Medicare is a complex government program with a lot of rules that are very important to understand:
When you get your Medicare coverage, you might choose to participate in the Medicare program through a Medicare Advantage Plan (Medicare Part C) and/or Medicare Prescription Prug Plan (Medicare Part D). Most Medicare Advantage plans have integrated Part D coverage included in the plan. You could also choose other private health coverage that is not part of the Medicare program called a Medicare Supplement plan (Medigap).
Medicare has marketing rules for plans sold in the Medicare Advantage program which includes standalone prescription drug plans. After your initial enrollment period, you are locked into your plan until the next annual election period between October 15-December 7 every year. You can make as many changes as you like during this period to make sure you get the plan you want. Coverage in the new plan or renewal with the same plan that are part of the Medicare program will be effective January 1 of the following year. You may qualify for a Special Election Period (SEP) if you involuntarily lose your coverage during the enrollment period.
Aside from your Initial Election Period which includes the 7 months bracketing your birthday month and the Annual Election Period. These plans are annual contracts that insurers have with Medicare to replace Medicare during the enrollment period between January 1 and December 31. Plans are pretty likely to change on an annual basis, especially as regards to prescription drugs. If your costs are mostly drug driven then an annual review with me is undoubtedly a good idea, especially if you have never had a review. It doesn't cost you anything for a review with this office or to get my help understanding or enrolling in plans.
If you are newly eligible for Medicare because you turned 65, you can use your Initial Enrollment Period (IEP/ICEP) toenroll in a Medicare plan during the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. Your coverage will begin the first day of the month after you ask to join a plan. All plans must accept you without asking health questions, ecxept in the case of end stage renal disease, because there is a special program for people that have been diagnosed or being treated for ESRD. If you join during one of the 3 months before you turn 65, your coverage will begin the first day of the month you turn 65.
If you are newly eligible for Medicare because you have a disability (under 65) you can sign up for a Medicare Advantage Plan or a Medicare Prescription Drug Plan. In some states you might be able to sign up for a Medicare Supplement plan instead of Medicare Advantage. For people getting Social Security Disability, your Medicare coverage begins 24 months after you get Social Security or Railroad Retirement Board (RRB) disability benefits. You can enroll during the 7-month period that starts 3 months before your 25th month of getting Social Security or RRB disability benefits and ends 3 months after your 25th month of getting disability benefits. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you first get Medicare, your coverage will begin the first day of your 25th month of entitlement to disability payments.
There are different types of Medicare Advantage plans: PPO, HMO, or PFFS. PPO plans allow you to see any doctor but you will pay more to see a doctor out-of-network, and they often have smaller lists of doctors in-network.
Private-Fee-For-Service (PFFS) Plans with no network restrictions are available -- see any health provider that accepts Medicare and accepts the plans terms and conditions of payment.
No health questions asked. All Medicare beneficiaries, including people on Medicare due to a disability, are guaranteed acceptance regardless of health conditions (except End Stage Renal Disease). "Special Needs Plans" with lower or no out-of-pocket costs may be available for you as a "Dual Eligible" -- people enrolled in both Medicare & Medicaid or if you have certain chronic illnesses.
To keep reading about Medicare go to our Medicare Supplement page.