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Medicare 101: A "Deductible is an amount you could owe during a coverage period (usually one year) for covered health care services before your plan begins to pay. An overall deductible applies to all or almost all covered items and services.

AEP begins October 15 and ends December 7 each year. During AEP, you can enroll in, disenroll from or change your Medicare Advantage plan or your prescription drug plan. You can also return to Original Medicare. Elections made during AEP are effective January 1 of the following year.

“We need to accept that we won’t always make the right decisions, that we’ll screw up royally sometimes―understanding that failure is not the opposite of success, it’s part of success.”

Point of Service (POS) plan is a type of Medicare Advantage HMO plan that allows members the ability to visit doctors and hospitals outside their network for some covered services, usually for a higher copayment or coinsurance. Some POS plans do not require referrals for specialty services.

Medicare-approved amount is the amount Medicare determines to be reasonable for a covered service. Providers who "accept assignment" agree to accept this amount as payment in full.

In 1965, the passage of the Social Security Amendments, popularly known as Medicare and Medicaid, resulted in one basic program of health insurance for persons aged 65 and older, and another program providing health insurance for people with limited income funded by state and federal sources, respectively.

We believe that the better educated you are about Medicare, the easier it will be for you to make the right decisions about your Medicare health insurance choices.

A person who never made a mistake never tried anything new.

Don’t forget that Medigap policies also do not include Part D, so you will purchase your drug plan separately.

Medigap is private insurance that fills in the gaps between your Medicare benefits and what you must pay out of pocket.

Confused About Medicare? It is not unusual for a client to bring in a whole bag of mail that he has received at home and ask for our help to identify which things should be kept or tossed out.

Medicare Advantage plans work differently from Medigap plans, so make sure you understand all the differences between the two before signing up for an Advantage plan.

“Opportunity is missed by most people because it is dressed in overalls and looks like work.”

In order for you to join a Chronic Illness SNP, your doctor will have to complete a chronic condition verification form at the time of your enrollment.

A Medicare Summary Notice (MSN) is a quarterly explanation of benefits statement that Medicare provides to show you the healthcare services received and what Medicare paid toward them. You should review your MSN to determine if you owe any balances that are due.

Like all Advantage plans, Special Needs Plans will have a network, usually either an HMO or a PPO.

The Income Related Monthly Adjustment Amount (IRMAA) is an additional monthly charge that people with certain high-income levels must pay on top of their Medicare Part B and D premiums.

What is Medigap Attained-Age Rating?
Attained-Age Rating is a rating class in which a Medigap insurance company determines the rate based on your current age (the age you’ve “attained”). Your premiums tend to go up as you get older.

What does Dual-Eligible mean?
To be dual-eligible means to be eligible for both Medicare and Medicaid.

The word Formulary means a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

Fast fact: You are still required to pay the Medicare Part B premium even if you have an Advantage plan.

Medicare Advantage plans, also known as MA, are NOT similar to Medigap plans – they are different. Members get their benefits from a private insurance company instead of Original Medicare.

Fast Fact: Medicare Advantage plans were created under the Balanced Budget Act of 1997 and signed into law by President Bill Clinton. These plans are commonly called Part C of Medicare . Some doctor’s offices call them replacement plans, more on that below.

Medigap Fast Fact: It’s Medicare Supplement Insurance sold by private insurance companies to fill “gaps” in Original Medicare coverage.

Medicare 101: Retiree coverage, including COBRA, does not count as creditable coverage for Medicare.

Medicare 101: On top of knowing when to enroll, you will also want to know the costs you can expect with Medicare and what coverage you will need. Contact us today for a no cost consultation.