan’s service area
Do not have end-stage renal disease (ESRD)
Medicare Plan Options
Part C Medicare Advantage
Medicare Advantage plans, typically HMO or PPO products, are insurance plans that combine the benefits of
Part A and B and, in most cases, includes prescription drug coverage and may include extra benefits and services for an additional cost.
What is the advantage of a Medicare Advantage plan?
The payments the company receives from Medicare help with the cost of the plan.
Most of the plans have provider networks that provide services at discounted rates.
The plan features also give the ability to manage costs and offer the coverage of Medicare A and B at a lower cost than Original Medicare.
Some of the extra benefits you could get with a Medicare Advantage plan
Prescription drug coverage
Access to wellness programs
Gym membership discounts
Routine hearing, vision and dental coverage and more
Prescription Drug Coverage
Medicare Part A and Part B do not cover prescription drug benefits.
For prescription drug coverage, you can enroll in a separate Part D plan.
Many Medicare Advantage plans already offer prescription drug coverage (Part D) as part of their benefits package.
Supplemental Coverage (Medigap Plans)
Some people who are covered by original Medicare purchase a separate Medi-gap plan, also known as Medicare supplemental insurance.
These plans help “fill the gap” by partially or fully covering expenses that original Medicare doesn’t provide.
What is the advantage of a Medicare Supplement plan?
A Medicare Supplement or Medi-gap plan offers the beneficiary more flexibility but at a higher premium.
The plans range from A to F so you can choose from a range of coverage within this plan.
This plan works hand and with Medicare paying the first 80% of all Medicare approved procedures and the supplement paying the other 20%.
These’s plans have little to no co-payments and no required network of health care facilities, doctors, and other professional.
The plan gives you access to any hospital or physician that accepts Medicare in any state.
Medicare supplements do not include Part D, that needs to be picked up separately.
Part D refers to the stand alone Prescription Drug Plan
Some plans have deductibles and some don’t.
These plans are based on different formularies (list of covered medications) and have different premiums and co-payments.
Medications are broken up into different tiers or levels including preferred and non-preferred generic and brand drugs.
All plans are based on CMS (Medicare) guidelines and have the same initial coverage stage.
There is a penalty for not having a credible prescription drug plan during the correct time frame.
Neighbor, I'm here to help...
Need assistance or not sure what plan meets your needs?
I am here to personally help you find the plan that’s best for you.
One-on-one we can look at your needs, explore your choices and decide on a plan with confidence.
As your trusted advisor, I’m here when you need me, not just at enrollment, but as a partner through your membership.
Andy Lopez (858) 549-6758 at Mira Mesa Office Mall San Diego California 92126 USA 10717 Camino Ruiz, # 101, San Diego CA 92126 Licensed Insurance Agent Mira Mesa, Miramar, Mission Valley, Mission Village, Murrieta, National City, Normal Heights, North Park, Ocean Beach, Oceanside, Licensed Sales Representative Old Town, Pacific Beach, Paradise Hills, Point Loma, Poway, Ramona, Rancho Bernardo, Rancho Penasquitos, Rancho San Diego, Rancho Santa Fe, Speak Filipino Licensed Sales Agent Santa Luz, Solana Beach, Sabre Springs, San Clemente, San Diego, Serra Mesa, San Luis Rey, San Marcos, San Ysidro, Scripps Ranch, Speak Filipino Independent Sales Representative Santee, Spring Valley, Temecula, Torrey Highlands, Tierra Santa, University City, University Heights, Vista, Alpine, Bonita, Speak Filipino Independent Mira Mesa Sales Agent, Carmel Valley, Cardiff By the Sea, City Heights, Clairemont, Carmel Mountain Ranch, College Grove, Coronado, Crown Point, Camp Pendleton, Carlsbad, Speak Filipino Licensed Agent Chula Vista, Del Mar, El Cajon, Escondido, Encinitas, Encanto, East San Diego, Fallbrook, Hillcrest, Imperial Beach, Mira Mesa Speak Filipino Licensed Insurance Agent, Jamul, Kensington, Kearny Mesa, La Costa, La Jolla, Lakeside, Lemon Grove, Leucadia, Logan Heights, Lake San Marcos, Speak Filipino Independent Sales Agent La Mesa, Linda Vista, Mission Beach, Mission Hills, Fashion Valley, South Park.
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