Important timelines and summary of:Original Medicare vs Medicare Advantage vs Medicare Supplement

Enrollment Timelines:

·       Enroll with Social Security office for your Part A & Part B, recommended 3-4 months prior to turning 65.

·       Guaranteed Issue, for Original Medicare, Medicare Advantage, Medicare Supplement, and Part D drug plans to enroll in: 

o   3 months before turning 65, the month of your birthday, 3 months after turning 65.

·       After Guaranteed issue:  

o   Life Penalties for enrolling in Part A and B with Social Security office.

o   Can enroll in a Medicare Supplement plan at any time, however subject to medical underwriting… which can either deny you getting approved for Med Supplement or pay a lot more in monthly premium to your pre-existing conditions.

o   Cannot enroll in Original Medicare, Medicare Advantage, or Part D drug plan must wait until annual open enrollment.

§  Annual Open Enrollment:   October 15^th – December 7^th each year (for a January 1^st effective date).

There are many differences between Original Medicare, Medicare Advantage (aka: Part C), and Medicare Supplements (aka: Medigap) plans. 

General Terms and information:

·       Part A: consists of Hospitalization and Skilled Nursing

·       Part B:  consists of office visits, specialist visits, outpatient surgery, DME, etc.

·       Part D:  drug plan (for prescription medications).   This is a separate plan, this is not covered under Original Medicare.

Original Medicare:

·       Keep Original Medicare coverage.   Still pay your Part B premium to the Social Security office.

·       Covers 80% of Part A & Part B which leaves you on the hook for 20% for these services.  

·       No out-of-pocket max protection.

·       A Part D drug plan is needed for prescription medications.

Medicare Advantage plans, also known as Part C:

·       Replaces your original Medicare coverage but still need to pay your Part B premium to the Social Security office.

·       Has layers of copay, coinsurance, deductible(s), and a yearly max out of pocket for Part A & Part B.  Follow the schedule of benefits of the plan for the private insurance carrier you pick.  Similar to a group health plan.

·       A MA only plan (Medicare Advantage), does not include Part D drug plan.

·       A MAPD (Medicare Advantage with Prescription Drug), does include Part D drug plan.

·       May have a monthly premium to the private health insurance carrier for the plan you chose.

Medicare Supplement Plans, also known as Medigap plans:

·       Keep Original Medicare Part A & B coverage.   Still pay your Part B premium to the Social Security office.

·       Fills in the gaps that are left behind from Original Medicare, leaving you with little to no out-of-pocket medical expenses.

·       Simple and easy to understand.

·       A Part D drug plan is needed for prescription medications.

·       Pay a monthly premium to the private insurance company carrier for the plan you choose. 

This is just a summary, for more information please contact Angela at Paroubek Insurance Agency to schedule an appointment:  aromenesko@paroubekinsurance.com or 920-347-9115.