TURNING 65...WHEN DO I SIGN UP FOR MEDICARE?

Introduction to Medicare Insurance

It's never too early to start planning. So, let Elisa help you get all the facts. Are you automatically enrolled in Part A? What about Part B? What are the associated costs? Now's the best time to learn about & explore all your choices. The more you know, the better decisions you'll make when the time comes.

6 Months Before You Turn 65

Start or continue to explore your Medicare insurance options.

3 Months Before You Turn 65

Enroll in Original Medicare, Parts A & B
Arrange for additional coverage to help fill the gaps that Medicare doesn't cover like vision & dental
NOW IS THE TIME TO SELECT ADDITIONAL INSURANCE BECAUSE ORIGINAL MEDICARE ONLY COVERS 80% & NO DRUG COVERAGE!

Your 65th Birthday Month - HAPPY BIRTHDAY!

By now, you should be signed up for additional coverage, even if you're already enrolled in Original Medicare! Medicare Parts A & B do not include prescription drugs, only pays for 80% of your medical expenses, and has no dental or vision coverage.

3 Months After You Turn 65

Be sure you're enrolled in Medicare by now because there are penalties if you're not
Get additional coverage in place before it's too late
Your deadline is the end of the 3rd month after your birthday month for enrollment in all Medicare insurance products without penality!

Let Me Help You Explore Your Medicare Insurance Options

Talk to a Medicare Insurance Specialist/Advisor soon after you turn 64:

Get introduced to Medicare insurance basics
Learn about the different types of coverage, including Medicare Advantage, Medigap, & Supplemental Plans like Dental & Vision
Take advantage of Elisa's FREE expertise to find the right plan to meet your needs

If you plan to keep working past 65, you may be eligible to keep your current health plan. Ask your employer about your eligibility.

What Medicare Doesn't Cover Everything by Brent Crawley

Most people pay into Medicare through their payroll for all their employment years, thinking that once they turn 65, the coverage will be free. You'd be wrong to believe so. The truth about this health insurance program is that it also has several expenses.

High-income earners pay more in terms of copays, deductibles, and premiums, and expect no out-of-pocket maximum. A significant contributor to the misconception is the "Medicare for all" debate that leads consumers into believing that the program is entirely free.

What Does Medicare Cover, And What Doesn't It?

Here are the different areas that Medicare covers, those that it doesn't, and the appropriate solutions for the coverage gaps:

Eye Examination and Optician

Original Medicare covers ophthalmologic costs like cataract surgery. However, it doesn't cover contact lenses and glasses or routine eye checkups. Some people may opt to purchase a vision insurance policy, which costs several hundred dollars annually.

Hearing Aids

Medicare covers any ear-related condition. Unfortunately for hearing aids or routine checkups, the insurance program doesn't cover all these. You may consider purchasing membership or insurance in discount plans covering such costs.

Dental Work

Both the Original Medicare and Medigap plans don't cover dental procedures like root canals, dentures, or routine checkups. Fortunately, several Medicare Advantage plans offer dental coverage. If your policy doesn't, purchase a dental discount policy or an individual insurance plan for dental care.

Overseas Care

A majority of Medicare Advantage plans in the United States and the Original Medicare don't cover any medical costs incurred outside the country. But there's a solution for frequent travelers. Several Medigap plans offer coverage for healthcare costs outside the U.S. What's more, several travel insurance policies provide this coverage, and you may also consider medevac (medical evacuation) insurance whenever you're planning an adventure abroad.

Podiatry

Medicare doesn't cover routine foot care like the removal of callus. Medicare Part B covers foot examinations and treatment provided it relates to nerve damage resulting from diabetes. It also covers care for foot ailments and injuries like heel spurs and hammertoe.

Cosmetic Surgery

Medicare doesn't cover elective cosmetic surgery. Procedures like tummy tucks and face-lifts aren't covered, but the plan covers plastic surgery to correct accidental injuries or breast reconstruction.

Nursing Home Care

Medicare covers limited rehab facility treatments. For instance, if you've undergone a hip replacement and thus require inpatient physiotherapy, your coverage will take care of the expenses. But if the condition worsens and needs to be transferred to a nursing home or an assisted living facility, the policy will not cover the custodial costs.

HMOs and Preventive Medicine

Health Maintenance Organization plans serve patients through a team of healthcare providers that agree to provide members with the services they need. The program covers a relatively wider diversity of preventive health services.

Members must select a PCP (primary care physician) to handle almost all their healthcare needs. Before visiting a specialist, you first have to be referred from your PCP. HMO plans are diverse, but their out-of-pocket healthcare costs are usually lower. You may need to pay a deductible before the beginning of the coverage, and the copayments are also low.

It's the ideal alternative if you are looking for lower premiums or if you need preventative care coverage like immunizations and checkups.

How to Keep Your Doctor and Ensure Coverage

You want to work with a health provider that you're comfortable with. They could be more familiar with your medical history or just a physician you can trust and share your information openly. This is a significant concern for most seniors, but is it possible once you enroll in Medicare?

If your coverage is Medicare Part B, you are free to visit your preferred physician if they accept a Medicare assignment. So if your preferred healthcare provider falls in this category, then you can easily stay with them. Medicare Part C, on the other hand, allows you to keep your physician. However, this depends on your particular Medicare Advantage plan and whether your specialist is in the network of providers.

Choosing A Medicare Supplement That Works for You

While Medicare health insurance may offer great coverage, it still doesn't cover all healthcare costs. If yours is the Original Medicare Plan and not the Medicare Advantage alternative, you can fill the gaps by acquiring a private supplemental insurance plan. Here are some crucial tips to finding a supplement plan for your healthcare needs:

Analyze the available options – Medicare supplements are standardized and are used in any facility that accepts Medicare payments. You can choose from 12 currently available plans labeled alphabetically from letter A to N.
Understand the pricing – After identifying the right plan, you'll proceed to shop, and the price is crucial for this. Don't just go for a plan because it's the cheapest as they are likely to raise the rates rapidly with time. You can choose between these three pricing categories: Attained-age rated, Issue-age rated, and Community-rated.
Talk to an insurance advisor/broker – Never fear to seek help from an insurance advisor/agent/broker whenever you're stuck. The law restricts them from charging a commission on the policy price. As such, you will end up paying the same premium as buying directly from the provider.
Time is money – In your 65th year, you'll be given seven months as the initial enrollment period. The duration comprises three months before you celebrate your birthday, the entire birthday month, and an additional three months afterward. During this period, you're assured of coverage with no underwritings. Once the time depletes, you can still acquire an appropriate Medicare supplement plan but it won't be guarantee-issue.

Medicare insurance plans are not entirely free, and you may have to pay some extra charges. Furthermore, the policy doesn't cover every healthcare service. But you can use different approaches to fix the coverage loopholes.

IF YOU ALREADY HAVE MEDICARE, IS YOUR PLAN RIGHT FOR YOU?

Looking Ahead: Why It's Important to Review Your Current Plan in 2024 & 2025...

Any time, is a great time, to review and compare your current Medicare insurance coverage with other plan options!

Even if you're happy with your current plan, it's important to check for any changes next year, and compare with other available options. You may even find plans that save you money! With plan premiums at historic lows, now's the time to explore your options and find the best fit for your needs and budget.

Just as your health care needs can change from year to year, so do Medicare insurance plans. And not all plans offer the same benefits. The Annual Enrollment Period (AEP) is your chance to review your Medicare coverage options, and find the best fit for you.

Here are some things to consider when shopping for Medicare insurance coverage:

Check if your doctors are still in-network and your prescriptions are on the plan's list of covered drugs, or "formulary."
With historically low plan premiums, be sure to also consider the plan's deductible and other out-of-pocket costs that factor into a plan's total costs.
Some plans offer extra benefits, like vision, hearing, or dental coverage, that could help meet your needs in 2025.

For more information, please call Elisa at 561-430-7075.

IF AFTER THE ANNUAL ENROLLMENT PERIOD YOU'RE NOT SATISFIED WITH YOUR MEDICARE ADVANTAGE PLAN, YOU WILL HAVE ONE TIME TO CHANGE IT: FROM JANUARY 1 - MARCH 31ST.

HOW TO FIND THE BEST MEDICARE INSURANCE SUPPLEMENT FOR YOU

by Jackie Trovato for Everyday Health & edited by Elisa

Finding the best Medicare Supplement plan to fit your healthcare needs can be very complicated. Here are questions you should ask yourself when researching your options. The best Medicare plan for you will depend upon your individual healthcare needs. Here are the key things you should consider when choosing a Medicare Supplement plan and provider.

The Centers For Medicare Services (CMS) suggest that you consider the following when choosing Medicare coverage:

1. How Much Will the Medicare Supplement Insurance Cost?

Determine the total cost of your monthly premiums, any deductibles, and other expenses you will incur using the plan you select. You should ask the provider how much you’ll pay for doctor visits and hospitalizations. Also, find out if you will have any annual limits on your out-of-pocket costs for these services.

For example, if you use only Original Medicare without a supplement, you won’t have a limit on the amount of out-of-pocket costs you may incur. This is why people often choose a Medicare Supplement plan like Medicare Advantage (Medicare Part C).

With Medicare Advantage plans, you will have a cap on the out-of-pocket costs you’ll have to pay each year. After you reach this amount, you won’t have to pay for any covered healthcare services for the remainder of the year. This is why Medicare Advantage plans are so popular with seniors.

2. What’s Covered in the Medicare Insurance Plan?

Does the plan cover the healthcare services you’ll require? For example, will it include hearing aids, dental, and vision services?

Original Medicare (Medicare Parts A and B) only covers services and supplies for hospitalizations, in doctor’s offices and other healthcare settings.

The best Medicare Advantage plans (also referred to as Part C) cover the services that Part A and B cover, as well as additional services like prescription & over-the-counter drugs, and devices for vision, hearing, and dental care.

3. What Other Health Insurance Coverage Do You Already Have?

If you already have health insurance or prescription drug coverage from an employer, ask the insurance provider how this will work with Medicare. You can also ask your health benefits administrator at work.

Consider what you may be paying now for covered services. It may be worthwhile to sign up for a Medicare Advantage plan if the cost share is lower than what you’re paying with your current health insurance.

Remember, many Medicare Advantage plans also offer vision, hearing, dental, and a host of other services that your current coverage may not provide.

4. Will You Need Prescription Drug Coverage?

The cost of prescription drugs is always on the rise. Seniors on a limited income may not be able to afford the prescriptions they need. The best Medicare Supplement plans include prescription drug coverage. If yours doesn't, you may be able to join a separate Part D plan.

You can sign up for a Medicare Advantage plan (Part C) or you can access Medicare Part D through a Medicare Supplement plan that includes prescription drug coverage. With this option, you'll have your Medicare Part A (hospital insurance) and your Medicare Part B (medical insurance), as well as your prescription drug coverage (Medicare Part D).

5. Will the Medicare Supplement Plan You Select Cover Your Choice of Hospitals and Doctors?

When you choose a Medicare Supplement plan, you should use healthcare advisors who participate in the plan’s network. Be sure to ask how close the plan network’s doctors, hospitals, and pharmacies are to your home.

Some Medicare Supplement insurance plans will offer out-of-network coverage. Find out if yours does and if you will have any additional fees for using them.

6. What Is the Quality of Care Provided by the Medicare Insurance Plan?

The quality of healthcare services offered by each Medicare Supplement plan will vary depending on their providers. Every year CMS rates each provider on a scale of 1 to 5 stars with 5 being the best. Find out how Medicare rates each plan you’re considering and compare plans.

7. Will You Be Able to Obtain Healthcare When You Travel with the Medicare Supplement Plan?

With Original Medicare only, you won't be able to obtain covered healthcare services outside the United States. The same goes for most Medicare Advantage plans. Check to see if the plan you're considering offers additional coverage for healthcare services or supplies outside the United States. If the Medicare Supplement plan you’re considering doesn’t offer emergency care outside the United States, you’ll want to purchase supplemental insurance that offers travel coverage.

Steps to Take Now: For more information about the Best Medicare plan for you or a loved one, contact a licensed expert to determine your options for Medicare. They will ensure that you choose the best coverage for your particular situation. Be sure to stay informed, do your research, and use the services of a professional when it comes to Medicare. BTW, Medicare plans change annually. Be sure to get a "Medicare Check-UP" each year as you can potentially save a lot of money and worries if you do.

WHAT SENIORS, LOVED ONES, AND CAREGIVERS SHOULD KNOW

By Jason Carrasco & edited by Elisa

Although their names sound similar, Medicare and Medicaid are two different types of healthcare programs offered by the United States government. While both cover healthcare costs, the eligibility requirements for each program are different.

From the government’s perspective, the collective goal is to provide healthcare coverage to American citizens and residents age 65 and older, to those who have a disability (regardless of age), or to low-income individuals and families.

If you fall into any of these categories, depending on which category you fall under, you will want to either enroll in Medicare, Medicaid, or both. Medicare and Medicaid do not offer automatic enrollment, and each program has different costs, benefits, and coverage.

If you're here, you already have a good idea of what Medicare is. The Medicaid program primarily concentrates on the healthcare needs of low-income families and individuals as well as those with disabilities. Medicaid is jointly funded by the U.S. states and the federal government. Therefore, Medicaid coverage differs by state.

Medicaid benefits generally include the following:

Care and services from a hospital or skilled nursing facility
Home health care services
Care from a federally qualified health center
Long-term care
Doctor and nursing services
Lab services and X-rays

Want to Learn More?

Medicaid is, in fact, the largest single source of long-term care funding in the country. To learn more about Medicaid in Florida, simply reach out to Elisa at (561) 430-7075.

SIMPLIFYING MEDICARE INSURANCE PLANNING