Medicare Planning

Part A? Part D? What does it all mean?

We know that trying to understand Medicare can be very difficult, we pride ourselves in our ability to helping clients understand all parts of Medicare and Medicare Advantage and guiding them to the best coverage for their situation. One of the most important elements of risk management in retirement is addressing medical expenses that could deplete your financial assets. Furthermore, the cost to manage that risk must fit a client’s budget and retirement plan. One of the most important services we provide our clients is an annual Medicare health plan review. We certify with all the Medicare health plans in Connecticut and do a thorough review for each client to make sure you’re adequately protected and getting the most for your healthcare dollars.

The Medicare Basics

What are all the different types of Medicare?

There are 4 different types of Medicare. Part A, Part B, Part C, and Part D.

Part A: Hospital
- Medicare Part A is offered to those who paid Medicare taxes while working.
- It covers things such as impatient hospital care, skilled nursing facility care, nursing home care, hospice care and home health care
- For most, there is no monthly premium on this coverage
Part B: Medical
- Part A and Part B makes up original Medicare
- You must sign up for Part B 3 months before turning 65, the month you turn 65, and 3 months after.
- It covers doctor visits, lab tests, medical equipment, and some preventative services.
Part C: Medicare Advantage (MA)
- Medicare Advantage plans are Medicare approved plans offered by private insurers
- It covers Part A and B (sometimes Part D) and may include dental, vision, and hearing benefits
- You must sign up for both Parts A and B to enroll into a MA Plan
- Medicare Advantage plans also offer prescription drug coverage
Part D: Prescription Drug Coverage
- Part D is usually included with Part C, you would only need a Prescription Drug Plan if you take supplemental insurance
- It covers prescription drugs

Medicare VS Medicaid

Medicare and Medicaid are entirely different, however you can have both. Medicare is for patients 65 and older (or patients with a qualifying disability) while Medicaid offers health care coverage for low-income individuals of any age.

If you have Medicaid AND Medicare, you can qualify for whats called a DSNP plan, talk to an agent to ask what best suits your needs.

What is Medicare Supplement Insurance (MediGap)?

Medigap is Medicare Supplemental Insurance that helps “fill the gaps” in Original Medicare. This insurance helps pay for some of the cost for health care services and supplies. It mainly helps costs such as co-payments, coinsurance and deductibles. Although it does not cover things such as long term care, vision or dental, hearing, or some nursing.

What you need to know:

You must have both Parts A and B
There is a premium for Supplement Insurance on top of Part B
As long as you pay the premium, the insurance company cannot cancel your MediGap policy.
MediGap policies sold after January 1, 2006 do not include Prescription Drug Coverage. If you need drug coverage, you can enroll into a Part D PDP Plan.
If you have a Medicare Advantage plan, it is illegal to be sold a MediGap policy unless you are switching to original Medicare.

What is the 5 Star Rating System? How does it work?

The 5 star rating system was designed in to measure how well Medicare Advantage and Prescription Drug Plans preform. A plan can get a rating between 1 and 5 stars. Medicare updates these ratings each fall for the upcoming year.

Medicare Advantage Plans are rated based on:

The health plan’s customer service
Staying healthy (Screenings tests and vaccines)
Managing chronic conditions
Plan’s responsiveness and care
Member complaints and issues with services (and switching plans because of these issues)

Prescription Drug Plans are rated based on:

The drug plan’s customer service
Member complains, issues with services(and switching plans because of these issues)
Member experience
Drug pricing and patient safety

Keep in mind the star rating isn’t everything, when comparing plans you must also compare the plans premium, drug coverage, and if the plan provides the benefits that suits your needs.

Generally, you are only able to change your Medicare Advantage plan during IEP (Initial Enrollment Period, when you turn 65) or AEP (Annual Enrollment Period, it runs from October 15th to December 7th), however if you are not happy with the plan you enrolled in during AEP you are able to switch your plan during the 5-Star SEP (Special Enrollment Period, this SEP runs from December 8th and ends November 30th of the year the plan has 5 stars). You can only use this SEP once throughout the year.

Turning 65?

First, contact social security (Also known as the railroad retirement board) and start collecting!
- Call 800-772-1213 (TTY 800-325-0778)
- Once approved for social security benefits, you’ll automatically enroll into Part A with no premium.

Sign up for Part B
- Call 800-772-1213 (TTY 800-325-0778)
- Contact your local Social Security Office: Click here
- Apply Online: Click here
- When your benefits are approved, you will receive a welcome package from Medicare with your Medicare Card.

Enroll into a Medicare Advantage plan (Part C)
- To quote, compare plan options and enroll, Click here
- If you’d like a second opinion on comparing plans, you can call our office today and we’d be happy to clear things up for you.

Keep in mind, if you are 65 and are covered by your employer or veterans program you won’t need to worry about enrolling into Medicare until you are retiring and losing your current health coverage.

We do not offer every plan available in your area. Any information we provide is limited to those plans
we do offer in your area. Please contact Medicare.gov or 1-800-Medicare to get information on all of your options.