Pinnacle Insurance Services

What if I have insurance coverage through my employer, will that affect my getting Medicare?

admin — Mon, 13 Nov 2023 14:56:32 +0000

If you have insurance coverage through your employer, it can affect your eligibility for Medicare and how Medicare works for you. Here are some key points to consider:

Medicare Eligibility: Most people become eligible for Medicare at age 65. If you have insurance coverage through your employer and plan to continue working past the age of 65, you may delay enrolling in Medicare Part A and/or Part B without incurring penalties. This is because your employer-provided coverage is considered creditable coverage, and you can typically enroll in Medicare during a Special Enrollment Period (SEP) when you or your spouse’s employment ends or your employer coverage ends.
Coordination of Benefits: If you have both employer-sponsored insurance and Medicare, your employer coverage is typically considered the primary payer, and Medicare is the secondary payer. This means your employer coverage will pay first, and Medicare will pay secondary to cover costs that your employer plan doesn’t.
Employer Size: The rules for how Medicare coordinates with employer coverage can vary based on the size of your employer. If your employer has 20 or more employees, Medicare is usually the secondary payer. If your employer has fewer than 20 employees, Medicare is generally the primary payer, and you may be required to enroll in both Medicare Parts A and B when you become eligible.
HSA and FSA: If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA) through your employer, there are specific rules and restrictions regarding contributions and the use of funds after enrolling in Medicare. It’s important to understand these rules to avoid any tax-related issues.
Medicare Part D (Prescription Drug Coverage): If you have prescription drug coverage through your employer, you should evaluate whether it’s creditable prescription drug coverage. If it is creditable, you may be able to delay enrolling in Medicare Part D without incurring late enrollment penalties. Your employer can provide this information.
Retiring or Losing Employer Coverage: When you retire or lose your employer-sponsored coverage, you can typically enroll in Medicare without penalties during a Special Enrollment Period. It’s important to do this within the specified time frames to avoid gaps in coverage.

It’s essential to discuss your specific situation with your employer’s benefits administrator and with Medicare to understand how your employer coverage will interact with Medicare. It’s also a good idea to consider your individual health needs and financial circumstances when making decisions about when to enroll in Medicare. Pinnacle Insurance Services can answer all your Medicare questions at 816-477-0180 or email us at mspurgeon@pinsbroker.com

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What if I’m New to Medicare?

admin — Mon, 06 Nov 2023 20:08:18 +0000

If you are new to Medicare, it’s important to understand how the program works and what steps you need to take to ensure you have the healthcare coverage you need. Here are some key things to consider:

Eligibility: Medicare is a federal health insurance program for individuals aged 65 and older. It’s also available to certain younger people with disabilities and those with end-stage renal disease. Make sure you are eligible for Medicare before proceeding.

Enrollment Periods: There are specific enrollment periods for Medicare, and it’s crucial to enroll during the right time to avoid penalties and coverage gaps. The initial enrollment period starts three months before your 65th birthday and lasts for seven months. The enrollment period for 2023 is October 15th to December 7th.

Parts of Medicare: Medicare has different parts, each covering specific aspects of healthcare:

Original Medicare vs. Medicare Advantage: You have a choice between Original Medicare (Part A and Part B) and Medicare Advantage (Part C). Original Medicare is provided by the federal government, while Medicare Advantage plans are offered by private insurance companies. These plans often include additional benefits but may have a more limited network of healthcare providers.

Medicare Supplements (Medigap): If you choose Original Medicare, you may want to consider a Medigap (Medicare Supplement) plan. Medigap plans help cover some of the out-of-pocket costs associated with Original Medicare, such as deductibles and copayments.

Part D Prescription Drug Coverage: If you have Original Medicare and do not enroll in a Medicare Advantage plan that includes prescription drug coverage, you should consider enrolling in a standalone Part D prescription drug plan to help with the cost of medications.

Cost Considerations: Understand the costs associated with each part of Medicare, including premiums, deductibles, copayments, and coinsurance. Medicare Advantage plans often have their own costs, which can vary.

Choosing Healthcare Providers: Check which doctors, hospitals, and healthcare providers accept Medicare, especially if you choose Original Medicare. Some Medicare Advantage plans have provider networks, so you need to ensure your preferred providers are in-network.

Review Plan Options: It’s essential to compare and evaluate different Medicare plans to find the one that best meets your healthcare needs and budget. The Medicare website and the Medicare Plan Finder tool can help you compare plans.

Enroll on Time: Make sure to enroll during your initial enrollment period or special enrollment periods if you qualify. Missing enrollment deadlines can result in late enrollment penalties and gaps in coverage.

Seek Help: Medicare can be complex, and there are many options to consider. If you’re unsure about what to choose or how to enroll, call Pinnacle Insurance Services, 816-477-0180 or email us at mspurgeon@pinsbroker.com.

Stay Informed: Keep yourself updated on any changes or updates to the Medicare program, as policies and options can change from year to year.

Taking the time to understand your options and make informed decisions when you’re new to Medicare is crucial to ensure you have the healthcare coverage that suits your needs and financial situation. Pinnacle Insurance Services works with you to find the best Medicare coverage for you. We can answer all your Medicare questions at 816-477-0180 or email us at mspurgeon@pinsbroker.com

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What changes to my Medicare plan may I make during the enrollment period?

admin — Mon, 30 Oct 2023 13:00:42 +0000

What changes to my Medicare plan may I make during the enrollment period?

Medicare’s annual enrollment period, also known as the Annual Election Period (AEP), runs from October 15 to December 7, 2023. During this period, you can make several changes to your Medicare coverage, including:

1. Switching from Original Medicare to Medicare Advantage: You can enroll in a Medicare Advantage plan if you’re currently on Original Medicare (Part A and Part B). Medicare Advantage plans often include prescription drug coverage and may offer benefits like dental and vision coverage.

2. Switching from Medicare Advantage to Original Medicare: If you’re currently on a Medicare Advantage plan and want to return to Original Medicare, you can do so during the AEP.

3. Switching between Medicare Advantage Plans: If you’re already on a Medicare Advantage plan, you can switch to a different Medicare Advantage plan during the AEP. You can also change from one plan to another or add or drop prescription drug coverage.

4. Joining or Changing Your Medicare Prescription Drug Plan (Part D): If you’re on Original Medicare, you can join, switch, or drop a Medicare Part D prescription drug plan. You can also change your current Part D plan.

5. Making Changes to Supplemental (Medigap) Insurance: If you have a Medicare Supplement Insurance (Medigap) policy, you can make changes to it, but this may be subject to underwriting requirements depending on your state and the specific plan.

6. Reviewing and Updating Medicare Advantage Plans: Even if you don’t want to switch plans, it’s a good idea to review your current Medicare Advantage plan each year to make sure it still meets your needs. Plan benefits can change from year to year.

7. Enrolling in Medicare for the First Time: If you’re turning 65 or otherwise becoming eligible for Medicare for the first time, you can use this period to enroll in Original Medicare, Medicare Advantage, or a Part D prescription drug plan.

8. Dropping Medicare Advantage and Returning to Original Medicare: If you’re on a Medicare Advantage plan, you can return to Original Medicare during this period. You may also be able to enroll in a standalone Part D plan.

It’s essential to review your current plan, consider your healthcare needs and budget, and compare your options before making any changes during the Medicare AEP. Be aware that any changes you make during this period generally take effect on January 1 of the following year. Be aware that specific rules and timelines may vary depending on your location and circumstances, so it’s a good idea to consult with Pinnacle Insurance Services, your local Medicare expert for personalized guidance. We can answer all your Medicare questions at 816-477-0180 or email us at mspurgeon@pinsbroker.com

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What is the Medicare Annual Election Period?

admin — Sat, 14 Jan 2012 13:13:53 +0000

What is the Medicare Annual Election Period?

The Medicare Annual Election Period (AEP), also known as the Annual Enrollment Period, is an important time frame during which individuals who are eligible for Medicare can make changes to their Medicare coverage. The AEP typically occurs from October 15 to December 7 each year, with any changes taking effect on January 1 of the following year.

During the Medicare AEP, eligible individuals can take several actions:

Enroll in Original Medicare (Part A and Part B): If you haven’t already enrolled in Original Medicare, you can do so during this period.
Switch from Original Medicare to Medicare Advantage: You can enroll in a Medicare Advantage plan (Part C) if you have Original Medicare. Medicare Advantage plans are offered by private insurance companies and often include additional benefits such as prescription drug coverage.
Switch from Medicare Advantage to Original Medicare: If you have a Medicare Advantage plan and wish to return to Original Medicare, you can do so during the AEP.
Change or join a Medicare Part D prescription drug plan: If you have Original Medicare, you can sign up for a Part D plan during this period to help cover the costs of prescription medications. You can also switch from one Part D plan to another.
Switch between different Medicare Advantage plans: If you’re already enrolled in a Medicare Advantage plan, you can switch to a different one during the AEP.
Make changes to your Medicare Advantage or Part D coverage: You can switch, drop, or add coverage options within your existing Medicare Advantage or Part D plan during this period.

It’s important to note that the AEP is the main opportunity for most Medicare beneficiaries to make changes to their coverage. However, there are some other enrollment periods throughout the year for specific circumstances, such as the Initial Enrollment Period (when you first become eligible for Medicare) and the Special Enrollment Periods (for those with certain qualifying events, like moving or losing employer coverage).

It’s a good idea to review your Medicare coverage annually during the AEP to ensure that your plan continues to meet your healthcare and prescription drug needs, as plans and costs can change from year to year. You can also consult with a Medicare counselor or insurance agent for assistance in making informed decisions about your Medicare coverage.

Pinnacle Insurance Services works with you to find the best Medicare coverage for you. We can answer all your Medicare questions at 816-477-0180 or email us at mspurgeon@pinsbroker.com.

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