OEP in San Diego, CA
Frequently Asked Questions:
Medicare, Supplement Plans, Advantage Plans, Long Term Care
What is the Medicare Open Enrolment Period?
If you were not able to make the changes you wanted to during AEP, Open Enrollment Period could be the perfect opportunity for you to switch your plan. Open Enrollment Period begins on January 1st and continues until March 31st.
During this time you are allowed to:
- Switch from one Medicare Advantage plan to another Medicare Advantage Plan.
- Disenroll from a Medicare Advantage Plan and return to Original Medicare (with or without a Part D drug plan).
You are not allowed to:
- Switch from Original Medicare to a Medicare Advantage Plan
- Add or switch a Medicare Prescription Drug Plan (if enrolled in Original Medicare).
Call us Toll-Free at (855) 213-0460 to speak with a Senior Health Specialist about making a change to your plan this OEP season.
If I am eligible for Medicare, how do I enroll?
If you are turning 65 and receiving Social Security or Railroad Retirement benefits, you may be automatically enrolled. If you are not automatically enrolled, you can enroll by calling Social Security at (855) 213-0460, visit the web site (www.ssa.gov), or apply at your local Social Security office. Apply three months before your 65th birthday. That way, you can be sure that your benefits will start on time.
Is Part B coverage required?
Once your employment or coverage ends (whichever happens first):
You have 8 months to sign up for Part B without a penalty. If you don’t enroll in Part B during this 8 month period, you may have to pay a penalty after you enroll for as long as you have Part B. You won’t be able to enroll until the next General Enrollment Period and you’ll have to wait until July 1st for your coverage to begin.
When you enroll in Part B your Medicare Supplement Open Enrollment Period begins.
How do I pay for Medicare?
You usually do not pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. If you aren’t eligible for premium free Part A, you may be able to pay for Part A if:
1) You’re 65 or older, you have enrolled (or are enrolling) in Part B, and meet citizenship & residency requirements.
2) You’re under 65, disabled, and your premium free Part A coverage ended because you returned to work.
If you are receiving Social Security benefits at the time you enroll in Medicare, your Part B premium will be deducted automatically from your monthly check. Monthly premium is $104.90 (in 2015) for beneficiaries with individual incomes of $85,000 or less.
If you have not begun to receive Social Security yet, you will receive a quarterly bill for your premium, which you can pay several different ways.
If you enroll in a Medicare Advantage Plan, Prescription Drug Plan, or Medicare Supplement Plan: if there is a plan premium, there is a number of different ways you can pay that premium. The different ways to pay your supplemental insurance premium is just one of the many things our Senior Health Specialist will review with you.
Can you have Medicare insurance coverage after age 65 while you or your spouse is working?
If your employer has 20 or more employees, your employer must offer you the same group health plan that is offered to the other employees. If you choose to have both the employer´s group health plan and Medicare, the employer plan will be primary and pay first. Medicare will be secondary and will pay only after the employer plan.
Are you entitled to Medicare Insurance coverage if you are younger than 65, on Medicare, and you, your spouse, or a parent is still working?
Can you be eligible for Medicare coverage if you are younger than 65 and have permanent kidney failure?
Others are covered by the employer plan even after they are unable to work. If you have ESRD and are covered by an employer group health plan, and you have Medicare, the employer plan is required to pay first for 30 months following the effective date of your Medicare benefits. This is true regardless of the size of the group and regardless of whether the person with ESRD is working or not.
What is Extra Help?
If you have limited income or resources, you may qualify for Extra Help. Extra Help is a Medicare program to help those with limited income and resources pay their Medicare prescription drug costs, like premiums, deductibles, and coinsurance. If you have Extra Help there are supplemental Medicare plans available to you as well.
To apply for Extra Help call Social Security at (855) 213-0460 or visit your state Medicaid office.
Does Medicare cover foreign travel?
In general, Original Medicare does not cover health care while you’re traveling outside the United States.
There are some exceptions such as if you were to board a ship within the territorial waters adjoining the land areas of the U.S.
Medicare may pay for inpatient hospital care, doctor, or ambulance services in a foreign country in rare cases:
1) If you are in the U.S. when an emergency occurs but the foreign hospital is closer than the nearest U.S. hospital.
2)If you are traveling through Canada from between Alaska and another state when an emergency occurs, and a Canadian hospital is closer than the nearest U.S. hospital.
3) If you live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.
It is important to look into your Supplemental Insurance options as well as Travel Insurance if you are a frequent traveler or are traveling outside of the United States.Travel Insurance can help protect you and your family from unforeseen disaster or emergency.
Call us Toll Free at (855) 213-0460 to speak with a Specialist about your options today!
When can I enroll in a Medicare Supplement policy?
Medicare Supplement Insurance, also known as Medigap, can help pay some of the health care costs that Medicare doesn’t cover.
You have a one time, 6 month, Open Enrollment Period that starts the first month you are 65 and enrolled in Part B. During this period, you can enroll into any Medicare Supplement Plan regardless of your health status.
Call us Toll Free at (855) 213-0460 to speak with a Senior Health Specialist and talk about your Medicare Supplement options.
What is the Part D enrollment penalty?
The late enrollment penalty is an amount that’s added to your Part D premium. You may owe a late enrollment penalty if at any time after your initial enrollment period is over, there’s a period of 63 days or more days in a row when you don’t have Part D or other credible prescription coverage.
If you receive Extra Help, you will not pay the late enrollment penalty.
Call us Toll Free at (855) 213-0460 to speak with a Senior Health Specialist about your Part D options and avoid paying the enrollment penalty.
What is the donut hole?
For 2015, once you enter the donut hole, you pay 45% of the plan’s cost for covered brand-name drugs and 65% of the plan’s cost for covered generic drugs until you reach the end of the coverage gap. Not everyone will enter the coverage gap because their drug costs aren’t high enough.
Once you get out of the donut hole, you enter catastrophic coverage. Within this stage, you only pay a small coinsurance amount or copayment for covered drugs the rest of the year.
When can I change my Senior Health Insurance Plan?
You don’t need to sign up for Medicare each year. However, each year you will have a chance to review your coverage and make changes.
If you are currently on a Medicare Advantage Plan or Prescription Drug Plan, you can change your plan during the Annual Enrollment Period which begins October 15th and ends on December 7th. Also, if you are on an MAPD or PDP you may change your plan if you qualify for a special election period such as moving counties, losing or gaining Medicaid status, or if you live in an institution (i.e nursing home).
If you are on a Medicare Supplement Plan and want to make a change, you must qualify for a guaranteed issue reason or go through underwriting.
If you would like to know if you are eligible for a special election period or guaranteed issue reason, please contact us Toll Free at (855) 213-0460 .
Do all long term care insurance policies cost the same?
No, that’s one reason why it pays to speak with a knowledgeable long-term care insurance professional.
The cost of long-term care depends on the type and duration of care you need, the provider you use, and where you live. Costs can be affected by certain factors, such as:
- Time of day. Home health and home care services, provided in two-to-four-hour blocks of time referred to as “visits,” are generally more expensive in the evening, on weekends, and on holidays.
- Extra charges for services provided beyond the basic room, food and housekeeping charges at facilities, although some may have “all inclusive” fees.
- Variable rates in some community programs, such as adult day service, are provided at a per-day rate, but can be more based on extra events and activities
Call us Toll Free at (855) 213-0460 to speak with a Long Term Care Specialist today.