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Medicare Basics
Medicare Annual Enrollment Period
The annual enrollment period for Medicare is October 15th until December 7th. This is the only time of year that a member can change their plan unless they qualify for a special enrollment period.
Special Enrollment Period
There are an array of events that qualify a member for a special enrollment period. See below for a in depth list.
What is Part A
Medicare Part A is hospital insurance. Part A generally covers inpatient hospital stays, skilled nursing care, hospice care, and limited home health-care services. You typically pay a deductible and coinsurance and/or copayments.
What is Part B?
How much is Medicare Part A and B going to cost me?
Medicare Part B is medical insurance. It generally covers services and items such as:
- Doctor office visits
- Preventive services, such as certain tests and screenings
- Flu shots
- Pneumococcal shots
- Mental health care (outpatient)
- Alcohol use counseling
- Chemotherapy
- Physical therapy
- Diabetes screenings, supplies, and self-management therapy
- Durable medical equipment, such as wheelchairs
This is not a complete list
What on Earth is a Donut Hole??
How much is Medicare Part A and B going to cost me?
How much is Medicare Part A and B going to cost me?
In 2025 the coverage gap phase (also known as the “donut hole”) will be eliminated, which will result in standard Part D coverage consisting of a three-phase benefit: a deductible phase, an initial coverage phase, and a catastrophic phase.
How much is Medicare Part A and B going to cost me?
How much is Medicare Part A and B going to cost me?
How much is Medicare Part A and B going to cost me?
You usually don't pay a monthly premium for Original Medicare Part A coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called "premium-free Part A."
Most people get premium-free Part A.
You can get premium-free Part A at 65 if:
- You already get retirement benefits from Social Security or the Railroad Retirement Board.
- You're eligible to get Social Security or Railroad benefits but haven't filed for them yet.
- You or your spouse had Medicare-covered government employment.
If you're under 65, you can get premium-free Part A if:
- You got Social Security or Railroad Retirement Board disability benefits for 24 months.
- You have End-Stage Renal Disease and meet certain requirements.
Most people will pay the standard $164.90 premium amount. If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA).
To View the costs click the link below scroll down to Part B and click who pays a higher Part B premium because of income?. This will pull up the income chart for you.
Where does Medicare Cover?
Where does Medicare Cover?
Where does Medicare Cover?
Did you know that medicare ends at the U.S border? Your Medicare Advantage plan may offer worldwide emergency coverage. Depending on which Medicare Supplement you have it may offer some benefits. A senior travel insurance plan may be a good option
Special Enrollment Periods
You change where you live
- You moved to a new address that isn't in your plans service area
- You moved to a new address that's still in your plans service area, but you have new plan options in your location.
- You moved back to the United States after living outside the country
- You moved into, currently living in, or just moved out of an institution (liked a skilled nursing facility or long-term care hospital)
- You were just released from jail.
You lose your current coverage
- You are no longer eligible for Medicaid
- You left coverage from your employer or union (including COBRA coverage)
- You involuntarily lose other drug coverage that's as good as Medicare drug coverage (creditable coverage), or my other coverage changes and is no longer creditable.
- You had drug coverage through a Medicare Cost Plan and you left the plan.
- You dropped coverage in a Program of All-inclusive Care for the Elderly (PACE) plan.
You have a chance to get other coverage
- You have a chance to enroll in other coverage offered by an employer or union
- You have or are enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage)
- You enrolled in a Program of All-inclusive Care for the Elderly (PACE) plan.
Your plan changes its contract with Medicare
- Medicare takes an official action (called a "sanction") because of a problem with the plan that affects me.
- Medicare ends (terminates) my plan's contract.
- Your Medicare Advantage Plan, Medicare Prescription Drug Plan, or Medicare Cost Plan's contract with Medicare isn't renewed.
Other special situations
- You're eligible for both Medicare and Medicaid
- You qualify for Extra Help paying for Medicare prescription drug coverage
- You enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility.
- You dropped a Medigap policy for the first time you joined a Medicare Advantage plan.
- You have a severe or disabling condition, and there's a Medicare Chronic Care Special Needs Plan (SNP) available that serves people with your condition.
- You enrolled in a SNP and no longer have a condition that qualifies as a special need that the plan serves.
- You joined a plan, or chose not to join a plan, due to an error by a federal employee.
- You weren't properly told that you other private drug coverage wasn't as good as Medicare drug coverage (creditable coverage).
- You weren't properly told that you were losing private drug coverage that was as good as Medicare drug coverage (creditable coverage).