Medicare Center

 

 The Annual Election Period starts

October 15 -- ending December 7 th.

or


 Turning 65 ........ talk to US!!



 



If you recently became eligible for Medicare, you can ask to enroll right here


on our website for a Medicare Supplemental Insurance (Medigap) and Part D or an Advantage Plan.






 



For questions about how to enroll if you qualify under other special circumstances,


just give us a call - 330-502-8816


Peter G. Magada LUTCF® is an Independent Agent


for these quality Insurance Companies -----------


 


 


 


 




 


 



 


 



  


       


 


 


 


 


 


CLICK HERE for Enrollment Application



 





Medicare Coverage Basics



A Guide To The Basics On All Parts of Medicare   



Medicare is health insurance offered by the federal government to people who are 65 or older and meet the eligibility requirements. Some younger people who have disabilities, permanent kidney failure or Lou Gehrig’s disease can also qualify. Medicare helps pay for healthcare, but does not cover all medical expenses. The United States Medicare system is managed by the Centers for Medicare & Medicaid Services. Read these articles to determine your eligibility.


Medicare has four parts:



• Medicare Part A is the original Medicare insurance coverage and helps pay for hospital bills.

Medicare Part B is a supplemental insurance option for people who qualify for Medicare. It pays for physician services and supplies outside of the hospital.

Medicare Part C or, Medicare Advantage Plans (like HMOs and PPOs) are private health plans that are Medicare approved.

Medicare Part D is the newest addition to Medicare. It is prescription drug coverage. You must be enrolled in Medicare before you can apply for Part D coverage.  






Medicare Supplemental Insurance (Medigap)





Medigap Basics



What is a Medigap Policy? Medigap policies are sold by private insurance companies, but are not like Medicare Advantage Plans (HMOs, PPOs). It is sometimes called "Medicare Supplement Insurance." A basic Medigap policy works with Original Medicare coverage to help pay some of your out-of-pocket costs like copayments, coinsurance, and the yearly Medicare deductible.


There are many Medigap supplemental health insurance plans from which to pick. There can be big differences in the charges of various plans for the same basic benefits. Medigap policies must follow the Federal and State laws that are designed to protect you. Insurance companies must clearly identify their policies as 'Medicare Supplement Insurance' on the front of the policy. A Medigap policy can only cover one person. If you are married both you and your spouse must buy separate policies



When do I Enroll in a Medigap Policy?



It is highly recommended that you purchase your Medigap policy during open enrollment. Your open enrollment period begins on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. This period will last for six months. During that 6 month period an insurance company cannot:



  • Refuse to sell you any plan it offers
  • Make you wait for coverage to start
  • Charge you more for a Medigap policy if you have a health problem
  • In some cases Medigap insurance companies can make you wait, up to six months, for coverage of a 'pre-existing condition.' Be sure and do your homework and ask if you will be required to wait due to a pre-existing condition. Not all Medigap plans require you to wait.



The supplemental health insurance company must shorten or eliminate any waiting period if:



  • You bought your Medigap during an open enrollment period
  • You buy your policy after open enrollment, but you had health coverage that will pass Medicare's 'Creditable Coverage' criteria, which includes most types of health care insurance coverage. To find out if your basic health coverage is creditable coverage, call a Medigap insurance company or your State Insurance Department
  • For coverage to be creditable you cannot have had a break in coverage that lasted more than 63 days in a row immediately before you buy your policy.



What do I do if the open enrollment period has passed?



Once you are past your "open enrollment" period, the insurance companies do not have to sell you a policy. In addition they are allowed to charge you extra for the policy. There are some exceptions to that; for example, your private health care coverage ended or you were in a Medicare Advantage Plan. If you have decided to not sign up for a basic Medigap policy during open enrollment, you will need to have copies of the following paperwork to prove your guaranteed issues rights:



  • A copy of any letters, notices, and/or claim denials as proof of continued health care coverage
  • All paperwork must have your name on it
  • All postmarked envelopes from the insurance company in which the papers came, this helps prove dates of coverage



Other words of advice: If you did not get a Medigap insurance policy during open enrollment and are thinking of one now:



  • Apply before your current health coverage ends
  • You can choose to start your Medigap coverage the day after your current policy ends. This will prevent a break in your health coverage
  • Consider looking into a Medicare Advantage Plan which may offer additional benefits



Can my Medigap insurance company drop me?



If you bought your Medigap policy after 1992, in most cases the Medigap insurance company can’t drop you because the Medigap policy is guaranteed renewable. This means your insurance company can’t drop you unless one of the following happens:



  • You stop paying your premium.
  • You weren’t truthful about something on the Medigap policy application.
  • The insurance company becomes bankrupt or insolvent.



However, if you bought your Medigap policy before 1992, it might not be guaranteed renewable. At the time these Medigap policies were sold, state laws might not have required that these Medigap policies be guaranteed renewable. This means the Medigap insurance company can refuse to renew the Medigap policy, as long as it gets the state’s approval to cancel your Medigap policy. However, if this does happen, you have the right to buy another Medigap policy 


 




 Great Rates Available in Ohio ... now.CLICK HERE for Enrollment Application


 A guide to Medicare Advantage plans 








Medicare Advantage Plans





What is a Medicare Advantage Plan?



Medicare Advantage Plans (also known as Advantage Medicare) are health care options (like a HMO or PPO) for the Medicare program. These are programs that are approved by Medicare and run by private companies. They are sometimes referred to as Medicare Part C. With these options, you generally get all your Medicare-covered health care through one plan. They provide all your Part A and Part B-covered services. Generally, these plans offer extra benefits, and many include Medicare Part D (drug coverage). If you are enrolled in a Medicare Advantage Plan, your Medicare services are covered through this one plan, and are not paid for under Original Medicare.





 


Different plans for different needs


 

Medicare Advantage Plan options may include:



  • Medicare Health Maintenance Organization (HMO) - A HMO plan must cover all Medicare Part A and Part B health care. Some HMOs also cover extra benefits, like extra days in the hospital. In most HMOs, you can only go to doctors, specialists, or hospitals on the plan's list, except in the case of an emergency. Your costs may be lower than in the Original Medicare Plan.
  • Preferred Provider Organizations (PPO) - With this type of Medicare Advantage Plan you use doctors, hospitals, and providers that belong to your designated PPO network. You may use doctors, hospitals, and providers outside of the network, but there will be an additional cost.
  • Private Fee-for-Service Plans - In this type of plan, you can go to any Medicare-approved doctor or hospital that accepts the plan's payment. The insurance plan decides how much it will pay and what you pay for the services. You may pay more or less for Medicare-covered benefits. You may also have more benefits than the Original Medicare Plan.
  • Medicare Medical Savings Account (MSA) Plans - Medicare Advantage Plans provide Medicare Part A and Part B coverage. You don't pay a monthly premium for this plan because it's a high-deductible type of plan. However, you do have to continue to pay the usual Medicare Part B premium. You are responsible for paying the bill for any Medicare-covered services. You have the option of using the funds in your account to pay these bills. Once you meet the plan's high deductible, the plan pays for Medicare-covered services. These plans do not include Medicare Part D prescription drugs.
  • Medicare Special Needs Plans - This plan generally limits membership to people with specific diseases or conditions. They tailor their benefits, choose their providers, and create their list of covered drugs to best meet the specific needs of the groups they serve. Most Medicare Special Needs Plans are designed to serve people who have specific diseases or conditions, such as diabetes, congestive heart failure, or HIV/AIDS. They always include Part D prescription drug coverage.



How do I qualify for a Medicare Advantage Plan?



You can generally qualify for a Medicare Advantage Plan if you meet these conditions:



  • You live in the service area of the plan you want to join. Contact the plans you're interested in to find out about their service area.
  • You have Medicare Part A and Part B coverage.
  • You do not have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)



Choose your plan carefully; for the most part you will only be able to change plans once a year. In certain situations, you may be able to switch plans at other times.



How do I join a Medicare Advantage Plan?



Once you choose an Advantage Medicare Plan, you may be able to join by completing a paper application, calling the plan, or enrolling online. Talk with the plan representatives to find out how you can join. When you join a Medicare Advantage Plan, you will have to provide your Medicare number from your Medicare card and the date your Medicare Part A and/or Part B coverage started.



What will a Medicare Advantage Plan cost?



The costs of Advantage Medicare depend on a number of factors. Here are some questions to consider when purchasing a Medicare Advantage Plan:



  • Does the plan charge a monthly premium in addition to your Part B premium?
  • Does the plan pay any of the Part B premiums?
  • Does the plan have a yearly deductible?
  • Does it charge any deductibles for any of the services?
  • How much will you pay for each service or visit (co-payments)?
  • What type of health services do you need? How often?
  • Will you be using network providers or out-of-network providers?
  • Are there any extra benefits in the plan? Do you need them? What do these benefits cost?



Since private companies run the Medicare Advantage Plans, costs will vary. It's important to call any plan before joining to find out the rules, your costs, and to make sure the plan meets your needs. In some plans, if you see a provider who doesn't participate with the plan, your services may not be covered at all, or your costs will likely be higher.




 


Compare -


Medicare Advantage plans to Original Medicare


























Original Medicare plans


Medicare Advantage plans


Gaps in Coverage


Additional benefits significantly reduce gaps in coverage


Deductibles and coinsurance when you use health care services


Predictable costs that are easy to budget no matter the health care services you use


May need supplement plan


No supplement plan needed


No coverage outside the United States


Worldwide coverage for emergency and urgently needed care



 





 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 

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