It’s important to know your benefits and how they work together. Here is an easy to understand article so you fully understand Medicare’s Parts  in order to customize coverage that works for you! Here at Total Benefit Solutions, Inc we have highly trained and certified Medicare Enrollment Specialists to help you each step along the way. If your Medicare options confuse you, or you just want the piece of mind of having an impartial review your needs prior to selecting a plan, feel free to reach out to us at 215-355-2121!

Medicare Part A helps cover hospital costs.

This part is free for most and is provided by the federal government.

For more info click here.

Medicare Part B helps cover doctor visits and outpatient care.

This part is optional and has a monthly premium.

In 2019, it costs $135.50 for most people. It also has a deductible of $185.

For more info click here

Part A and Part B are the basics when it comes to Medicare. Once you have this coverage, you get to decide to go one of two ways: You can choose to get a Medicare Advantage Plan (Part C) or  a Medicare Supplement Policy. The question now is, which one would work best for you?

Part C is also called a Medicare Advantage Plan. Part C combines Parts A and B, and sometimes Part D (more on Part D soon!). It may include extra benefits like vision and hearing exams, gym memberships and preventive services for a $0 copay. Part C is completely optional and is provided through private insurance companies. For these policies you are subjected to Enrollment Periods. If outside of those Enrollment Periods, you can not purchase one of these policies. Some policies will have a $0 premium while others can be rather expensive. Many Insurance Companies offer Medicare Advantage Plans and all offer different coverage. Here at Total Benefit Solutions, Inc, we contract with many different Insurance Companies to offer you as many options as possible. This ensures you can find a policy to meet your individual needs. For more information on Part C, please

Medicare supplement insurance, or Medigap. This is private insurance that fills in some of the gaps in Original Medicare (Parts A and B) coverage. These plans are optional and have an additional monthly premium along. Many different companies offer these policies and they may be subjected to Medical Underwriting. Medigap Plans follow a Plan Structure (Plan A, B, C, D, F, G, K, L, M, or N). Each plan has different coverage options and different price points. 

Medicare Part D helps cover prescription drug costs. This part is optional and costs money. You can sign up with a Medicare Advantage Plan (Part C) which also has Part D included. However, if you choose to get a Medigap Policy, you would need to purchase a Part D drug plan to cover your prescription costs. Just like with Part C plans, these are plans ran by Private Insurers so plans have different coverage levels and premiums. Also, just like the Part C plans, there are Enrollment Periods to sign up on these plans. If you try to sign up outside of your enrollment period, you will not be eligible to purchase this type of plan until another enrollment period comes. For more information, please click here.

Throughout this information, I have mentioned “Enrollment Periods” For Medicare there are certain times you can apply for coverage. Here are some of the enrollment periods you may be eligible to choose a new plan during:

 Initial Enrollment Period: You become Eligible for Medicare on your 65th birthday. Your Initial Enrollment Period begins the 3 months prior to your birthday, the month of your birthday, and then the following 3 months after your birthday. This is a 7 month window to make sure you are signed up on Part B (usually people are automatically added to Part B, but some may have to apply for this coverage to be added. Without Medicare Part B, you can not get Part C, Part D or a Medigap Policy. If you do not elect Part B when first eligible, you may face a fine) and what type of Medicare coverage you prefer. You can also choose to stick with your Employer Plan if still working. 

Annual Election Period is every year between October 15th til December 7th. Coverage during this enrollment period begins on January 1st for the new year. If you do not select a new plan during this time, you may not choose one later unless a Special Enrollment Period applies to you.

Sometimes life gives us surprises… We may loose Employer benefits. We may move to a different area or we may loose eligibility (or gain it) for a Gov’t Program. When those things happen, it can limit your access to your health plan. Because nothing is guaranteed, there are specific reasons that you may drop or change your Medicare plans. Below are some of the common reasons:

  1. You lose creditable drug coverage through no fault of your own or want to keep or enroll in creditable coverage
  2. You join or drop employer/union health and/or drug coverage regardless of whether it is creditable. Employer coverage may be current or former (retiree plan)
  3. You are institutionalized.
  4. You are enrolled in a qualified State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility
  5. You have Medicaid, a Medicare Savings Program (MSP) and/or Extra Help. (You will have no Part D premium penalty if you have Extra Help.)
  6. You gain, lose, or have a change in your Medicaid, MSP, or Extra Help eligibility status.
  7. You enroll in/disenroll from PACE (Program of All-Inclusive Care for Elderly).
  8. You move (permanently change your home address).
  9. You have had Medicare eligibility issues.
  10. You experience contract violations (such as misleading marketing) or enrollment errors.

This is not an inclusive list and each situation has it’s own rules and guidelines for acceptance of a Special Enrollment Period. For more information on specific reasons, please feel free to contact us at (215)355-2121.