What is Medicare?
Created in the 1960s, Medicare is the federal health benefit plan for persons age 65 or older (subject to certain residency requirements). Known as "Original Medicare," the plan is divided into two "parts": Part A is also known as "Hospital Insurance" and Part B is known as "Medical Insurance." Part A covers medically necessary expenses incurred when a beneficiary is admitted to an acute care hospital, after payment of a benefit period deductible and for up to 60 days following admission. Benefits are subject to daily copays if still hospitalized after 6o days, but only for the next 30 days. If still hospitalized after 90 days, a beneficiary may use the 60 "lifetime reserve" days with which he or she has been credited at age 65, subject to a much higher daily copay. After payment of the annual deductible, Part B covers charges for physicians' and surgeons' expenses (in or out of the hospital) and most outpatient hospital expenses (such as Emergency Room, radiology, or laboratory services, or Urgent Care).
Part A is provided "premium free" to most persons because they (or their spouse) have achieved "fully insured" status over ten or more years of work (persons who do not qualify for premium free Part A will be required to pay a monthly premium dependent on the actual number of earned Social Security "credits"). Part B is optional and requires payment of a monthly premium, and the premium is based on adjusted gross income ("AGI") in the tax year two years prior to the current benefit year (persons with higher incomes pay higher premiums). Failure to enroll in either Part A or Part B can result in premium penalties.
Medicare Advantage . . .
represents one of the most economical ways to obtain your Medicare health care services and prescription drug benefits. Depending on your county of residence in California, most Medicare beneficiaries have access to multiple "$0 premium" HMO and/or PPO plans that substitute their benefits for Original Medicare Parts A & B, and include coverage for the Medicare Part D (Prescription Drug Plan). Although you must still pay your Medicare Part B monthly premium (and any applicable Part A premium for persons who are not "fully insured" as a result of your own or your spouse's work history), Medicare Advantage plans may reduce many of your out-of-pocket expenses to $0, such as copays when you visit your physician or need certain lab tests or other routine diagnostic procedures, and many plans include "value-added" benefits which are not included in Original Medicare, such as vision, dental, hearing aids, chiropractic and acupuncture, and transportation, as well as coverage while traveling outside the U.S. Expenses for hospitalization may also be substantially reduced. Some plans include membership in a local fitness club or program.
As a California-licensed Accident & Health Agent, I represent several of the most highly rated Medicare Advantage plan providers in California. There may be several plans available in your area. Each company's plans are different, and there are a number of factors that need to be considered before choosing a plan. I will help you identify the plans that best meet your needs, discuss both the advantages and disadvantages of each plan, and help you choose the one plan that is most suitable for you.
The "Annual Election Period" begins on October 15 and ends on December 7 each year, with coverage beginning on January 1. You may change plans annually, and you may also disenroll from Medicare Advantage and reenroll in Original Medicare. Persons turning age 65 at any time of the year may enroll in a Medicare Advantage plan up to three months prior to or after turning age 65, with coverage beginning as soon as the first day of the month in which you turn age 65, or the first day of the month following enrollment after turning age 65. There is also a "Special Enrollment Period" of up to eight months for persons leaving employer-sponsored health plans.
If you would like more information about Medicare Advantage plans available in your area, please use the Contact Us! page to send an email or give us a call at (909) 618-4841 or (909) 865-7873.
Beware of Medicare Advantage scams!
Federal laws prohibit anyone from calling you or coming to your home unless you have first invited them to do so. Your friends or family members cannot give anyone permission to call your phone number or show up on your doorstep unless you have designated them as your "personal representative." Before any agent may meet with you in your home to discuss Medicare Advantage (or Medicare Supplement) insurance plans -- or any other type of life insurance, annuities, or long-term care insurance, you must be given a written "Scope of Appointment" notice at least 48-hours in advance.
If you are currently enrolled in any Medicare Advantage plan and want to remain in that same plan, there is nothing you need to do for 2017. Your coverage will automatically be continued. You do not need to meet with an agent, or fill out any enrollment forms. But if you enroll in a Medicare Supplement plan or a stand-alone Prescription Drug Plan, you will automatically be disenrolled from your Medicare Advantage plan. If this is not what you want to do, please do not meet with anyone who claims to represent your health plan, or claims to represent Medicare. No one from your present Medicare Advantage (or Medicare Supplement) plan will call you and Medicare does not have any agents or employees who will contact you concerning enrollment in any kind of health plan or supplemental benefit plan.
=Last updated 4/30/2016=