The four main parts of Medicare are:

Original Medicare Part A – Medicare Part A (hospital insurance) covers Medicare inpatient care that is care received while in a hospital, skilled nursing facility, and, in certain circumstances, at-home treatment. Original Medicare Part B – Medicare Part B (medical insurance) covers medical services provided by doctors, nurses, and other health care professionals. Part B coverage includes outpatient care, ambulance services, preventive services, and durable medical equipment. It also covers part-time home care and rehabilitative services, including physical therapy. Part C (Medicare Advantage) – Medicare Advantage is a bundled Medicare plan offered by private insurance companies that completely replaces your Original Medicare Part A and Part B benefits and often included Part-D drug benefits. Part-D (Prescription Drugs) – Medicare Part-D covers prescription drugs and is a Medicare plan offered by private insurance companies that provides drug coverage to those enrolled in Original Medicare, Original Medicare with a Medicare Supplement, and Medicare Advantage (MAPD) plans that include drug coverage. There is one additional product also included in the Medicare family of options; they are called Medicare Supplements (Medigap). Medicare Supplement policies are offered by private insurance companies that help fill “gaps” in Original Medicare. Kevin Leinum Medicare Agent makes Medicare easy!

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What is a Medicare HMO plan?

Several types of Medicare Advantage plans are available, and a Health Maintenance Organization (HMO) is one of them. If you join an HMO Plan, you will need to go to your Primary Care Physician (PCP) within the HMO’s network of doctors to get most of the routine care you will need. If you do need to see a specialist, you will need to get a referral from your PCP before you see them; otherwise, those services may not be covered. This process is much easier than it used to be, and most referrals are done electronically, so you don’t have to pick up a paper referral from your PCP’s office. There are some cases when you can receive services from doctors outside the HMO network, including the following: Emergency care Out-of-area urgent care Out-of-area dialysis There is also a variation of HMO plans called HMO-POS (the POS stands for Point-Of-Service). These plans allow you to go out-of-network for certain services. But, it usually costs more if you go to one of those out-of-network doctors. Kevin Leinum Medicare Agent – your local Medicare Expert – can help you understand the many parts of Medicare and determine what the right fit is for you. Give us a call to discuss the options available to you.

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I didn’t sign up for Part B Medicare when I first became eligible, but want to now. Is that possible?

If you didn’t enroll in Medicare during your initial open enrollment period when you first turn 65 or become eligible for Medicare, there is an annual General Enrollment Period. The General Enrollment Period runs from January 1st through March 31st every year. During this time, you can sign up for Part A and/or Part B if you didn’t sign up when you were first eligible if you aren’t eligible for a Special Enrollment Period. If you don’t enroll in Part B when you’re first eligible, you may pay a penalty of 10% for each 12-month period you could’ve had Part B but didn’t sign up. In most cases, you’ll have to pay this penalty each time you pay your premiums for as long as you have Part B. The penalty increases the longer you go without Part B coverage, so it is crucial to enroll in Part B when you are eligible to avoid any late enrollment penalties. If you are still working and covered under an employer group health plan when you turn 65, don’t worry, you can defer your enrollment in Medicare with no penalty. You will be given an 8-month Special Enrollment Period (SEP) to sign up for Part A and/or Part B that starts at one of these times (whichever happens first): – The month after the employment ends. – The month after group health plan insurance based on current employment ends. Call Kevin Leinum Medicare Agent to discuss your Medicare needs.

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Do I have to get a Part D (Rx coverage) Medicare plan?

You are not required to enroll in a Part D prescription drug plan; however, you will not have coverage for most prescription drugs if you don’t. If you don’t enroll in a Part D plan when you first become Medicare eligible, you will also incur a late enrollment penalty if you enroll later. You will have to pay a late enrollment penalty for any period of 63 or more days in a row when you don’t have Medicare drug coverage or other creditable prescription drug coverage after your initial enrollment period. In most cases, you will have to pay the penalty for as long as you have Medicare drug coverage. The amount of the late enrollment penalty is dependent on how long you did not have Part D or creditable prescription drug coverage. The penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($33.06 in 2021) times the number of full, uncovered months you didn’t have Part D or other creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium. Call Kevin Leinum Medicare Agent – your local Medicare Expert about what Medicare covers or how enrolling in a Medicare Advantage or Medicare Supplement plan can improve your coverage and reduce your out-of-pocket costs.

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How often can I change Medicare plans?

Original Medicare Part A & Part B Outside of your initial open enrollment period, when you first turn 65 or become eligible for Medicare, there is an annual General Enrollment Period. The General Enrollment Period runs from January 1st through March 31st every year. During this time, you can sign up for Part A and/or Part B if you didn’t sign up when you were first eligible, and you aren’t eligible for a Special Enrollment Period. Kevin Leinum Medicare Agent – your local Medicare Expert – can help you understand the many parts of Medicare and determine what the right fit is for you. Give us a call to discuss the options available to you. Medicare Supplemental (Medigap) You can change Medicare Supplement plans anytime during the year. However, if you make a change outside your 6-month Medicare Supplement Open Enrollment Period, in most cases, you will have to go through medical underwriting. Medicare Advantage & Part D In general, if you are enrolled in a Medicare Advantage or Part D plan, you can only change plans once a year during the Annual Election Period (AEP), which runs from October 15th through December 7th. You may be able to change plans outside this enrollment period if you qualify for a Special Enrollment Period. You can also make one change during Open Enrollment, which runs from January 1st through March 31st if you selected the wrong plan during AEP.

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We do not offer every plan available in your area. Currently, we represent 8 organizations which offer 75 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options. This is a proprietary website and is not associated, endorsed, or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program, please visit the Official U.S. Government Site for People with Medicare located at http://www.medicare.gov.

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