2024 Enrollment Season Medicare and Medigap Frequently Asked

Medicare is a federal health insurance program primarily for people aged 65 and older, but it also covers certain younger individuals with disabilities and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Medicare is divided into four parts:

• Part A (Hospital Insurance)
• Part B (Medical Insurance)
• Part C (Medicare Advantage)
• Part D (Prescription Drug Coverage)

We make Medicare very simple and easy to understand.

You can enroll in Medicare through the Social Security Administration. You simply log into www.ssa.gov and set up an account, and from there you can apply for Medicare.  If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. If not, you can sign up during your Initial Enrollment Period (IEP), which begins three months before your 65th birthday and ends three months after. You can also enroll during the General Enrollment Period (January 1 to March 31) if you miss your IEP, but you may face late enrollment penalties.

We like to use acronyms, in this case, A stands for “Admitted.” Medicare Part A is hospital insurance that covers inpatient care in hospitals, skilled nursing facility care (not long-term care), hospice care, and some home health services. Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. There are deductibles and coinsurance for services under Part A.

For this acronym, to make it easy to remember, B stands for “Bye-Bye” anytime you come and go in the same day. Medicare Part B covers medically necessary services and preventive care, including doctor visits, outpatient hospital services, durable medical equipment, and mental health care. Part B also covers certain preventive services like flu shots, screenings, and annual wellness visits. Most people pay a monthly premium for Part B, which may be higher based on income.

Medicare is a federal program that provides health coverage if you are 65 or older or have a qualifying disability. Medicaid is a state and federal program that offers health coverage to low-income individuals, regardless of age. While Medicare covers a broader spectrum of health care services for seniors, Medicaid may cover additional services like nursing home care and personal care services.  If you qualify for both at the same time you are referred to as a dual eligible.

Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare (Parts A and B) offered by private insurance companies approved by Medicare. These plans often include additional benefits like prescription drug coverage (Part D), dental, vision, hearing, and wellness programs. Medicare Advantage plans usually have networks of doctors and hospitals.

Medicare Part D provides prescription drug coverage and is offered by private insurers approved by Medicare. Part D plans vary in terms of drugs covered and costs, but all plans must cover a standard list of medications. You can enroll in a standalone Part D plan if you have Original Medicare or your Medicare Advantage plan may include prescription drug coverage.

Costs for Medicare vary based on the parts you enroll in:

• Part A: Most people don’t pay a premium for Part A, but there is a deductible ($1,632 in 2024) and coinsurance for hospital stays longer than 60 days.
• Part B: The standard monthly premium is $174.70 in 2024, but it can be higher based on your adjusted gross income. There is also a deductible ($240 in 2024) and 20% coinsurance for most services.
• Part C: Costs vary by plan, including premiums, deductibles, and copayments.
• Part D: Premiums vary by plan and income, and there may be a deductible and copayments for prescription drugs.

Medicare open enrollment occurs from **October 15 to December 7** each year. During this time, you can join, switch, or drop a Medicare Advantage or Medicare Part D plan. Any changes made during this period will take effect on January 1 of the following year.

If you don’t sign up for Medicare Part B or Part D when first eligible, you may face a late enrollment penalty. For Part B, the penalty is a 10% increase in your premium for each 12-month period you were eligible but didn’t enroll. For Part D, the penalty is 1% of the national base beneficiary premium multiplied by the number of months you went without coverage.

Medigap, or Medicare Supplement Insurance, helps cover the out-of-pocket costs that Original Medicare (Parts A and B) doesn’t cover, such as copayments, coinsurance, and deductibles. Medigap policies are sold by private insurers and are standardized across most states. You cannot enroll in a Medigap policy if you have a Medicare Advantage plan.  And there are rules about when and how you can change from one plan to another.

Choosing the right Medicare plan depends on your specific health needs and budget. If you prefer the flexibility of seeing any doctor who accepts Medicare, Original Medicare (with or without a Medigap policy) may be best. If you want all-in-one coverage, including drug coverage and extra benefits like dental or vision, a Medicare Advantage plan may be better. Consider premiums, coverage options, and network restrictions when choosing a plan. As independent agents we can help show the advantages and disadvantages of both types of plans, and explain the rules about switching if you ever wish to make a change.