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How & When Do I Enroll in Medicare Parts A & B?

January 24, 2019/in High Deductible Plan F, Medicare Supplement (Medigap), Plan C, Plan F, Plan G, Plan N /by Karl Paras

There are a number of times when you can sign up for Medicare Parts A & B and each of these come with a set of guidelines and limitations. For some who are lucky, they get automatically signed up for one or both programs. For others, the government offers a window of seven months wherein you can enroll in Medicare without being pressured by any medical underwriting. In some instances, the application process will have to be manually done.

The ideal time to enroll into Medicare Parts A & B is when you’re about to turn 65 years old. You will be provided an initial enrollment window for applying to Parts C and D, as well. It is important to know what this period covers especially if it is your first time.

WHEN to Apply for Medicare Part A and Part B

Initial Enrollment Period (IEP)

The seven months allowed for the IEP cover the following:
3 months before you turn 65 years’ old
The month of your 65th birthday
3 months after your 65th birthday

For example: If your birthday is in August, your IEP begins May 1 and ends November 31.

Note: If you are not able to enroll during this 7-month period, you have another chance during the next General Enrollment Period. You will also find yourself without health insurance for the entire duration of waiting, which can be risky. Medicare allows for late enrollment, however, but you will have to be prepared to shoulder the late fees and penalties.

General Enrollment Period

The GEP happens between January 1 and March 31 of every year. During this time, you can sign up for Medicare Part A and/or Part B if you were not able to sign up during the IEP and if you are not covered by the Special Enrollment Period although you might be required to pay a higher premium. If you decide to go with this option, your coverage will begin July 1 of the same year.

Special Enrollment Period for Medicare

SEPs may be availed if you were able to delay your enrollment to Medicare services. These will only apply for very specific terms, such as when you still have insurance coverage from your office (employer), eight months after this coverage closes for Part A and Part B, and 63 days after this coverage ends for Part C and Part D.

SEP can also apply if you are still covered by benefits from a union group health plan from your current employment or your spouse’s. If you have a disability and are working, or are receiving benefits from a family member who is employed, the SEP can also be considered if the company where you or your family is working has 100 employees or more.

Special Enrollment is also open to individuals who are volunteers and are serving in another country.

Open Enrollment

If you WERE able to avail of Medicare programs during the given period but would like to change your plan, you can do so during the Open Enrollment Period. Also Annual Coordinated Enrollment Period or Annual Election Period, this happens from October 15 to December 7 every year.

If you avail of this option, your revised coverage will begin January 1 of the following year. Open enrollment was created for several reasons, not just for those who missed the Initial Enrollment Period. To be clear, it is open to the following:

Those who have Medicare Part A and Part B who want to shift to a Part C
Those with Medicare Part C who want to return to Part A and Part B
Those with Medicare Part C who want to change to new Part C program
Those who are just signing up for Medicare Part A and Part B (who will be given the option to join, cancel, or switch to a Part D plan for prescription medication)

When to Apply for Medigap Plans

You can only avail of any of the 10 Medigap plans when you are already enrolled in Medicare Part A and Part B.

HOW to Apply for Medicare Part A and Part B

Some people will get enrolled into Medicare automatically, while some have to apply for it.

If you are already receiving disability benefits or Social Security retirement benefits the moment you turn 65 years old, you will be automatically enrolled in Part A and Part B. If this is so, you can expect to receive a welcome packet and Medicare ID card in the mail about three months before your birthday.

If not, there are three ways to apply: By Phone, Online, or in Person.

By Phone: Call the Social Security customer hotline 1-800-772-1213
In Person: Visit the Social Security office in your area
Online: Visit the Social Security official website

Things to Remember

You do not need to enroll for Medicare every year. However, you will be given a chance during the Open Enrollment period to review your program and make a switch as you wish.
Medicare is under the management of the Centers for Medicare & Medicaid Services (CMS). Social Security operates closely with the CMS by ensuring that citizens are enrolled into the program.
The Medicare ID is red, blue, and white. It will contain important information such as your Medicare Claim Number, what parts of Medicare (A or B) you have, when your coverage begins, and how to contact Medicare.
The Medicare number is typically the same as your Social Security number for practical reasons. Be sure to keep this safe and not share it with just anybody, save for your doctors and healthcare providers.

Is Original Medicare Enough for You?

January 24, 2019/in High Deductible Plan F, Medicare Advantage Plans (Part C), Medicare Prescription Drug (Part D), Medicare Supplement (Medigap), Plan C, Plan F, Plan G, Plan N /by Karl Paras

Original Medicare includes a wide range of medical services and treatments, but they do not cover everything that a person over 65-years of age may eventually require. Because the federal government is the one that provides it, it easy for recipients to assume that it offers comprehensive benefits. However, closer inspection of the actual needs of a senior will reveal that it only shoulders a portion of the potential medical expense one could be faced with.

This doesn’t mean that Medicare is a Band-Aid solution and is only meant to create a semblance of protection. For many people who are perfectly healthy, it is, indeed, sufficient but only until the unexpected may occur. The issue is that many people at age 65 are in need of ongoing medical care and this is why Medicare Supplement plans are offered by private insurers as add-ons.

What Original Medicare Includes

Before deciding if Original Medicare is enough for you, we have to first lay out what it does cover. There are four parts to the Original plan, with each responsible for a specific set of medical services.

Part A	Part B	Part C*	Part D
Inpatient and hospital coverage	Outpatient and medical coverage	Also called Medicare Advantage, it is an alternative way of obtaining Medicare benefits and consists of different health plans regulated by Medicare itself but operated by private insurance companies (such as PPOs and HMOs)	Coverage for prescription drugs

*Part C may only be obtained only if you already have Medicare Part A and Part B

HMO = Health Maintenance Organization; PPO = Preferred Provider Organization

More About Medicare Advantage

Medicare Advantage or Medicare Part C offers the same benefits as Part A and Part B, and most also cover Part D drug coverage in their packages. It is up to the insurance provider to decide how extensive its package will be and those who subscribe may or may not be asked to pay a monthly premium.

These plans are not available in all geographical areas and HMO’s typically require its members to visit only the hospitals and doctors that are listed in their networks to obtain full benefits, except when it is an emergency. Some PPOs allow members to seek services outside of the network but will charge higher copays. This is why Medicare advisors do not recommend this plan to people who do a lot of traveling.

What Original Medicare Does Not Include That U.S. Seniors Need?

Original Medicare does not cover most types of hearing, vision, or dental care. While Medicare Part A pays for specific dental services that happen in a hospital setting, and Part B covers care caused by an injury, that’s all there is to it. It does not include tooth extractions, dental plates, cleanings, fillings, dentures, and related services. Hearing aids, getting prescription eyeglasses, routine eye exams, and contact lenses are also not part of the plan.

Even Medicare Supplements (Medigap) do not cover these types of medical care. If they do (Enhanced Plans), you will have to pay a higher premium. If these are important to you and you do not want to pay upfront fees per procedure, you can enroll in a Medicare Advantage plan or purchase a supplemental insurance policy that covers specifically these services. Some private insurers offer special policies for vision, dental, and hearing only.

Another thing that Original Medicare does not cover is Long-term Care Coverage. This includes services received in a skilled nursing facility, a day care center for older adults, and an assisted living community. Given that these services can be very expensive, it’s not really a surprise why the government will not cover these costs. For that reason, you might want to enroll in a stand-alone long-term care insurance policy.

Why a Medicare Supplement Plan Is Important

The gaps in the Original Medicare are the reasons why Medigap (Medicare Supplement) is necessary. Because many 65-year-olds need ongoing care – and even if they don’t currently, the consequence of age could eventually reveal new illnesses, Medigap plans offered by private insurers are a necessity.

There are 10 different types of Medigap policies that priced differently depending on the extent of the coverage and benefits that are offered. Medigap may only be acquired if you have Medicare Part A and Part B and can only be purchased through private insurance companies. The coverage of the Medigap plans are standard across the U.S. but the fees will differ by company.

It is, thus, crucial that you shop around and compare rates first before deciding on which Medigap plan to sign up for. Just take note that you only have a limited period before and after your 65th birthday to choose a policy without being required to undergo medical underwriting. During this Open Enrollment Period, insurance providers are required to sign you up regardless of your pre-existing medical condition or health status.

Medicare and Dental Coverage for Seniors

January 24, 2019/in High Deductible Plan F, Medicare Advantage Plans (Part C), Medicare Part A, Medicare Part B, Medicare Prescription Drug (Part D), Medicare Supplement (Medigap), Medicare Supplement Companies, Medicare Supplement States, Original Medicare Parts A & B, Plan F, Plan G, Plan N /by Karl Paras

Does a Medicare supplement plan include dental care? It does not. While Original Medicare Part A and Part B do shoulder some dental procedures that are necessary when you are in the hospital as an in-patient, it does not cover any procedure or consultation outside of a hospital stay. Seniors who would like to expand their insurance coverage to include dental care will have to purchase private dental insurance.

The types of procedures that Medicare will cover when you are in the hospital are those that are necessary to protect your overall health, or are prerequisites to another procedure that Medicare actually shoulders. Here are some instances where Medicare does provide dental coverage.

When Medicare DOES Cover Dental

There are specific instances when you will need to undergo a dental procedure so the doctors can proceed to another treatment that is covered by Medicare. For example, it may shoulder:

– Dental services necessary for certain jaw-related ailments prior to radiation treatment, such as oral cancer

– Oral exams prior to a kidney transplant

– Surgical procedures to rectify fractures on the face or the jaw

– Oral exams in a Federally Qualified Health Center or rural clinic before a heart valve replacement surgery

– Dental wirings and splints necessary post jaw surgery

– Surgeries that involve ridge reconstruction during a facial tumor removal procedure

– Dental-related hospitalizations where you require observation due to a health-threatening situation

In the case of hospitalizations that are dental-related, Medicare may cover the likes of x-rays, anesthesia, and even room and board, depending on the condition. However, it will not shoulder the expenses related to dentist fees and the charges for other attending physicians, such as anesthesiologists and radiologists.

Options for Senior Citizens to Acquire Dental Coverage

If you need a dental care plan in your senior years, you will need to be prepared to have it as an out-of-pocket expense because it will not be covered by Medicare. While there are specific inclusions, mostly related to hospitalization, it’s better to count it as an additional coverage that you must pay for.

So how can a senior citizen obtain a dental plan? There are several options.

Enrol in a Medicare Advantage (Part C) plan

Medicare Advantage plans are another way to access Medicare benefits and may include dental care. While Medicare is administered by the U.S. government, Medicare Advantage is offered via private insurance agencies that are working under the rules set by the CMS (Centers for Medicare and Medicaid Services). Medicare Advantage are required to offer the minimum benefits under Original Medicare Part A and Part B, they have greater leeway when it comes to what more they can offer because they are private agencies. Typically, the extra benefits included are vision and dental care, as well as hearing care.

Generally, Medicare Advantage plans that offer dental benefits will cover preventive and diagnostic procedures such as x-rays, cleanings, and annual exams. Many Medicare Advantage providers can also include fillings, extractions, root canals, crowns, dentures, bridges, and treatment of gum diseases. Take note, however, that these plans might require to seek dental care only from a pre-selected list of dental clinics. You can also expect to pay a certain set amount for these services regardless of how much they really cost, while some might put a cap on the dental benefits that you can avail in a year.

Check if your spouse has an existing dental plan and if you can enroll in it

If your spouse is currently employed and is enjoying a group plan that includes dental coverage, you might also qualify for this coverage. Ask your partner to inquire with his company on extended coverage for family members.

Join a club that offers discounts on routine dental procedures

There are organizations where you pay a fee to become a member and then be entitled to a range of services on discount. Look for those clubs that offer special rates for dental procedures or are partnered with clinics that offer cheaper rates, in addition to other healthcare and lifestyle perks.

Sign up for a stand-alone dental insurance policy

Most private insurance agencies offer dental coverage as an independent plan and you can certainly subscribe to a dental only policy. You will be asked to pay a monthly or quarterly premium, but the cost will generally be offset by lower out-of-pocket expenses. Many of the dental plans will require that you work only within a pre-listed network of clinics and healthcare professionals—and this list will vary depending on the private insurer you sign up with. Some plans will allow you to go outside of their network, although be prepared to pay a little more for their consultation fees and services.

What We Offer

At SecureCare65, we offer four types of dental care plans with features that range from routine checkups to the more advanced orthodontic care procedures. The maximum benefit of each also varies depending on the type of plan you sign up for and every package will have varying degrees of coverage for Preventive, Basic, Major, and Orthodontia procedures.

Plans *(For Year 1 only)**	Preventive	Basic	Major	Orthodontia
Spirit Choice 3500	100%	65%	25%	10%
Spirit Choice 1200/2500/5000	100%	50%	10%	10%
Spirit Choice 1200	100%	50%	25%	10%
Spirit Choice 750/1000/1250	100%	50%	10%	none

*The percentage of coverage increases as your subscription extends from year 1 to year 2 and to year 3.

For Spirit Choice 1200/2500/5000 and Spirit Choice 750/1000/1250, here is the distribution of benefits.

Spirit Choice 1200/2500/5000	Preventive	Basic	Major	Orthodontia
Year 1 (max. benefit $1,200)	100%	50%	10%	10%
Year 2 (max. benefit $2,500)	100%	60%	30%	25%
Year 3 (max. benefit $5,000)	100%	80%	50%	50%

Spirit Choice 750/1000/1250	Preventive	Basic	Major	Orthodontia
Year 1 (max. benefit $750)	100%	50%	10%	n/a
Year 2 (max. benefit $1,000)	100%	60%	30%	n/a
Year 3 (max. benefit $1,250)	100%	80%	50%	n/a

Preventive: 3 cleanings and 2 exams per calendar year

Basic: Sealants for 16 years old and below, 1 topical fluoride annually for 16 years old and below, basic fillings, 1 series of bitewing x-rays annually, and space maintainers

Major: Includes implants, simple extractions, oral surgery and restoration services, endodontic and periodontics’ treatments, 1 diagnostic x-ray in panoramic or full in any 3-year period, and prosthetic services such as dentures and bridges

Orthodontia: orthodontic care of proper teeth alignment for dependents under the age of 19 years; has a $1,200 lifetime maximum per child

Note: These rates are guaranteed for your first 12 months and may change in the succeeding years.

Some Reminders About Senior Dental Care

Dental coverage acquired as a stand-alone policy gives you the freedom to avail of any service you want at a price that it lower than the usual market rates. While you are paying a premium for these services, you will find that the healthcare providers included in the private company’s network will be more affordable, if not free. Should you want to obtain services of a dentists who is not part of the network, you will have to be ready to pay larger out-of-pocket fees.

To further illustrate the difference, let’s say you are having a crown installed. This is considered a Major procedure. Here is a sample of your possible fees.

Network	Usual Dentist’s Fee	Reduced Network Fee	Your Plan’s 50% coverage	Your out-of-pocket expense
Within the network	$985	$685	$342.50	$342.50
Outside the network	$985	$750	$375	$610

Before deciding on any dental care policy, talk to your preferred insurance agency about their inclusions and exclusions. For example, you might think that you can get veneers for aesthetic purposes and be able to get it for free because you have a dental plan, and then find out later that your policy does not cover it.

Be upfront with your queries and plans when it comes your oral healthcare, whether it’s for practical healthcare or aesthetic reasons. Better yet, talk to our team of healthcare plan experts so we can help you find the best and most cost effective policy that matches your and your family’s needs and budget.

Let us help you get an accurate quote before enrolling in any dental insurance plan by visiting us at https://securecare65.com/. You can also give us a call at 1-800-354-1078 so our customer service team can assist you immediately and answer any questions you might have