Learn about Private Medicare Plans.
When it comes to Medicare, you have options. These health insurance plans provide Medicare benefits through a private insurance company.
Medicare Made Simple
New to Medicare
Medicare Part A pays for hospital stays and inpatient care. Medicare Part B helps pay for doctor visits and outpatient care. Medicare Parts A and B represent “Original Medicare.”
Individuals turning 65 who have enough work credits can enroll in Medicare Part A at no cost. If you have not paid Social Security taxes for at least 40 quarters/10 years, you must enroll in Part B to purchase Part A coverage and pay an additional premium.
If you are taking your Social Security retirement benefits, you should automatically be enrolled in Part B when you turn 65. If you are not taking any Social Security benefits, you will need to proactively sign up for Part B.
A Medicare supplement or Medigap policy helps cover the costs such as deductibles, copays, and coinsurance that Original Medicare does not pay.
These plans are secondary to Original Medicare, offer various levels of coverage, and are offered by insurance companies who are licensed by the states to sell them.
You pay a monthly premium to the insurance company for the plan you select in addition to your Part B premium. Some plans have additional benefits that Medicare does not cover, such as free gym memberships to help you stay active.
Medicare Advantage (Part C) is a private Medicare insurance plan that offers an alternative to Original Medicare. The government pays the Medicare Advantage company on your behalf to take on your medical risk.
Many plans have low and even zero dollar monthly premiums. You pay for medical services as you use them in the form of copays and coinsurance
Unlike Original Medicare, Medicare Advantage plans have an out of pocket maximum to protect your finances. Many plans also include benefits for things like dental & vision coverage. Limitations, copayments, and restrictions may apply.
Medicare Part D
Medicare Part D Plans work like pharmacy cards that give you lower-cost medications. Instead of paying the full cost for your prescriptions, you will pay only the copays required by the plan.
Up until 2006, there was no retail prescription drug coverage for Medicare beneficiaries.
Medicare Part D is voluntary, which means each individual can decide whether or not to enroll. However, you should think about not just the medications you are taking now, but also those that you may need in the future. Part D plans are very affordable, so you should definitely look into your options.
Medicare Dates & Timelines
Annual Enrollment Period: October 15 – December 7
1. Happens every year October 15 – December 7
2. You can join, switch or drop a Part C or Part D plan without penalty.
3. Any changes made will go into effect on January 1 of the following year.
Initial Enrollment Period: Date varies by person, 7 months
1. This is your first opportunity to enroll in Medicare.
2. It begins 3 months before your 65th birthday month & ends 3 months after.
3. You may enroll in Medicare Parts A&B, a Medicare Advantage plan (Part C) or a Part D prescription drug plan.
Medicare Supplement Open Enrollment Period: Dates vary by person, 6 months
1. This 6-month period begins once you are 65 or older and enrolled in Part B.
2. During this time, you’re guaranteed the right to buy a Medicare supplement insurance plan regardless of health history & cannot be denied coverage or charged more due to pre-existing conditions.*
*You can enroll in a Medigap plan at any time, but maybe denied coverage or charged higher premiums if enrolling after this period.
Special Enrollment Period: Dates vary by person, 2-8 months
If you have a Medicare Advantage (Part C) or Part D prescription drug plan & experience a “qualifying” life event (like moving)…
1. You may qualify for a 2-month Special Enrollment Period.
2. You can change or drop a Medicare Advantage (Part C) or Part D prescription drug plan.
Special Enrollment Period: Working Past 65
If you have not yet enrolled in Medicare or only have Part A & you have creditable employer coverage…
1. You may qualify for an 8-month Special Enrollment Period.
2. You can enroll in Medicare Parts A & B.
3. You can also enroll in a Medicare Advantage (Part C) or Part D prescription drug plan.*
*Must do within the first 2 months to avoid penalty.
Medicare Advantage Open Enrollment Period: January 1 – March 31
1. You can switch to a new Medicare Advantage plan.
2. You can drop your Medicare Advantage plan and return to Original Medicare.
3. If you qualify, you may also enroll in a standalone Part D plan.