PROVIDING MEDICARE INSURANCE GUIDANCE AND PLANNING IN ARIZONA AND BEYOND

Part A includes inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. A monthly premium may be required for Part A for those who have not paid into Medicare for at least ten years.

Part B helps to cover medically necessary doctor’s expenses, outpatient care, and preventative services like seasonal flu shots and other vaccines. It includes a monthly premium that can be deducted from a person’s social security check.

Before you can enroll in a Medicare plan, you must first make sure you are eligible.

Most people are automatically eligible if they are 65 years or older and either themselves or a spouse has worked for the past ten years while paying into Medicare. You may also be eligible if you are already getting benefits from Social Security or the Railroad Retirement Board. People are also eligible under 65 if they have ESRD or are on Social Security Disability Income for 24 months or longer.

Initial Enrollment Period: If you are turning 65 and have received your Medicare card, you have seven months to choose between a Medicare Advantage Plan or a Medicare Supplement plan. Your Initial Enrollment Period will begin three months before the month of your 65th birthday, the month of your birthday, and three months after your 65th birthday. 

Annual Enrollment Period (AEP): You can enroll or review and change your current plan each year between October 15th and December 7th. 

Medicare allows enrollment under other various circumstances. If you do not meet one of the above time periods and are in need of a Medicare plan, please call our office to speak to one of our licensed insurance agents so they can provide you with your options. 

Medicare Advantage Plans are health plans offered by private insurance companies that contract with the government to provide Medicare Parts A and B, also known as Part C. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans also offer prescription drug coverage; these plans are known as Medicare Advantage Part D Plans (MAPD).

Prescription Drug Plans (Part D) are a supplement to original Medicare (Parts A & B) by providing additional prescription drug coverage. They can be attached to regular Parts A and B, Medicare Supplement Plans (also known as Medigap Plans), some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. Private insurance companies approved by Medicare offer these plans. Prescription drug coverage may also be included by Medicare Advantage Plans and follow the same rules as Medicare Prescription Drug Plans.

Medicare Supplement Plans, also known as Medigap, are designed to fill in the coverage gaps of Original Medicare A & B. Most of them will cover Medicare Co-Insurance and deductibles. Medigap plans are also provided by private insurance companies contracted through the government.

Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics such as limited income. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.  Chronic Condition SNP (C-SNP): You have one or more of these severe or disabling chronic conditions: Cardiovascular disorders, Chronic heart failure, Diabetes, Chronic lung disorders End-Stage Renal Disease (ESRD).  These plans can be changed once a quarter every calendar year.