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 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, enrollment in Part A is free 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 premium.
Medicare Part B – When you enroll in Part A, you are automatically enrolled in Part B unless you request otherwise. Part B helps pay for doctor visits and outpatient care such as routine and non-routine practitioner office visits. Part B is optional and requires a monthly Part B premium. The Part B monthly premium is tied to an individual’s income level and is deducted from any Social Security benefits.
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.
Medicare Part D – Medicare Part D can be a standalone plan which includes coverages and help with paying for prescription drugs. If you choose not to enroll in a drug plan whether through an advantage plan, or a stand-alone plan, there is a penalty of 1% of the average monthly premium for each month enrollment is delayed.
- 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.
You are eligible to enroll in Medicare if you meet the following, even if you are still working:
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 15th – December 7th
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:
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.
There are a few advantages of choosing a Medicare Advantage plan over original Medicare:
There are three main types of Medicare advantage planes:
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:
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.
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