There are 4 Parts to Medicare:
Part A = Hospital Insurance (Inpatient) Typically premium free, taxes paid during your working years pays for Part A.
Part B = Medical Insurance (Outpatient) not premium free. Usually deducted from your social security check if collecting or billed quarterly. 2019 enrollees will pay $135.50, 2020 enrollees will pay $144.60.
(Medicare Parts A & B are referred to as ORIGINAL MEDICARE) Original Medicare does not cover preventative dental or routine vision. Click the link at the top right of this page to look at dental and vision plans.
Part C = Medicare Advantage Plans (offered by private insurance companies approved by Medicare)
Part D = Prescription Drug coverage (offered by private insurance companies approved by Medicare)
Once enrolled into Medicare A & B you then have to choose one of the two options available:
Choose the alternative to Original Medicare by enrolling into a Part C Medicare Advantage plan. Part C plans include all Part A, Part B and most times Part D prescription drug coverage, all in one plan. Some Plans also include extra benefits not covered by Original Medicare such as preventative dental, routine vision, hearing aid allowance and a monthly gym memberships. (Extra benefits will vary from plan to plan). *There are 46 Plans available in Berks County for 2019 (7 of which do not include prescription drug coverage) (53 available in 2020) with each having their own plan design.
Keep Original Medicare and supplement it by enrolling in a Medicare Supplement plan. There are 11 Plans to choose from with each one having a different level of coverage. They are identified by a letters: A, B, C, D, F (the most comprehensive coverage, however, no longer available for those enrolling in Part B 1/1/20 or later) (High deductible F) G, K, L, M & N. Plans are standardized meaning each Plan of the same letter has the same benefit regardless of the company you purchase it from. The only difference is what you'll pay.
Part D Prescription Drug coverage:
When you keep Original Medicare you'll need to enroll in a separate Part D Prescription Drug plan. There are 30 Drug plans available in Berks County for 2019 (31 available in 2020).
**Medicare says enrolling into Part D is optional. However, if you do not enroll when first eligible and enroll at a later date you may end up paying a Late Enrollment Penalty (the LEP begins after 63 days of not having creditable drug coverage. You'll have to pay this penalty for as long as you're enrolled in a prescription drug plan or a medicare advantage plan that includes drug coverage.
Understanding the above is crucial in order for you to make an educated decision when it's time to choose.
*Verify that your prescriptions are on the Plan's formulary and that your doctors are in the Plan's network before enrolling!
IMPORTANT NOTE: Regardless of the option you choose, you must continue to pay your Part B premium!
How/when do I enroll in Part A & B? You can enroll into Medicare by going online at ssa.gov or by calling the Reading Social Security office at: 1-800-772-1213 and scheduling an appointment.
If you are 65 and working or are on a spouse's plan who is still working you can delay enrolling into Medicare until you retire or your spouse retires if on their plan. The employer must have more than 20 employees in order to delay enrolling into Part B without a penalty.
If, when turning 65, you are not on an employer plan and not collecting Social Security you can call or go online 3 months prior to your 65th birthday to enroll.
If you are collecting Social Security you will receive your Medicare card within 3 months of your 65th birthday (remember you can opt out of Part B if you are on a spouse's plan and that spouse is actively working for an employer with 20 or more employees) or on the 25th month of collecting Social Security disability payments.
If you are older than 65, still working, and already enrolled in Medicare, you'll have 63 days after employer coverage ends or employment ends whichever is later, to enroll in a Medicare Advantage Plan, Prescription Drug Plan or a Medicare Supplement Plan.
These are just a few scenarios. If you have a situation I didn't cover here, please call me.
Your insurance needs are specific to you. Whether it's a Medicare Supplement plan, a Prescription Drug plan or a Medicare Advantage Plan you want, I'll shop the market and select the plan that's best suited for you.
I received my Pennsylvania Insurance license in April 2006 and began my insurance career selling Life insurance and Annuities. During this time I worked with companies such as Monumental Life Insurance and American General Life Insurance. I was introduced to Medicare in 2013 and have been helping clients in this market ever since. I have helped hundreds of people maneuver through the Medicare maze.