Home » Medicare Basics: A Beginners Guide to Medicare Open Enrollment
Pam Powers & Jenny Habel, Benefits Consultant and Benefits Assistant
Who is eligible for Medicare? Most beneficiaries are age 65 and over or are on Medicare if they have a certain illness or if they have been on disability for over 24 months. The best time to start applying for those aging into Medicare is 3-4 months prior to your birthday month.
What does Medicare consist of? Medicare is made up of two main parts; Part A and Part B. Part A and Part B are commonly known as “Original Medicare.”
Part A: Covers your hospital and inpatient needs, skilled nursing/rehab facilities, and hospice. Most beneficiaries get premium-free Part A coverage.
Part B: Covers outpatient needs like office visits, medical testing, and procedures. Part B monthly premiums in 2024 start at $174.80 and increase depending on your income threshold.
But wait, there’s more! “Part C” Medicare Advantage and a Medicare Supplement are two options that help cover holes original Medicare does not cover. We at Fogle Insurance Group would help clients obtain or learn about those coverage options. Part C Medicare Advantage plans are contracted with Medicare and provide all Part A and B benefits. A Medicare Supplement plan would work alongside ‘original Medicare’ and supplement the coverage already provided by Part A and B. Medicare Part D covers prescription drugs. Most Medicare Advantage plans will include coverage for medications in addition to medical benefits. Medicare Supplement plans do not cover prescriptions. If you have a Supplement, you would need to enroll in a stand-alone prescription plan. Although Part D of Medicare is voluntary, Medicare does penalize a beneficiary who has more than a 63-day gap in prescription drug coverage by charging an additional 1 percent of the national average for every month they went without coverage.
Does Original Medicare Cover Everything? No! Medicare Part B will only cover about 80% of medical claims – as the beneficiary, you would be responsible to pay the leftover 20%.
Can I get more coverage? Yes! There are two main paths you can take. One, a Medicare Supplement AKA “Medigap” plan that works along with your Original Medicare. Or two, you can enroll in a Medicare Advantage plan that contract with Original Medicare and provide the Part A and Part B coverages and typically prescription drug coverage – many offer more benefits like dental, vision, and hearing!
Can I delay Medicare? Maybe! Those over 65 who continue working and are enrolled in employer sponsored health insurance have the option to delay coverage. If you have “credible coverage”, you can delay enrollment in Part B. Get with your employer to see if your plan is considered credible, if not, you could pay a penalty.
Am I stuck with my choice? No! You can make changes to most plans during the Open Enrollment period, October 15 – December 7 every year. This time is when those on Medicare Advantage or Part D plans can explore options and make changes. You can also change your Medicare Supplement plan during this time, but there may be additional eligibility questions required.
How to Decide What Plan is Right for You?
This is where Pam Powers, Benefits Consultant, and Jenny Habel, Benefits Consultant Assistant, at Fogle Insurance Group, come in! We sit down with every client to assess their needs, budget, and eligibility.
Pam and Jenny will learn about your doctor, medication, and personal needs, so they can give each client an individualized recommendation and experience. Medicare is not a system where one plan fits all. Some clients have a need for lower specialist copays where another client may want to maximize their dental care benefits – we have options for both!
Learn more and request a Medicare consultation and quote today!
