Medicare Short Course

Once you are eligible (a subject in itself) you enroll in Original Medicare.  If you want to do so, you can stop right there.  Maybe not the best idea, but it's an option (another subject in itself).

Once enrolled in Medicare you can 'enhance' your coverage, to suit your circumstances (another subject in itself).  You can cover your share of Medicare's deductibles and co-pays, partially or in full (again, another subject in itself).

Likely, by now, you've picked up on the fact that Medicare is both simple and complex as well.

We listen to you.  We ask questions.  We explain, in understandable terms, how all the PARTs of Medicare work and how you can use them in your best interest in your circumstances.

We have affordable offerings in all product groups (see the Disclaimer).

Medicare determines eligibility to enroll into Medicare PARTs A/B/C/D/E.  Eligibility varies depending on age and other factors.

Medicare has defined enrollment periods, depending on your situation.  Usually, it's age dependent, however, other criteria offer opportunities to enroll as well; disability, and certain illnesses.

There are different enrollment periods.  The Annual Election Period is each year, October 15th to Dec 7th.  Medicare gives everyone in the country, who is currently enrolled in Medicare Advantage, the opportunity to assess what their personal situation might be in the upcoming year, compare what is available next year and then, should one wish to do so, switch coverage for the next calendar year.

This period generates a market frenzy because it occurs once a year for 47 days and encompasses some 30.8 million people nationwide.  The sizable market attracts marketing efforts from multi state agencies, direct mailers, insurance companies and local agents.  And, Fraud.  And, Misrepresentation.  And, outright lies. 

The truth is, all marketers, no matter who they are,offer exactly the same coverages from the same companies, at exactly the same price.

The only difference is your choice as to how you buy.  The stakes are high because there are lots of competitors with a lot at stake in a short period of time.  Telemarketers need to convert prospects to enrollees quickly and move on to the next prospect so as to make their business concept work.  Tactics are standard: swamp the TV, robocalls and mailboxes with offers of free 'help' in the form of comparing your benefits to other plans, confirming your doctors are still providers (some change, most do not) and promoting specific benefits.  All designed to elicit a response from you.  The telephone becomes a weapon.  Misinformation and selective information is commonplace.  Scammers and fraud abound.

After the first of the year, until March 31st, another enrollment period is offered which allows a one-time switch.  If you are enrolled in a Medicare Advantage plan, (aka PART C), Medicare gives you one chance to either switch your plan or return to Original Medicare with a PDP (Prescription Drug Plan).  You may invoke this right from Jan 1st until March 31st each year.  Agents/Companies are not allowed to market to you during this enrollment period.  If you contact them first, though, they can market to you.

Medicare has rules about how beneficiaries can be contacted and what materials are offered.  Materials are approved and regulated by the companies and Medicare.  Medicare mandates that you must give explicit permission before a salesperson may engage with you either by telephone or in-person.   Once you engage, Medicare takes the position that you give your permission to be solicited.

Medicare does not allow high pressure tactics, misrepresentation or selective partial information.  However.  Those folks anxious to contact Medicare beneficiaries circumvent the rules with a form of 'bait and switch'.   Usually you'll get a call from an unlicensed, unregulated third party whose job is get you to start a conversation offering 'help' in some form with your current insurance situation.  Once you engage, an agent can legally discuss benefits and switch your coverage with your permission.  The rules are...you must be told you are talking with an agent and you must consent to be switched from your current coverage to another plan.  Not everyone follows the rules.

All health products have moving parts that move in different ways depending on the health events.  Everything has to fit together to make a plan that works for....you.

Should you decide to buy, You are free to choose whichever purchase process makes the most sense for you in your situation.

If you so choose, you can buy from the telephone agent who you never actually meet and are unlikely to ever hear from again.

Or.  You can buy direct from the company agent after working through voice menus.  The main problem with the phone is you are never quite certain who you're actually dealing with.

Or.  You can buy exactly the same product at the same price from a local agent who meets with you, discusses your situation and needs.  And, offers options to fit your circumstances.  And, will be the same person in the future you'll talk with should you have questions or need help.

Choose whichever method makes the most sense for you.   Your insurance should be easy to use, perform as you expect and cost you the least possible under the circumstances.

If you are happy with your existing coverage.  And.  You accept the changes your company is making.  And.  Your company offers the same plan next year as the one you have this year, the likely best choice is...do nothing.  Your company will automatically enroll you into the same plan for next year.  To you, all the marketing efforts are just background noise. 

If you are not happy with your coverage.  Maybe the best idea is to first discuss your concerns with someone who really knows the actual situation, i.e. an agent (who provides accurate truthful advice based on discussing your needs compared to the options).  Friends and family, in spite of good intentions are not medically qualified to know the actual situation.  They know their actual situation, but your actual situation is not likely to be actually the same as theirs.  Only you and your doctors know your actual situation.If your company is not offering your plan next year, or for whatever reason, and you want or need to change, you can easily switch your coverage.  There are lots of choices.Independent agents have lots of choices.  Choosing your plan is a process.  First, confirm your physicians are good.  Second, confirm your prescriptions are good.  Third, check the Maximum Out of Pocket (MOOP) so you understand your maximum risk for the upcoming year.  Fourth, look through your intended coverage to understand your risks.  After you look at why you might choose a plan, then you can assess the perks that sweeten your choice.  Considering perk(s) as a primary decision is not a good idea because trade-offs are made in other benefits that, if triggered, may cost you more than the perk(s) .Should you, for whatever reason, discover after committing to a new plan it's not what you want or your circumstances have changed, or, was misrepresented, Medicare offers two 'outs'.  If you are still within AEP, you can enroll in another plan; the 'Last Man Standing' provision is where the last plan submitted to Medicare is the valid one.  Or.  You can make a one-time switch in the MAOEP which is from Jan through March. 

There are three Medicare product groupings: Supplement (aka Medigap), Medicare Advantage (aka PART C) and Drug Plan (aka PART D).  All are designed to enhance the Federal insurance program (aka Traditional or Original Medicare) which consists of PART A:Hospital, PART B:Medical, PART C:Medicare Advantage and PART D:Prescription Drugs. Within the three groupings of products, there are several types and within those types, several variations.  All designed to allow beneficiaries to elect the products to best serve in their situation.

We have complete offerings in all product groups (see the Disclaimer).

All of the product groupings offer additional Benefits (aka Supplemental, aka Extra, aka Ancillary, aka pot sweeteners, aka incentives, aka, goodies).  Advantage Plans offer an array.  All are designed to enhance the market attractiveness of the product.

These are benefits that Medicare does not offer but the plans offer because Medicare has expanded what can be offered.

The companies have responded.  Depending on the plan, you can enjoy an Over-The-Counter credit account (where you can buy food/vitamins etc., pay utility bills), transportation to appointments, meals after hospitalization, fitness club memberships, dental, vision, hearing and so on.

The latest 'bennie' is Premium Reduction, (aka The Giveback, aka Rebate).  Here's how the pitch works...'Buy our plan and we, the insurance company, will provide a cash rebate in some form'.

However...not all is as it seems.  The benefits have to be funded.  Somehow.  So.  An attractive benefit here, usually means making you pay more there.  Whether or not that attractive benefit actually improves your cash flow in the next year depends on how the upcoming year works out.

Think carefully about those attractive goodie.  What is your situation?  What is offered?  What is your risk needing the actual medical benefits?  An ethical agent will not recommend you increase your risk.

Supplement plans, aka Medigap (as titled by Medicare) are paid monthly in advance to have your share of charges paid by your insurance company.  They pay your share of Original Medicare benefits under PART A and PART B.  There are 10 plan variations.   Not all companies offer all the variations.  Coverages vary from covering (your share of) all of Medicare's medical benefits to specific benefits.  Premiums vary by plans, companies, age and geographic location.  Usually, more premium, more coverage.  Premiums are company specific which can stay the same or increase monthly or annually.

The Medicare statute has a provision to allow insurance companies to offer approved plans that bundle the provisions of the statute: PART A:Hospital, PART B:Medical and, most of the time, PART D:Prescription Drugs, all into one plan (aka PART C:Medicare Advantage).

Medicare Advantage Plans offer bundling your PART A, PART B and PART D and additional benefits (perks...not covered by Medicare; dental, vision, etc) into one package.

While the 'perks' are attractive, remember, the reason you purchase the plan is your medical and drug coverage..

Medicare approves, oversees and disciplines companies that offer these plans.  Not all plan designs are available everywhere or to everyone.

Plans are designed where one sees only network providers.  Plans are designed where one can see either network or non-network providers. Plans are designed for regions and groups of counties within states.  Plans are designed for different income and health circumstances. Plans are designed for Medicare only recipients.  Plans are designed for those on Medicare and Medicaid.

The way the plans work is Medicare pays a stipend to the plan in return for the plan becoming the administrator of the benefits.  The members pay a monthly premium, usually low to zero (some 'rebate').

PART C plans require you to agree to pay a share of costs when you use the benefits. Some plans pay all of your costs.   While all benefits offered by Medicare must be offered by each plan, the cost share may vary between plans and between companies.

All plans feature, by law, an annual maximum out-of-pocket (MOOP) limit which is a trigger amount. where, should the sum of the medical copays total the MOOP amount, the plan converts to 100% coverage for the rest of the policy year.  Only a small percentage of beneficiaries ever reach the trigger within a policy year.

As one of the Medicare Advantage variations, the Medicare statute authorizes companies to offer plans that pay upfront funds annually to beneficiaries to use as they see fit.   The cash payment belongs to the beneficiary who is free to use the funds as they wish; note there are tax implications if used for non-medical expenses.  The plan has a trigger (MOOP) where coverage converts to 100%.  There are specific rules.

We have an offering for this type of plan.

The Medicare Statute authorizes private insurance companies to offer PART D:Medicare Rx Plans which cover Medicare approved prescription drugs using statutory provisions mandated by Congress.  Medicare uses a Master Formulary (drug list) from which each plan can select all, most or some drugs to cover in their plans.  All PART D plans follow statutory mandates.   At least 2 drugs from each category.  An annual deductible can be waived or partially applied.  Defined coverage stages, each governed by a defined amount threshold and defined co-pays.  Here too, Medicare approves, oversees and disciplines.

Medicare takes the position that, unless you are exempt, you must enroll in Medicare when you are eligible or pay a penalty.  If you do not enroll within the grace period defined for that respective part of Medicare, you must pay the prescribed penalty.  Medicare usually makes the insurance company collect the amount which is then paid to Medicare.

Income Related Monthly Adjustment Amount.  Should your income meet certain higher thresholds than the standard amount, set by Congress, you must pay a higher PART B and PART D premium.  The Plan collects the amount and forwards it to Medicare.