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You are ELIGIBLE to sign up for Medicare when you turn 65 years of age – or for those under 65 and on Disability for 24 months – or as a Foreign National, a lawfully admitted alien (green card) living in the US for at least 5 consecutive years. In some cases, a Foreign National may also be eligible for Medicare by marriage to a US citizen.

Your initial enrollment Period (IEP) is your first chance to enroll in Medicare.  The IEP is seven months long and includes the three months before you turn 65,  your birthday month and the three months after your birthday month.

If you are born on the first of the month, your Medicare coverage begins the month prior to your birthday.  Example:  If you are born on June 1st you are eligible for Medicare benefits on May 1st.

There are various enrollment options with Medicare – enroll online at www.ssa.gov/benefits/medicare/

 or call 1.800.772.1213.  Enrolling in person at a Social Security office is currently not an option during the Covid-19 Pandemic.  

Know and understand the four parts of Medicare:

Part A   Hospital Insurance

  • Inpatient care in hospital
    • Skilled nursing facility care
  • Hospice care
  • Some home health care 

Part B   Medical Insurance 

  • Services from doctor and other health care providers
  • Outpatient care
  • Home health care (not Long Term Care)
  • Durable medical equipment (wheelchairs, walkers, hospital beds)
  • Preventive services (such as screenings, shots, vaccines and yearly ‘Wellness’ visits)

Part C   Medicare Advantage –  is an ‘all in one’ alternative to Original Medicare.  These plans include Part A, Part B and usually Part D and are referred to as a MAPD. Most plans offer extra benefits that Original Medicare doesn’t cover – vision, hearing, dental and more.  The beneficiary receives their Medicare through the insurance company which in turn, the Federal government pays a per capita fee to the insurance company.

Part D  Prescription Drug coverage – stand alone prescription drugs plans.

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Your Health care plan options:

– Original Medicare (Part A and Part B) –  which is provided by the Federal government.  Medicare pays 80% of your costs.  You will be responsible for the other 20%  as well as deductibles, co-insurance and co-pays.

–  Medicare Supplement Insurance, also known as Medigap insurance.  These are standardized plans by the Federal government and sold by Insurance companies.  Plans assist in paying deductibles, co-insurance and co-pays not covered by Medicare.  These plans have no networks.  You can choose to see any doctor that accepts ‘Medicare Assignment” and use any hospital Nationwide. N.B.  These plans may differ from State to State.  In California we have the ‘Birthday Rule’ which allows a policy holder to change Supplement plan without undergoing ‘health underwriting’. In 2020, California the birthday rule was expanded to 60 day period .  

Medicare Advantage (Part C).  These are network plans – usually HMO or PPO   These plan include Part A,  Part B and usually Part D and are referred to as a MAPD. Most plans offer extra benefits that Original Medicare doesn’t cover – vision, hearing, dental and more.  The beneficiary receives their Medicare through the insurance company which in turn, the Federal government pays a per capita fee to the insurance company.

Medicare Costs:

Part A:  For most people there is no premium payment.  If you have worked 40 quarters equivalent to 10 years  – you pay no premium. If you have not completed your 40 quarters, you will have a premium payment as noted below:

– applicant has worked less than 30 quarters (40 quarter is 10 years)      $458.00

– applicant has worked between 30 – 39 quarters                                             $252.00 

Part B:  Is income based and calculated on your tax return two years prior to applying for Medicare, i.e. if you turn 65 in 2020 your Part B premium is based on your Modified  Adjusted Gross income earnings in 2018.  In 2020, the Part B premium for those earning under $87,000 is $144.60 monthly.

N.B. Your premium bill for Part B  will be sent to you  quarterly by Social Security.  If you are not yet receiving your  Social Security benefits, you  will receive your first bill  which will include the first  3-4 months  premium payment depending on when you enrolled in Medicare.  You can pay your Part B premium via check, bank draft, debit card, or credit card.  If you are receiving Social Security or Rail Road Retirement benefits you’re Part B premium can automatically be taken from there.

The cost of your Medicare health plans.  

Medicare Supplement plans have monthly premiums that vary  from Insurance company to Insurance company.  It is worthwhile noting that while many of the Medicare Advantage Plans in Los Angeles County have either low monthly premiums – a few have no monthly premiums they are network plans with restrictions.  The best time to purchase a Medicare Supplement plan is during your Initial Enrollment Period – when you are first eligible for Medicare as this creates a ‘Guarantee Issue’ where there is no health underwriting ‘ and premiums are not impacted by potential ‘pre-existing’ conditions.  Prescription drug plans are sold separately and have premiums ranging from $15 – 80.00/monthly depending on your prescription medications.

In addition to the above Medicare costs there is also IRMAA – Income Related Monthly Adjustment  Amount which is a surcharge that high-income earners may pay in addition to their Medicare Part B and Part D  premiums.  

Special Enrollment Periods  (SEP)- You can make changes to your Medicare health plan when certain events happen in your life – moving residence,  losing health care coverage due to divorce, or coming off of Group health coverage.  Rules differ depending on the SEP.   

The Covid-19 Pandemic created an SEP that  the Centers for Medicare & Medicaid Services (CMS)  are allowing people extra time  to enroll in Medicare . The SEP is  referred to as ‘equitable relief’ and is for enrolling in Medicare Part A and B  due to delays and difficulty accessing Social Security.  Some of the Insurance carriers are also offering SEPs to their MAPD (Medicare Advantage + Prescription drugs) and  PDP (stand alone prescription drug plan) beneficiaries.

Changes occur annually in Medicare and it is advisable to review your coverage during the Medicare Annual Open Enrollment Period  which is October 15th through December 8.   Insurance companies roll out new product benefits and drug formularies change from year to year.  Beneficiaries have the option to change their Prescription drugs plans or change Medicare Advantage plans.  In addition, this is also an opportunity for people to enroll in a Medicare health plan if you for some reason have missed your Initial Enrollment Period (IEP).

Medicare is excellent health care coverage though complex with many changing rules.  As I am a licensed agent/broker, I am available to assist you and answer questions regarding your Medicare health care options.  

I am reachable at [email protected] and by cell at 310.871.3743.  

Carol Seligson Fabi

Turn 65 USA

Life & Health – CA license        #0J14493

                             NY license        #LA-1416344

Texas license   # 2504591

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