MEDICARE | Mary 1

Understanding Medicare

Who Is Eligible For Medicare?

Age 65 and older
People with End-Stage Renal Disease(have permanent kidney failure and require kidney dialysis or a kidney transplant)
People with ALS(Amyotrophic Lateral Sclerosis or more commonly called, Lou Gehrig's Disease)
People who have been on Social Security Disability for at least 24 months

When Are Election Periods?

When can I enroll in Medicare or switch my Medicare Plan?

Initial Enrollment Period(IEP)

This is a very important time when eligible individuals can enroll in Original Medicare Part A, which is hospital insurance. This is also the time individuals can enroll in Medicare Part B, which is medical insurance for those eligible individuals. If you already have medical insurance you can delay enrolling in Medicare Part B. You are also able to enroll in a Medicare Advantage Plan(initial enrollment is formally called ICEP), which is Part C(MA/MAPD) or enroll in a prescription drug plan, which is Part D(PD). MA/MAPD/PD plans are offered by private insurance companies. The Initial Enrollment Period or IEP spans seven months(three months before your 65th birthday month until three months after your birthday month). Example: If your birthday is in May you could enroll from the beginning of February until the end of August.

Annual Enrollment Period(AEP)

This is the period between October 15th-December 7th, where eligible individuals can change their current Medicare Advantage Plan(Part C) or Prescription Drug Plan(Part D). Medicare Advantage Plans are also referred to as MA plans and Medicare Prescription Drug Plans are also referred to as an MAPD. These plans are administered by private health insurance companies.

Special Enrollment Period(SEP)

This is a period that that would depend on individual circumstances. If you move outside of your current plan's service area you will be able to switch to Original Medicare or change your Medicare Advantage Plan. There are many scenarios involving changing your residence. Please call Mary's Insurance Team if you have a question about moving. Another reason for using a Special Enrollment Period would be that you lose your current coverage. You may no longer be eligible for Medicaid. Again, there are several reasons you may lose your current coverage. Don't hesitate to call us. Other reasons include changes in your coverage, chances to get get more coverage, you can dual enroll(you have Medicare and Medicaid), you have a severe medical condition or disabling condition which allows you to enroll in an SNP(Special Needs Plan). Please reach out with any questions as there are many additional reasons you may qualify for an SEP.

Open Enrollment Period(OEP)

This occurs from January 1st until March 31st. OEP is when you are are able to take a look at your plan and make the changes necessary for your needs. You may want to switch to a different Medicare Advantage plan or you simply may want to drop the Medicare Advantage plan and go back to Original Medicare.

PART A

Inpatient Hospital Care
Skilled Nursing Facility Care
Hospice Care
Home Healthcare
Nursing Home(not custodial or long-term care

PART C

Benefits Not Available With Original Medicare
Routine Dental Care
Vision Care(glasses & contacts)
Wellness Programs & Fitness Center Memberships

PART B

Doctor's Services & Tests
Outpatient Care
Home Health Services
Durable Medical Equipment
Other Medical Services
Some Preventive Services

PART D

Covers A Wide Range Prescription Drugs
Includes Drugs In Protected Classes(Cancer Drugs & Drugs To Treat HIV/AIDS)
Does Not Cover Cosmetic Drugs or Hair Growth

Medicare Supplement Plans

Coverage in Addition to Original Medicare
Private Insurance Companies
Plans A through N are Standardized Plans
Able to Choose any Doctor or Hospital

We do not offer every plan available in your area. Currently we represent 15 organizations which offer 257 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.