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Go To www.AndWhyAdvantage.com Medicare Advantage (Part C)
Medicare Prescription Drug Plan (Part D)
Medicare Supplement (Medigap)
When you first enroll in Medicare and during times of the year
you can choose how you get your Medicare coverage.
There are 2 main ways to get Medicare:
Original Medicare includes Medicare Part A (Hospital Insurance ) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Medicare drug plan (Part D). To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance, you can also shop for and buy supplemental coverage.
Medicare Advantage (also known as Part C) is an "all in one" alternative to Original Medicare. These "bundled" plans include Part A, Part B, and usually Part D. Most Plans offer extra benefits Original Medicare does not cover-life dental, vision, hearing, and more.
Medicare health plan decisions affect how much you pay for coverage, what service you get, what doctors you can use, and your quality of care.
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.
If you're 65 or older, have group health plan coverage based on your or your spouse's current employment, and the employer has fewer than 20 employees, Medicare pays first, while your company insurance plan becomes your secondary payer.
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.
What's the Part B late enrollment penalty?
If you don't sign up for Part B when you're first eligible, you may have to pay a late enrollment penalty for as long as you have Part B.
Your monthly premium for Part B may go up 10% for each full 12 months in the period that you could've had Part B, but didn't sign up for it. If you're allowed to sign up for Part B during Special Enrollment Period, you usually don't pay a late enrollment penalty.
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
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 or offer extra benefits and services with no 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 or discounts
Routine hearing, vision and dental coverage and more
Transportation to doctor visits
Over the counter drugs
Services that promote your health and wellness
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 Medigap plan offers the beneficiary more flexibility but at a higher premium.
This plan works hand-in-hand with Original Medicare paying the first 80% of all Medicare approved procedures and the supplement paying the other 20%.
These 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.
Medicare prescription drug coverage is an optional benefit. There is a penalty for not having a credible prescription drug plan during the correct time frame.
What's the Part D late enrollment penalty?
The cost of the late enrollment penalty depends on how long you didn't have creditable prescription drug coverage.
You may owe a late enrollment penalty if at anytime after your Initial Enrollment Period is over, there's a period of 63 or more days in a row when you don't have Part D or other creditable prescription drug coverage. You'll generally have to pay the penalty for as long as you have Part D coverage.
Neighbor, I'm here to help...
Need assistance or not sure what Medicare plan meets your needs?
I am here to personally help you find the Medicare plan that’s best for you.
One-on-one we can look at your needs, explore your choices and decide on a Medicare 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
Office Mall Mira Mesa San Diego California 92126 USA 10717 Camino Ruiz, # 101, San Diego CA 92126 Medicare Insurance Agent Mira Mesa, Miramar, Mission Valley, Mission Village, Murrieta, National City, Normal Heights, North Park, Ocean Beach, Oceanside, Medicare Sales Representative Old Town, Pacific Beach, Paradise Hills, Point Loma, Poway, Ramona, Rancho Bernardo, Rancho Penasquitos, Rancho San Diego, Rancho Santa Fe, Speak Filipino Medicare 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 Medicare Sales Representative Santee, Spring Valley, Temecula, Torrey Highlands, Tierra Santa, University City, University Heights, Vista, Alpine, Bonita, Speak Filipino Mira Mesa Medicare Sales Agent, Carmel Valley, Cardiff By the Sea, City Heights, Clairemont, Carmel Mountain Ranch, College Grove, Coronado, Crown Point, Camp Pendleton, Carlsbad, Speak Filipino Medicare Insurance Agent Chula Vista, Del Mar, El Cajon, Escondido, Encinitas, Encanto, East San Diego, Fallbrook, Hillcrest, Imperial Beach, Mira Mesa Speak Filipino Medicare Insurance Agent, Jamul, Kensington, Kearny Mesa, La Costa, La Jolla, Lakeside, Lemon Grove, Leucadia, Logan Heights, Lake San Marcos, Speak Filipino Medicare Sales Agent La Mesa, Linda Vista, Mission Beach, Mission Hills, Fashion Valley, South Park. See Me or Call Me (858) 707-0640 Tawag Na Andy Lopez Speak Filipino.
Are you turning 65 or new to Medicare?
Medicare is not free. Neither Original Medicare nor a Medicare Advantage plan will pay for everything. The amount you will pay depends on the coverage you choose and the health care services you receive. Medicare and Medicare plans charge premiums. A premium is a fixed amount you pay each month for coverage. You also pay a share of the cost for health care services you receive. The 3 methods of cost sharing are: deductible, copay, and coinsurance. Consider the costs when comparing your Medicare choices, low premium might come with high deductibles, copays or coinsurance rates.
When it comes to Medicare, you have choices.
Let us help you find the best plan to fit your health care needs.
Are you or a loved one enrolling in Medicare this year? Are you thinking about retiring?
Is Original Medicare enough health coverage for you?
Are your prescriptions covered?
What do Medicare Part A, B, C, and D mean?
How much will it cost? Do you have deadlines to enroll?
No matter your situation, we can help you get answers to your Medicare questions.
Original Medicare (Part A and B) helps pay for doctor visits and hospital stays, but it does not cover everything and it does not cover prescription drugs.
Medicare Advantage plans (Part C) put a cap on your out-of-pocket costs for Part A and Part B services covered by the plan. It is called Annual Out-of-Pocket Maximum and it provides built-in financial protection. There is no out-of-pocket cap with Original Medicare. Many people choose additional coverage by enrolling in one or more private Medicare or Medicare related plans. We can help you to select a Medicare Advantage plan (Part C) combine Part A, Part B and often prescription drug coverage (Part D) with some plans may offer additional benefits such as: hearing tests, routine vision, dental exams, wellness programs and fitness membership, often with no additional premium. Medicare Advantage plans can also cover more extra benefits than they have in the past, including services like transportation to doctor visits, over-the-counter drugs, adult day-care services, and other health-related services that promote your health and wellness.
Medicare prescription drug plan (Part D) that help pay for medications prescribed by a doctor or other health care professional.
A Medicare supplement insurance plan (Medigap) help pay some of the out-of-pocket costs that come with Original Medicare.
Let us guide you in choosing the right Medicare plan from several private insurance companies.