Elderly couple holding hands, walking and smiling at each other in a park lined with trees.
 

Medicare Plans

At a time in life when one would expect things to become more simple – Medicare happens.

If you are over the age of 65 and have worked more than 40 quarters or have been on Social Security Disability for 2 years you are eligible for Medicare.

Medicare Coverage

If one qualifies, enrollment in Medicare Part A (which covers hospital services) is automatic. Many people mistakenly believe that if they work and have coverage through their employer, they need not enroll in Medicare Part B (which covers medical services in or out of the hospital) – that could not be further from the truth.

If a Medicare-eligible employee works for a firm that has less than 20 employees…

  • Medicare automatically becomes primary coverage even if they are on the employer’s health plan.  That health plan will NOT pay any expenses that Medicare would have covered, the insurance company will simply carve those expenses out of the payment. That employee MUST enroll in the Part B portion of Medicare.

If the Medicare-eligible employee works for a firm of more than 20 employees and is covered by them…

  • Medicare coverage becomes secondary coverage, and Part B is not required until they are no longer on that plan.  Once outside a group plan, Medicare Parts A and B do not cover everything (there are deductibles and co-insurance with no out of pocket maximums), and it is wise to purchase either a supplement or an advantage plan (called Part C ) in combination with drug coverage (called Part D).

Contact Us to Check Your Medicare Eligibility

 

Medicare Premiums

Medicare Part A has no premium.

Medicare Part B has a monthly premium. If you receive Social Security, this premium is deducted monthly. If you do not receive Social Security, the premium is billed quarterly.

 

Annual Enrollment Period

The Annual Enrollment Period (AEP) for Medicare Advantage (defined as private insurance for Medicare) plans is October 15 through December 7 allowing those on Advantage plans to change plans. Those over or nearing 65 will begin to receive a plethora of propaganda in the mail – be very careful with this as some appear very official but are just advertisements.

Effective January 2025, Part D is changing dramatically, and out-of-pocket maximums are dropping to $2000 annually; however, it will drive up the initial deductibles on some plans.

Choosing a plan can be a little cumbersome and is certainly very personal (costs and coverages can vary widely). We can help ease the confusion and stress that it can cause by helping to sort out the plans that work best for each individual.

Get help enrolling in Medicare
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