Medicare FAQS

Medicare Coverage is available for people age 65 or older and for people under age 65 on Social Security Disability. Since Medicare does not cover all of your costs, many people choose to purchase additional coverage, especially if they do not qualify for Medicaide benefits. The determing factor in eligibility for the plans outlined below is the effective date of your Part B Medicare Coverage.

There are a variety of plans available for Medicare beneficiaries such as:

Medicare Supplement or Medigap Plans.

These plans are issued by over 40 companies in NC and they fill in the gaps in Medicare coverage. Each company must provide the same benefits for Plans A-J. Most companie’s premiums are based on the insureds “Attained Age” which mean your premiums can go up as you move into another age bracket…A few compainies are ” Issue Age” companies and this means you can “lock-in” your premium age bracket and your premiums only increase due to claims experience.

Medicare Advantage Plans

Medicare Advantage policies provide a different set of benefits than Medigap policies. These plans have co-pay and co-insurance features which do not cover all of your costs. There are several types ofMedicare Advantage plans such as: HMO/PPO plans that have in place a provider network in the counties where these plans are available

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These plans have limited providers in place and these providers may decide to accept or not to accept the coverage on a “Case-by-Case” basis. Premiums are usually lower than HMO/PPO MA plans or with Medigap plans. Recent rules from the Medicare people require PFFS plans to have provider networks in place within the next two years and premiums will have to increase to allow for compliance with these rules.

Medicare Advantage plans may beneficial to Medicare beneficiaries who cannot afford a Medigap plan or for those who are willing to assume some of their healthcare cost

Medicare Drug Part D Drug Coverage.

These plans became available and were introduced in 2005 to become effective on January 1, 2006. When you qualify for Medicare, you can enroll in this coverage unless you have other credible drug coverage, such as employer or VA drug coverage. You can enroll 3 months before or after the month your Part B Medicare effective date. Should you not enroll during this Initial Enrollment Period, you will have to pay an increased premium of 1% per month for each month you did not enroll when you were eligible to do so. Each year, in November, you may change your drug plan to another drug plan to meet your needs based on the drugs you are taking. This special period is known as the Annual Enrollment Period. There is a Special Enrollment Period available for people who lose their credible drug coverage or move to another state where their existing provider does not offer the Part D coverage.