The Two Ways to Get Medicare Coverage

Let’s talk about what Medicare part A and B covers, what it doesn’t and your options.

Medicare Part A

Covers: hospital, hospice, home health care skilled nursing facility/rehab, nursing home care that is not custodial or long-term care.

Medicare Part B

Covers: medically necessary services or supplies that diagnose or treat a medical condition. Preventive services.

What Medicare is Not

Medicare Part A and Part B do not cover acupuncture, routine foot care, cosmetic surgery, most dental, eye exams related to prescribing glasses, long-term care, dentures, hearing exams or exams for fitting them.

Original Medicare was never meant to be your only source of coverage. There are some holes or gaps, in the coverage; so how do you fill those gaps?

There are two main ways to get your Medicare coverage. You can choose to stay with Original Medicare Parts A and B or join a Part C Medicare Advantage Plan.

1.Original Medicare with Medigap Supplement Policy:

If you choose to stay with Original Medicare, you can enroll in a Medigap Supplement Policy and add a Medicare Part D Prescription Plan. Medigap Supplement policies fill in the gaps of the Original Medicare services. Medigap Supplement plans are sold by private insurance companies. You can use this type of coverage nationally if you see a provider that accepts assignment with Medicare.

2.Part C, a Medicare Advantage Plan:

If you choose to enroll in a Medicare Advantage Plan, also known as Part C, you will have all the services offered by Original Medicare and may be offered some additional services like vision and dental.Most plans will include a Medicare Part D Prescription Plan. Medicare Advantage Plans are sold by private Medicare approved insurance companies. These plans, however, may have different rules on how they cover services. This type of coverage has networks of providers that must accept your plan.

*You can only choose one way to get your Medicare. You cannot have both a Medigap Supplement and an Advantage Plan.

Can I Switch my Coverage Type?

You can make changes to your coverage annually during the Annual Election Period in the fall. This period runs October 15th to December 7th.

If you have a Medicare Advantage Plan and want to change to a Medigap Supplement plan you may be limited depending on the state that you live in, unless it is your first time enrolling in a Medicare plan. In New York State, Medicare beneficiaries are eligible for continuous open enrollment for Medigap Supplement policies. In New York, you can be sold a Medigap Supplement Policy at any time.Companies must sell you a policy no matter your age or health status, and they must sell to people who under and over age 65 with Medicare. If it is your first time enrolling in a Medigap Supplement policy, then you have a guaranteed issue right. This means that you cannot be denied enrollment and are given the best available rates regardless of health. Guaranteed issue right also prevents companies from imposing a waiting period for pre-existing conditions.

If you have Original Medicare with a Medigap Supplement, you can change to Part C Medicare Advantage plan at the Annual Enrollment Period every year. If you have a Part C Medicare Advantage Plan you can change during the Annual Enrollment Period every year or during the Medicare Advantage Open Enrollment Period, January 1st to March 31st, every year.

You also may be eligible for a Special Enrollment Period (SEP).

Contact Simco Capital to help you find the best option for you and whether you are eligible for a special enrollment.