DISCLAIMER: 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.
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Understanding Medicare
Medicare vs. Medicaid
Wondering what’s the difference between Medicare and Medicaid? You’re not the only one. Both are government-funded health insurance programs, but they serve different purposes.
Medicaid is government insurance administered by the state based on income and assets. Medicare is for those 65 or older or those who have a qualifying disability. Medicare administered by the federal government or private insurance providers (Medicare Advantage).
We can help you understand your options and eligibility.
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Who Qualifies?
There are 3 general groups of people who qualify for Medicare.
1. People age 65 or older
2. People with disabilities
3. People with End Stage Renal Disease
What’s the enrollment period?
Initial Enrollment Period
The initial enrollment period is 1) three months before you turn 65, 2) the month you turn 65, and 3) three months after.
Annual Enrollment period
October 15th – December 7th each year
This is the time you are able to change prescription drug plans or Medicare Advantage plans for the next year C.
Medicare Supplement Open Enrollment
If you are turning 65 and enroll in Part B, this begins the month you turn 65 and runs for 5 months after. If you are on employer coverage and over age 65, this begins the first of the month when your Part B starts and runs for 5 months after.
General Enrollment
You can sign up for Part A and/or Part B between January 1 and March 31 each year. Your coverage will start July 1 and you may be subject to penalties.
Medicare Advantage Open Enrollment
This runs from January 1 – March 31 each year and allows individuals enrolled in a Medicare Advantage plan to make a one-time election to go to either another Medicare Advantage plan with or without drug coverage or Original Medicare.
If you chose to go back to Original Medicare you will be allowed to enroll in a Medicare prescription drug plan.
Steps to get coverage
If you are under age 65 and eligible for Medicare
3 months before your Medicare starts, you can enroll in either a Medicare supplement or Medicare Advantage plan and it will start on the month your Medicare starts. Because you have to be disabled for 24 consecutive months you will automatically be enrolled in Medicare Parts A&B. You will have an initial Enrollment period for both Medicare supplements and Medicare Advantage plans.
If you are turning 65 and already receiving your social security benefits
Approximately 3 months before the month you turn 65 you should receive your Medicare card in the mail. If you do not want to enroll in Medicare Part A&B then you can fill out a form and ask to not be enrolled at that time.
You will have your initial enrollment period starting 3 months before the month you turn 65 and running for the next 6 months
If you are over age 65 and losing employer coverage
If you have not enrolled in Part A or B previously, you will need to do so before you lose the employer coverage so that there is no gap in coverage. Once you are enrolled in Part A&B you will have 6 months from the start of Part B to enroll in a Medicare supplement plan. You only have 63 days from the end of the employer coverage to enroll in a Prescription Drug Plan or a Medicare Advantage Plan with prescription drug coverage to avoid a Part D penalty.
Medicare Supplement Plans
This is secondary insurance to Original Medicare. They only pay if Medicare pays first. They do not include prescription drug coverage. Anyone can sign up for them during their initial enrollment period, after that you will have to answer health questions to see if they qualify.
In Idaho you can change Medicare supplement plans each year starting the date of your birthday and running for 63 days to the same plan or lower plan with another carrier and have it be guaranteed issue. You can change supplement plans at any time of the year with health questions.
YOU CANNOT BE ENROLLED IN BOTH A MEDICARE SUPPLEMENT PLAN AND A MEDICARE ADVANTAGE PLAN AT THE SAME TIME.
Medicare Advantage Plans
Medicare Advantage combines Part A, B and often D. It often offers additional benefits like dental, vision, hearing, gym memberships, or over-the-counter medications. Everything gets billed through the Medicare Advantage carrier.
They have a network and are often less expensive than a supplement. You can change plans during the Annual Enrollment Period each year or during the Medicare Advantage Open Enrollment. You do not have to answer health questions to join.
Important things to know about Medicare
You will be hounded by solicitations starting about six months before your 65th birthday and during the Annual Enrollment Period each year.
Not every plan that is on TV is available in our area. Availability of plans differ with where you live.
The ads you see on TV are not always factual.
If you have questions about any mail or phone call you receive, contact us and we can help you navigate your options.
Need help paying for Medicare
If you need helping paying for Medicare, you can apply for Medicaid coverage and qualification is determined by income and assets. You can also apply for help with prescription drug coverage based on income and assets.