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The following disclaimer is required by The Center's for Medicare and Medicaid:

"We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."

The purpose of this required disclosure is to keep certain "bad actors" from deceiving customers, and performing insurance practices that are illegal and unethical. Oakley Insurance Group has contracted with some of the top Medicare plan carriers that we feel will serve our clients well.

Medicare Insurance

What Is Medicare?

Medicare is a social program developed and managed at the federal level to help the older population of our country retain medical coverage and manage medical expenses. The Medicare program is comprised of several different pieces to serve the different areas of healthcare.

Medicare Part A – For persons age 65 who qualify for Social Security benefits, they are entitled to Part A at not cost and helps pay for hospital stays, and inpatient services such as a skilled nursing facility. People not covered by Social Security benefits may obtain Part A coverage under certain circumstances by paying a monthly premium.

Medicare Part B – When you enroll in Part A, you are automatically enrolled in Part B unless you request otherwise. You may delay Part B enrollment if you are working and have health coverage through your employer. Part B helps pay for doctor visits and outpatient care such as routine and non-routine practitioner office visits including emergency room visits in which you are not admitted. Part B is generally optional but highly recommended and requires a monthly Part B premium. The Part B monthly premium is tied to an individual’s income level and is usually deducted from any Social Security benefits if those are being distributed. The Part B Premium for 2025 is $185 per month.

Medicare Part C – Once enrolled in Medicare part A and B which is referred to as original Medicare, you may enroll in Part C called a Medicare Advantage plan, which was added later and is made up of Part A, Part B, and Part D. Most advantage plans are designed to lower the cost of medical care by way of cost sharing such as copays and coinsurances. Part C often includes additional benefits to that of the original Medicare’s minimum essential coverages. Most Medicare Advantage Plans are $0 premium.

Medicare Part D – Medicare Part D can be a standalone plan or bundled with a Medicare advantage plan (above) which includes coverages for, and help with paying for prescription drugs. Once you enroll in Medicare, if you choose not to enroll in a drug plan whether through a Medicare Advantage plan, or a sand-alone Part D plan, or if you don't have other coverage such as Veteran Benefits, there is a penalty of 1% of the average monthly premium for each month enrollment is delayed. This penalty will be assessed once you enroll in a plan.

 Once you are enrolled in Medicare Parts A and B you can either enroll in Part C, called an “advantage plan” or you can choose to enroll in a Medicare Supplement Plan, also called a Medigap plan.

Medicare Supplement Plan – Medicare supplement plans have a monthly out-of-pocket premium but are designed to bridge most of the “gaps” in original Medicare, which is why they are also referred to as Medigap plans. Unlike a Medicare Advantage plan, Part D is not included in a Supplement plan, so a separate drug plan will need to be purchased.

Medicare Eligibility

You are eligible to enroll in Medicare if you meet the following, even if you are still working:

• You must be a U.S citizen or a legal resident who has lived in the U.S. for at least 5 consecutive years

and

• are at least 65 years of age (turning 65 in three months)
• or have been diagnosed with end-stage renal disease
• or have been receiving Social Security disability benefits for 24 months (automatic enrollment on the 25th month)

Medicare Enrollment

Initial Enrollment

If you are enrolling in Medicare for the first time you have an initial enrollment period (IEP) that begins 3 months before your birth-month, and up to 3 months after you birth-month. If your birthday is the first of the month, you have 4 months before your birth-month to enroll.

Annual Enrollment Period (AEP) October 15^th – December 7^th

Every year there is an enrollment period in which you can speak with your Medicare agent and review your plan, any new plans, plan changes, and add, drop, or switch Medicare coverage. Changes cannot be made to Medicare coverage the rest of the year unless you qualify for an SEP.

Special Election Period (SEP)

Under certain and special circumstances you may eligible to change your Medicare Advantage plan. Certain conditions include:

• Being diagnosed with a qualifying chronic health condition
• Moving to a new area that offers different plans
• Qualifying for extra help
• Retiring or losing employer coverage

Enrollment Options

You may enroll in Medicare Part A, Part B, or both. You then may choose to stay with original Medicare, enroll in a Medicare Advantage plan, or enroll in a Medicare Supplement plan and a Part D drug plan.

Medicare Advantage Plans

There are a few advantages of choosing a Medicare Advantage plan over original Medicare:

• An advantage plan is required to offer at least the federally required minimum essential coverage, but nearly all advantage plans offer many additional features and coverages.
• A Medicare Advantage plan always includes Part A and Part B, and most plans include Part D for prescription drug coverage. You may see the acronym MAPD for Medicare advantage plans that include Part D.
• Medicare Advantage plans usually have lower out-of-pocket cost than original Medicare, and often includes maximum out-of-pocket limit.
• More recently, companies have been adding other features to plans such as dental and vision allowances.

There are three main types of Medicare advantage plans:

• Health Maintenance Organization (HMO) plans consist of a larger network of providers that you stay within for your healthcare, including primary care, specialists, inpatient, and outpatient care. This HMO structure helps to manage out-of-pocket costs.
• Preferred Provider Organization (PPO) plans offer an even larger network of healthcare providers without the need for a referral to see specific doctors or specialist, and allows out-of-network coverage with an increase of out-of-pocket costs.
• Private Fee-For-Service (PFFS) plans are the least used type of plans but offer more freedom to choose providers – though sometimes a network arrangement may still apply. The providers must accept Medicare and agree to bill the PFFS plan according to its terms and conditions.

Medicare Supplement Plans

Medicare Supplement plans, also called Medigap plans were created to supplement Original Medicare and help pay most deductibles, copays, coinsurance, and excess charges that are not covered by original Medicare. Features of a Medicare Supplement plan:

• There is no limit to which provider you see.
• Though there is a monthly premium similar to that of a regular health insurance plan, nearly all medical costs are covered by the combination of Original Medicare and a Medicare Supplement plan.
• In general, once you choose your Supplement plan, they don’t really change so you don’t need to move between plans like with an advantage plan.

Factors to Consider When Making Medicare Choices

Cost: How much are you willing to pay each month in premiums whether you use services or not? How much are you willing to pay at the time of service in the form of deductibles (out-of-pocket cost before a plan pays), copays, and coinsurance?

Coverage: Which plans offer the coverage you need for the type and frequency of healthcare services you require? Are your prescription drugs covered by a specific drug plan?

Network: Do the doctors, specialist, pharmacies, or providers you use in a specific network?

Convenience: If you see providers are you willing to submit receipts, paperwork, or other additional actions for the plan to cover specific costs?

Health History: How often do you need care? Do you require access to certain specialists, or specialty pharmaceuticals?

Health Future: Is your health changing? Are you taking more action to reduce necessary healthcare intervention? Do you foresee increased provider usage?

Information Disclaimer: The above information is intended as an overview description of the federal Medicare program and is NOT an extensive or official explanation of the United States Medicare program. To view official documentation and learn about Medicare in its entirety please visit medicare.gov

Any information listed above is for customer education only and is not a detail of plans or services provided by original Medicare, or a Medicare plan provider. None of the information above is evidence of insurance; it is not binding of coverage; it is not to be used in any other manner than it is intended. You must work with and speak to a licensed health insurance and Medicare certified insurance agent to bind coverage.