Medicare

Our Medicare Plan Services

What is Medicare?

Medicare is health insurance for anyone who is 65 years of age or older and some people who have certain disabilities who are under 65 years of age.

To qualify for Medicare, you must be a U.S. citizen or a lawfully admitted permanent resident (green card holder) who has lived in the U.S. continuously for at least 5 years immediately before applying.

Medicare is broken up in several different parts.

Medicare Part A– Original Hospital Insurance (Inpatient Care)

Medicare Part B  – Original Medical Insurance for Outpatient Care (Preventive Care, Outpatient & Doctor Visits, etc…)

Medicare Part C  – These are Medicare Health Plans offered by private companies that contracts with Medicare to provide Part A & Part B benefits to people with Medicare that enroll in a plan.  These can include Medicare Advantage Plans, Medicare Cost Plans, (PACE) Programs of All – Inclusive Care for the Elderly, etc..  Several types of these plans are HMO, PPO, PFFS, SNP, MSA.  Most of the Medicare Advantage Plans do offer Prescription Drugs, but some do not.  To be eligible, Medicare requires policyholders to pay Part A and Part B Premium.  These plans can range in premium starting at $0 per month and out of pocket maximums can range to a maximum of $8,300 while many do not go that high.

Medicare Part D  – (PDP) – Prescription Drug Plan offered by private carriers for premium

When can I enroll?

Social Security & Medicare  – if you are receiving Social Security Benefits at 65, the beneficiary is automatically enrolled in Medicare Parts A & B.

Initial Enrollment Period (IEP) –  3 months before the 65^th birthday, the month of, and the 3 months after.

Annual Election Period (AEP) – October 15^th – December 7^th is when existing Medicare Beneficiaries can switch, enroll in or dis-enroll from Medicare Advantage or Prescription Drug Plans.  Medicare Supplements do not pertain.

Medicare Supplement Open Enrollment Period – 6 month period that begins the first of the month that one has Medicare Part B and is at least 65 years of age.  This period is dependent on Medicare Part B date and not age.  During this period, one can apply for a Medicare Supplement plan from any carrier.  No carrier can use any medical underwriting and must issue for policy that is applied for.

Guaranteed Issue Medigap Special Enrollment Periods (SEP)

• Employer Sponsored Plan Ends (Includes Cobra & Retiree Coverage)
• Move out of Medicare Service Area
• MA Plan no longer available or beneficiary leaves service area
• The Health Plan commits fraud or Medigap carrier goes bankrupt or stops providing coverage
• Medicare Advantage Trial within the first 12 months of electing a MA plan at age 65 decides to switch to Original Medicare and enroll in a Medicare Supplement Plan to any carrier or within the first 12 months after switching to a Medigap plan to a Medicare Advantage, one can go back to Original Medigap plan..

Year Round Enrollment for Medicare Supplement – Beneficiaries outside of the Special or Open Enrollment Period who do not qualify for a guaranteed issue special period, can still apply for a Medicare Supplement at any time, but will be subject to medical underwriting.

Other Things to Know

If you have an Health Savings Account (HSA) and you are enrolled in Part A & B, you can no longer contribute.  You can use your account for a variety of purposes such as helping pay for medical expenses, premiums, copays, coinsurance and any withdrawals from the account for qualified medical expenses will remain tax free.

Medicare does not pay for things such as dental, eyeglasses, hearing aids, home care or long term care.  Please ask when reviewing plans how the Medicare plan will pay for those services.

WE Can Help You

Our Licensed Sales Agent, Steve Grieco is available to help you explore the best plan and benefits to fit your needs.  Please call him at 607.846.4461 or email him at sgrieco@swanmorss.com and set up an appointment!

Medicare Resources

How to File an Appeal – https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals

How to File a Grievance – You can call 1-800-MEDICARE or visit https://www.medicare.gov/my/medicare-complaint.  You can also reach out to a State Health Insurance Program (SHIP) shiphelp.org to find your local SHIP and free, personalized health counseling.

CMS Appointment of Representative Form  https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms1696.pdf

Currently we represent 9 organizations which offer 87 products in your area.  You can also contact Medicare.gov, 1-800-Medicare, or your State Health Insurance Program for help with plan choices. 

Not affiliated with the U. S. government or federal Medicare program. This is a solicitation for insurance.