Medicare doesn't have to be confusing.

Medicare provides health coverage to over 49 million people who are age 65 and older, under age 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD). Your clients enroll in Medicare by calling Social Security (800.772.1213), by visiting ssa.gov or their local Social Security office. If they don't enroll on time, they may pay late enrollment penalties and their healthcare expenses may not be covered.

When Should Clients Enroll in Medicare?

Have your clients sign up early to avoid a delay in getting coverage for Part B services. In order to get their Part B coverage the month they turn 65, they must sign up during the first three months before they turn 65. If they wait until the last four months of their Initial Enrollment Period to sign up for Part B, their start date for coverage will be delayed.

There are two ways to get Medicare.

Original Medicare
Operated by the Federal government. Medicare pays fees for your care directly to your doctors/providers.
Part A
Pays for part of your hospital costs.

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Part B
Pays for your doctor and outpatient care.

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Part D (+ Medicare Supplement)
Stand-alone prescription drug plans can be added to help with the cost of prescription drugs.
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Medicare Advantage (Part C)
Plans are private health plans that contract with Medicare.
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PPO-HMO-PFFS-SNP
Medicare pays a fixed fee to the plan for your care at the doctor and hospital. The plan pays the doctor and hospital directly. 
Part D
Prescription drug coverage can be part of these plans. A PFFS plan is the only plan that can add drug coverage (separate) to the plan.
Additional Benefits
Often included, such as dental and vision, and nurse help lines. Most plans have a cap on out of pocket expenses.

Medicare Supplements vs. Medicare Advantage

Medicare Supplement

Medicare Advantage
Choice of doctors
Any doctor who accepts Medicare.
Doctors who participate in the plan's network.
referrals
Your client may see specialists without a referral.
Your client may need a referral and may be limited to specialists in the plan's network.
Coverage while travelling
Your clients are covered when travelling domestically, and may see any doctor who accepts Medicare.

​Plans F, G and N cover travel abroad.
Only emergency and urgent services are covered. Routine care is not covered.

​Only emergency services are covered abroad.
prescriptions
Prescription drug plans are separate and compliment a Medicare Supplement plan.
Many plans include drug coverage, but not all drugs are covered.
Dental & vision
Separate Dental, Vision and Hearing plans provide optional coverage.
Most plans include dental and vision.
plan cancellation
Plans cannot be cancelled as long as your client pays their premiums.
Plans can be cancelled at the end of every calendar year. Most renew, but not always.
co-pays & co-insurance
Co-pays and co-insurance depend upon the plan.
There are co-pays and co-insurance with Medicare Advantage plans.
premiums
Your client will have to pay a monthly premium in addition to their Part B premium.
Most plans have a low or $0 monthly premium. Your client will also need to pay their Part B premium.
benefits
Some plans offer additional benefits. Medicare Supplement benefits will always remain the same though.
Fitness memberships, transportation and even hearing are often included. Benefits may change from year to year though.

​Deductible and Co-insurance Amounts for 2021

Type of Cost Sharing
2020
2021
Part A Hospital Inpatient
​Deductible for each benefit period
$1408
$1484
Hospitalization Days 61 - 90
​Co-insurance per day of each benefit period
$352
$371
Hospitalization Days 91 and beyond
​Co-insurance per each "lifetime reserve" day after day 90 for each benefit period (up to 60 days over your lifetime)
$704
$742
Skilled Nursing Facility Care
Co-insurance per day of each benefit period (21 - 100 days)
$176
$185.50
Part B Deductible
​Calendar year deductible for Medicare approved amounts for covered services
$198
$203
Standard Monthly premium for Medicare Part B enrollees
$144.60
$148.50
High Deductible Plans F & G
(plans purchased prior to 2010)
$2340
$2370
Out of Pocket Limit Plan K
$5580
$6220
Out of Pocket Limit Plan L
$2940
$3110

Medicare Resources

Two Open Enrollment Periods

October 15th - December 7th
Medicare Open Enrollment Period

  • Change from Original Medicare to a Medicare Advantage plan (or vice versa)
  • Switch from one Medicare Advantage plan to another Medicare Advantage plan
  • Switch from a Medicare Advantage plan that doesn't have drug coverage to one that does offer drug coverage (or vice versa)
  • Join a Medicare Prescription Drug Plan (PDP)
  • Switch from one Prescription Drug Plan (PDP) to another PDP
  • Drop Medicare Prescription Drug coverage completely

January 1st - March 31st
​Medicare Advantage Open Enrollment Period

  • If your client is in a Medicare Advantage Plan (with or without drug coverage), they can switch to another Medicare Advantage Plan (with or without drug coverage).
  • They can disenroll from their Medicare Advantage Plan and return to Original Medicare. If they choose to do so, they'’ll be able to join a Medicare Prescription Drug Plan.
  • If they enrolled in a Medicare Advantage Plan during their Initial Enrollment Period, they can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without drug coverage) within the first 3 months they have Medicare.
Source: CMS.gov

The Differences Between Open Enrollment & Guaranteed Issue >