Affordable Care Act (ACA) Plans
This type of health insurance is based on the comprehensive health care reform law enacted in March of 2010. There primary purpose is to make affordable health insurance available to more people. Plans typcially provide subsidies ("subject to eligibility") that lower costs for households. ACA also expanded the Medicaid program coverage.
Medicare Advantage Plans
A Medicare Advantage Plan is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans are also called “Part C” or “MA Plans” and are offered by private health insurance companies approved by Medicare.
Medicare Supplement Plans
A Medicare Supplement Plan is supplemental insurance offered by private health insurance companies to help pay your share of out-of-pocket costs not covered from Original Medicare (Part A and Part B). These plans are also called "Medigap" plans and typically do not include Prescription Drug Coverage.
Prescription Drug Plans
Medicare Part A and Part B does not provide prescription drug coverage. These are standalone plans offered by private health insurance companies that provide coverage for prescription drugs, medications, and some vaccines.
Hospital Indemnity Plans
A Hospital Indemnity Plan supplements your existing health insurance to help pay for additional uncovered costs related to hospital stays.
Catastrophic Illness Plans
A Catastrophic Illness Plan is intended to provide coverage when a major medical event such as being diagnosed with Cancer or having a heart attack or a stroke.
ACA Plans
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Medicare
Original Medicare - Is it enough?
Think of Original Medicare as your basic or a minimum level of coverage. It primarily consists of Medicare Part A, Part B, and optional Part D coverage you can add if you choose to. If you are already drawing Social Security you should be automatically enrolled in both Part A and Part B. If you are close to turning 65 and not currently drawing Social Security, signing up for Part A and Part B is not automatic and must be done so by contacting The Social Security Administration directly. If you do not enroll in Parts A, B, or D when you are first eligible, you may be charged recurring penalties when you do enroll for as long as you remain enrolled.
You typically become initially eligible for Original Medicare when you turn 65. This eligibility will provide you with a 7 month enrollment window known as your Initial Enrollment Period (IEP - Described in the enrollment periods section) which consists of the three months prior to the month you will turn 65, the month you turn 65 and the three months following the month you turn 65. Certain circumstances may arise where you may become eligible for Medicare earlier if you have a disability or have end-stage renal disease or Lou Gehrig's disease.
Original Medicare consists of Part A, Part B and optional Part D coverage. You may also add supplemental coverage by adding a Medicare Supplement or Medigap plan. Each are described below.
Medicare Part A is your Hospital coverage. It helps to cover the costs related to inpatient hospital care, inpatient skilled nursing care at a facility, hospice care, home health care and inpatient care at a religious non-medical health care instituion.
Part A costs you pay include but are not limited to:
For inpatient hospital care you would pay a deductible and no coinsurance for days 1-60 of each benefit period, a coinsurance amount per day for days 61-90 of each benefit period, a coinsurance amount per lifetime reserve day over 90 days of each benefit period and all costs for each day after the lifetime reserve days have been exhausted.
For inpatient skilled nursing care at a facility you would pay nothing for the first 20 days of each benefit period, a coinsurance amount per day for days 21-100of each benefit period, and all costs for each day over 100 days in a benefit period.
Medicare Part B is your Medical coverage. It helps to cover medically necessary doctor's servces, outpatient care, home health services, durable medical equipment, and other medical services.
Part B costs you would pay include but are not limited to:
For inpatient hospital care you would pay a deductible and no coinsurance for days 1-60 of each benefit period, a coinsurance amount per day for days 61-90 of each benefit period, a coinsurance amount per lifetime reserve day over 90 days of each benefit period and all costs for each day after the lifetime reserve days have been exhausted.
For inpatient skilled nursing care at a facility you would pay nothing for the first 20 days of each benefit period, a coinsurance amount per day for days 21-100of each benefit period, and all costs for each day over 100 days in a benefit period.
Medicare Part D is your Prescription coverage.
While Medicare covers a significant portion of healthcare costs, it is important to note, it does not cover everything. You could be left to pay for ALL costs associated with the things Medicare does not cover. Some items not covered by Medicare Part A and B at all, include but are not limited to:
1) Dental Care
2) Eye Exams (for prescription glasses)
3) Dentures
4) Long-term Care
5) Routine Physcial Exams
6) Hearing Aids and Exams for Fitting
7) Covered Items or Services you get from an opt-out doctor or other provider (except in the case of an emergency or urgent need)
8) Concierge Medical Care (e.g. retainer based medical care, platinum practice, or direct care)
9) Massage Therapy
10) Cosmetic Surgery
Medicare Part C refers to any supplemental coverage (e.g. Medicare Supplement (Medigap) or Medicare Advantage).
Enrollment Periods
Timing is everything when it comes to enrolling in Medicare successfully. There are different types of enrollment periods which can be confusing. There can also be additional penalties assessed based on late enrollment. Here, we cover themost common enrollment periods.
Initial Enrollment Period (IEP) - This period runs throughout the year from January 1st to December 31st and is specifically for people who are newly eligible for medicare. Specifically, there is a seven month window to join when you are turning 65. The seven month window consists of the three months prior to the monnth of your birthday, your birthday month, and three months following the month of your birthday.
General Enrollment Period (GEP) - This period runs from January 1st to March 31st. During this time period, you can sign up for Medicare Part A and/or Part B if you did not sign up when you were first eligible and are not eligible for a Special Enrollment Period (SEP). You may have to pay a higher Part A and Part B premium for late enrollment if you did not sign up during your IEP or due to a qualifying Special Enrollment Period (SEP).
Medicare Advantage Open Enrollment Period (OEP) - This period runs from January 1st to March 31st. During this time period, individuals enrolled in a Medicare Advantage plan can make a one-time election to switch to another Medicare Advantage Plan or back to Original Medicare. Coverage will typically begin the first day of the month following the month in which the was made.
Annual Planning Period (APP) - This period runs from October 1st through October 14th each year. This time period is primarily for people who are currently enrolled in medicare to review coverage, upcoming changes, and coverage options. During this time period current coverage can be compared with other options.
Annual Enrollment Period (AEP) - This period runs from October 15th through December 7th each year. This is for people who are currently enrolled in medicare. During this time period you can change you health coverage for the following year. Examples include enrolling in, changing or dropping a Medicare Advantage Plan or Medicare Drug plan.
Special Enrollment Period (SEP) - A SEP occurs based on certain events that take place throughout the year requiring you to change your coverage. Common events that can result in a SEP include, but are not limited to: 1) You lose employer provided plan coverage. 2) Your plan drops coverage of your service area. 3) You move out of your plan's service area. 4) You move into or out of an institution such as skilled-nursing facility.
What is a Medicare Advantage Plan? See for yourself.
Medicare Advantage Plans are sometimes referred to as Medicare Part C. These are plans that offer supplemental coverage that is typically provided by private health insurance companies approved by Medicare. Medicare Advantage plans bundle your Medicare Parts A and B with supplemental coverage to aid with additional costs not covered by Original Medicare. These plans must follow a predetermined set of rules set by Medicare and most will include Part D prescription drug coverage also.
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