Are You Ready for the 2016 Medicare Enrollment Period?

Again this year the Annual Enrollment Period (AEP) period for Medicare recipients with Part A and Part B runs from October 15th to December 7th.

Beyond this (AEP) there is a Special Election Period (SEP) for those receiving the Medicare Low Income Subsidy and for those with Special Needs or a chronic illness, usually diabetes. 

The Special Election Period
This SEP specifically refers to the population which includes: the dual eligible, those with chronic illness, and those who are institutionalized. The dual eligible are those who qualify for both Medicare Part A and B and Medicaid. Those who have a chronic illness are those who a physician has certified as being treated for a qualified medical condition that is specifically designated in the plan. And those  institutionalized refers to those who are confined to a long-term care facility.

The Medicare Supplement Plan Enrollment
Finally, if you're interested in a Medicare Supplement Plan  you can enroll in it year around if you have Original Medicare A and B. If they accept Medicare, a Medicare Supplement Plan allows you to go to any doctor or hospital of your choosing . Also, you can change your Medicare Supplement Plan any time. 

It certainly may be a good idea to have a qualified agent to evaluate your coverage to see if you can save some money on your policy.

Call (773) 614-3201 for help in choosing the best Plan for yourself. 

Medicare ABCs You Need to Know

With the huge clutter of information available on the internet and otherwise about Medicare, it can be both confusing and overwhelming to you. 

Here I want to cut through the maze and to help you make the best decision when to comes to your health care. Remember, if you are age 65 and on Medicare is your concern is not Obamacare. Always feel free to call or e-mail me if you have any questions.

Part A Medicare
Part A usually costs nothing as people have already paid for it through payroll deductions.  It covers hospitalizations, inpatient services in a skilled nursing facility, home health care services, hospice services, and blood.  For beneficiaries who did not pay for Part A in payroll deductions, the payment is about $426 a month.

Part B Medicare
Part B usually cost about $104.90 per month. If you are a higher earner, you have to pay a higher monthly premium. And, if you are just signing up for Part B for the first time, your premium will be $159.30 per month. Part B covers other medical services, such as doctor visits, outpatient care, home health care services, durable medical equipment, ambulance services, chiropractic services, diabetes supplies, and preventive services. 

Many people buy Medicare Supplemental Insurance, commonly referred to as Med Supp or Medigap, to cover the services original Medicare does not cover.

Part C Medicare
Medicare Advantage Programs (Part C) are Medicare products that are offered by Medicare through private health insurance companies.  They are Medicare regulated, approved, and monitored, and usually offer more benefits at a lower cost.  For instance, unlike original Medicare, MA plans have yearly maximum out-of-pocket cost protection and may cover vision, hearing, and preventive dental coverage.  Medicare advantage plans are available with or without integrated part D prescription drug coverage, which may include zero co-payments for certain generic medications.

Part D Medicare
Medicare part D covers prescription drugs. 

Medicare beneficiary with original Medicare Part A and Part B, a Med Supp policy, and a stand alone Part D may pay about $250 or more each month in premiums.

Additionally, private health insurance may have long-standing relationship with Medicare to process claims under the original Medicare program.


Have a question regarding your Medicare benefits. Just call I'm ready to help.

How to Avoid the Medicare Part B Penalty

Medicare Part B is optional and covers outpatient expenses such as lab tests, outpatient surgeries, doctor visits and limited outpatient prescription drugs (typically not drugs you would administer yourself). 

Coverage begins after you meet an annual deductible of $147 (2015) as well as paying a monthly premium of $104.90. After meeting the deductible, you must also pay a coinsurance of 20 percent of the Medicare-approved charges for most doctor services.

You may be wondering whether you should sign up for Part B at the same time as Part A. Naturally, you are concerned about paying premiums for Part B if you don't need the coverage. But the timing for enrolling in Part B is a bit trickier and the stakes much higher, since late enrollment can cause you a permanent premium increase.

One thing you should consider: If you don't have employer group coverage, then this is a no-brainer. You should apply during their seven-month initial enrollment period.

If you are covered under a group health plan based on your current employment -- whether it's your employer or your spouse's -- you may qualify for a Special Enrollment Period, often abbreviated as SEP. If so, you may delay enrolling in Part B until your group health coverage is terminated, and avoid the late enrollment penalty.

The eight-month special period starts the month after the end of either your employment or the group health insurance coverage based on that employment -- whichever happens first. I'll remind you periodically regarding your Part B coverage.

Keep in mind that COBRA coverage does not qualify as employer coverage, and so it won't allow you to escape the penalty for delayed enrollment. Be sure to educate yourself so you don't make this common mistake.

There are other considerations as well. Some smaller employers require Part B coverage to be integrated with their existing insurance plans, for instance, while larger employers may not. Talk to your human resources department to find out whether Part B coverage is necessary for yourself.


Contact me if you have any questions, (773) 614-3201 or leave them below. Comments are welcome.