We've been in this industry for over 27 years. We'd like to think we know a thing or two about Medicare.

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.

The Road to Medicare >

Medicare & Group Coverage >

$10,000
National health spending will average upwards of this figure per person for 2018 - 2025
+5.6%
National health spending is projected to grow at an average rate for 2018 - 2025
+7.1%
Medicare spending is projected to grow an average rate per year.
1 in 5
Americans will be on Medicare in 2025
​
Current Medicare Beneficiaries in 2018
Projected Medicare Beneficiaries in 2025

When Should Clients Enroll in Medicare?

Have your clients sign up early to avoid a delay in getting coverage for Part B services. To get Part B coverage the month your clients 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.

Differences between Medicare Supplement plans and Medicare Advantage plans:

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 2019

Type of Cost Sharing
2019
Part A Hospital Inpatient
​Deductible for each benefit period
$1364
Hospitalization Days 61 - 90
​Co-insurance per day of each benefit period
$341
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)
$682
Skilled Nursing Facility Care
Co-insurance per day of each benefit period (21 - 100 days)
$170.50
Part B Deductible
​Calendar year deductible for Medicare approved amounts for covered services
$185
Standard Monthly premium for Medicare Part B enrollees
$135.50
Annual deductible for all Medicare Part B beneficiaries
$185
High Deductible Plans F & J
(plans purchased prior to 2010)
$2300
Out of Pocket Limit Plan K
$5560
Out of Pocket Limit Plan L
$2780

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

Learn More >

The Differences Between Open Enrollment & Guaranteed Issue >

Your Role as an Advisor

Advising your clients and showing them the differences between the Medicare Advantage and Medicare Supplement product, and then recommending the best solution(s) for them, while advising and helping them navigate the complexities of the Medicare program is what they need and expect.
Our Senior Solutions Managers can offer you guidance with which plans are best for your clients' needs. They can assist you with using our quote tool to determine the best plan, depending on your clients' location, health and budget.

Welcome to Medicare >

Choosing a Medigap Policy >

Medicare & You 2019 >

Medicare & You 2019 Spanish >