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Your Guide to Turning 65

Turning 65 is a milestone, and with it comes the important step of enrolling in Medicare. If you’re feeling overwhelmed or unsure where to start, you’re not alone. This guide will walk you through everything you need to know about Medicare, its different parts, and how to make the best choices for your healthcare needs.

Medicare 101

Medicare is a federal health insurance program primarily for people aged 65 and older. It also covers certain younger individuals with disabilities and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Getting Started

Enrolling in Medicare for the first time can be a straightforward process if you follow the right steps. Here's a step-by-step guide to help you navigate your initial Medicare enrollment:

 

1. Determine Your Eligibility

  • Age: Most people are eligible for Medicare when they turn 65.

  • Disability: If you have been receiving Social Security Disability Insurance (SSDI) for 24 months, you may be eligible for Medicare before 65.

  • Certain Conditions: People with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) are eligible at any age.

 

2. Understand the Parts of Medicare

  • Part A: Hospital Insurance

  • Part B: Medical Insurance

  • Part C: Medicare Advantage Plans

  • Part D: Prescription Drug Coverage

 

3. Sign Up for Medicare

  • Automatic Enrollment: If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare Part A and Part B. You will receive your Medicare card three months before your 65th birthday.

  • Manual Enrollment: If you are not receiving Social Security benefits, you need to sign up for Medicare manually.

    • Online: Visit the Social Security website at www.ssa.gov and follow the instructions to enroll.

    • By Phone: Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

    • In Person: Visit your local Social Security office.

      • South Florida Residents check out our Resources page for locations near you​

 

4. Decide If You Want Additional Coverage

  • Medicare Advantage (Part C): These plans are offered by private insurers and provide all Part A and Part B benefits plus additional benefits like vision, dental, and prescription drugs.

    • Medicare Advantage also has additional benefits like:

      • Over-the-counter Drug Card

      • Free Gym Membership

      • Food/Flex card for those who qualify​

  • Medigap (Medicare Supplement Insurance): These plans help cover out-of-pocket costs not covered by Original Medicare.

  • Part D (Prescription Drug Plan): If you choose Original Medicare, you can add Part D for prescription drug coverage.

 

5. Review and Compare Plans with your Agent

  • Once you have received your medicare Red White and Blue Card your agent at Ember Advisory Group will help in Reviewing and Comparing a plan that best fits your needs. 

  • Consider Your Needs: Think about your healthcare needs, including your preferred doctors, medications, and budget, when choosing a plan.

 

6. Enroll in Additional Coverage

  • Medicare Advantage or Part D: Enroll directly through the plan's website, by phone, or through Medicare's Plan Finder.

  • Medigap: Contact the insurance company offering the Medigap policy to enroll.

 

7. Confirm Your Enrollment

  • Confirmation Letter: After enrolling, you will receive a confirmation letter and your Medicare card in the mail.

  • Review Details: Ensure all details are correct and keep your Medicare card in a safe place.

 

8. Schedule a "Welcome to Medicare" Visit

  • Initial Preventive Visit: Schedule your free "Welcome to Medicare" preventive visit with your healthcare provider within the first 12 months of enrolling in Part B.

 

Important Enrollment Periods

  • Initial Enrollment Period (IEP): Begins three months before your 65th birthday, includes the month you turn 65, and ends three months after your 65th birthday.

  • General Enrollment Period (GEP): January 1 to March 31 each year if you missed your IEP.

  • Special Enrollment Period (SEP): For those who delayed enrolling because they were covered by a group health plan.

Important Links for Medicare

Navigating Medicare can be complex, but having the right resources at your fingertips can make the process much smoother. Here are some essential links to help you understand and manage your Medicare coverage.

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Government and Official Resources

Medicare.gov

  • Website: www.medicare.gov

  • Description: The official U.S. government site for Medicare. Provides detailed information on Medicare parts, coverage options, and enrollment periods.

 

Social Security Administration

  • Website: www.ssa.gov/benefits/medicare

  • Description: Information on applying for Medicare benefits, eligibility requirements, and managing your benefits.

 

1-800-MEDICARE

  • Phone Number: 1-800-633-4227

  • Description: Medicare’s official helpline for questions about coverage, enrollment, and more.

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Additional Support and Resources

State Health Insurance Assistance Program (SHIP)

  • Website: www.shiptacenter.org

  • Description: Provides free, local health insurance counseling to Medicare beneficiaries.

 

Eldercare Locator

  • Website: www.eldercare.acl.gov

  • Description: A public service of the U.S. Administration on Aging connecting you to services for older adults and their families.

 

Fraud Prevention and Reporting

Medicare Fraud Hotline

  • Phone Number: 1-800-HHS-TIPS (1-800-447-8477)

  • Description: Report suspected Medicare fraud and learn how to protect yourself from scams.

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Educational Resources

MyMedicare.gov

  • Website: www.mymedicare.gov

  • Description: A secure online service where Medicare beneficiaries can access personalized information regarding their Medicare benefits and services.

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Contact Us

For personalized assistance and to schedule a free consultation, contact Ember Advisory Group.

 

Phone Number: 561-318-4334
Email: info@emberadvisorygroup.com

Instagram & Tiktok: @emberadvisorygroup

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Our team is here to help you navigate your Medicare options and ensure you have the best coverage for your needs.

Medicare Has Parts?

Part A

Hospital Insurance

  • Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Part B

Medical Insurance

  • Covers outpatient care, doctor visits, preventive services, and some home health care.

Part C

Medicare Advantage

  • An alternative to Original Medicare (Parts A and B) offered by private insurance companies. Includes all benefits and services under Part A and Part B, and often includes additional benefits like dental, vision, and prescription drugs.

Part D

Prescription Drug Coverage

  • Helps cover the cost of prescription drugs. Part D plans are offered by private insurance companies.

Frequently Asked Questions About Medicare

When can I enroll in Medicare?

  • Your Initial Enrollment Period (IEP) starts three months before the month you turn 65 and ends three months after the month you turn 65.

 

What if I’m still working and have insurance through my employer?

  • You can delay enrolling in Part B without penalty if you have health coverage through your employer. You’ll have a Special Enrollment Period (SEP) to sign up for Part B without a penalty when your employment ends.

 

How much does Medicare cost?

  • Costs vary depending on the coverage you choose. Part A is usually premium-free if you’ve worked and paid Medicare taxes for at least 10 years. Part B has a standard premium, and there are additional costs for Part C and Part D plans.

Common Costs with Medicare

Part A: No premium for most people, but there are deductibles and coinsurance for hospital stays.

 

Part B: Monthly premium, annual deductible, and typically 20% coinsurance for most services.

 

Part C: Varies by plan, includes premiums, deductibles, and copayments.

 

Part D: Monthly premium, annual deductible, copayments, and coinsurance for medications.

Medicare Advantage vs. Medicare Supplement

Medicare Advantage (Part C)

Pros:

  • Comprehensive Coverage: Combines hospital, medical, and often prescription drug coverage in one plan.

  • Additional Benefits: Often includes extra benefits like dental, vision, and hearing.

  • Cost Savings: Lower premiums compared to Medicare Supplement plans.

  • Out-of-Pocket Maximum: Annual limit on out-of-pocket costs, providing financial protection.

  • Convenience: One plan card for all services, simplifying use.

  • Coordination of Care: Managed care plans like HMOs and PPOs often coordinate care to improve health outcomes.

  • Special Needs Plans: Available for individuals with specific diseases or characteristics.

  • Wellness Programs: Many plans offer fitness memberships and other wellness programs.

  • Emergency Coverage: Covers emergency care across the U.S., though regular out-of-network services may be limited.

  • Potential Savings with Network Providers: Lower costs if using doctors and facilities within the plan’s network.

 

Cons:

  • Network Restrictions: Limited to network providers for the lowest costs, may need referrals.

  • Prior Authorization: May require approval before certain services or medications are covered.

  • Plan Changes: Plans can change benefits, costs, and providers annually.

  • Geographic Limitations: Coverage can vary based on where you live; may not be ideal for frequent travelers.

  • Out-of-Network Costs: Higher costs for using out-of-network providers.

  • Complexity: Understanding the different types of plans (HMO, PPO, etc.) can be confusing.

  • Potential for Higher Out-of-Pocket Costs: Although premiums are lower, copayments and coinsurance can add up.

  • Limited Flexibility: Less flexibility in choosing healthcare providers compared to Original Medicare with a Supplement.

  • Enrollment Periods: Must adhere to specific enrollment periods to join or change plans.

  • Coverage Limits: Some services and items may not be covered as extensively as with Original Medicare plus a Supplement.

Medicare Supplement (Medigap)

Pros:

  • Freedom of Choice: See any doctor or specialist that accepts Medicare, without network restrictions.

  • Predictable Costs: Helps cover out-of-pocket costs such as copayments, coinsurance, and deductibles.

  • Portability: Coverage remains the same regardless of where you live in the U.S.

  • Stable Coverage: Coverage does not change annually; consistent benefits year-to-year.

  • No Referrals Needed: No need for referrals to see specialists.

  • No Pre-Authorization: Generally no pre-authorization required for services.

  • Guaranteed Renewable: Cannot be canceled as long as premiums are paid.

  • Supplemental Benefits: Can provide more comprehensive coverage when paired with Original Medicare.

  • Minimal Paperwork: Simplifies claims and billing processes.

  • Coverage Abroad: Some plans offer limited emergency coverage when traveling outside the U.S.

 

Cons:

  • Higher Premiums: Monthly premiums are generally higher than those for Medicare Advantage plans.

  • No Prescription Coverage: Does not include prescription drug coverage; must purchase a separate Part D plan.

  • No Extra Benefits: Typically does not cover additional services like dental, vision, or hearing.

  • Initial Underwriting: May require medical underwriting if enrolling outside of the initial enrollment period.

  • Separate Plans Needed: Requires separate plans for drug coverage (Part D) and potentially other services.

  • No Out-of-Pocket Maximum: No annual cap on out-of-pocket expenses, although coverage is more comprehensive.

  • Limited Enrollment Periods: Best time to enroll is during the Medigap Open Enrollment Period; later enrollment can be restricted.

  • Potential Redundancy: May pay for coverage not needed if Original Medicare covers most of your needs.

  • Complexity of Choice: Multiple plan options (A, B, C, D, F, G, K, L, M, N) can be confusing.

  • Does Not Coordinate Care: Lacks care coordination features found in many Medicare Advantage plans.

Once You Have Received Your Medicare
Red, White, and Blue Card

Congratulations on receiving your Medicare Red, White, and Blue card! Now that you are officially enrolled in Medicare, it’s time to make sure you have the best coverage to meet your needs.

 

Here’s how your agent at Ember Advisory Group can assist you in this important next step:

  1. Review Your Current Coverage

    • Understand Your Benefits: We will help you understand what is covered under Original Medicare (Part A and Part B) and identify any gaps in coverage that might affect you.

    • Identify Your Needs: Discuss your healthcare needs, including any specific doctors, medications, or treatments you require.

  2. Compare Medicare Plans

    • Medicare Advantage Plans (Part C): These plans offer additional benefits beyond Original Medicare, such as vision, dental, and prescription drug coverage. We will help you compare different Medicare Advantage plans to find one that best suits your needs.

    • Medigap (Supplemental Insurance): If you prefer to stay with Original Medicare, Medigap plans can help cover out-of-pocket costs like copayments, coinsurance, and deductibles. We will explain the different Medigap options available.

    • Prescription Drug Plans (Part D): If you need prescription drug coverage, we will help you find a Part D plan that covers your medications at a cost you can afford.

  3. Personalized Plan Selection

    • Tailored Recommendations: Based on your individual healthcare needs and budget, we will provide personalized recommendations for the best Medicare plans available to you.

    • Detailed Comparisons: We will provide detailed comparisons of the benefits, costs, and coverage options of different plans to help you make an informed decision.

  4. Enrollment Assistance

    • Seamless Enrollment: Once you have selected a plan, we will guide you through the enrollment process to ensure a smooth transition.

    • Ongoing Support: Our support doesn’t end after enrollment. We will continue to be available to answer any questions and provide assistance as needed.

  5. Annual Review

    • Yearly Check-In: We recommend reviewing your Medicare plan annually during the Open Enrollment Period to ensure it continues to meet your needs. We will assist you in comparing plans each year to see if there are better options available.

 

Your agent at Ember Advisory Group is dedicated to helping you navigate the complexities of Medicare and find the best coverage to fit your unique situation. Contact us today to get started!

Why Review Your Medicare Plan Every Year?

Medicare plans can change annually, including benefits, costs, and provider networks. Reviewing your plan during the Annual Enrollment Period (October 15 - December 7) ensures you have the best coverage for your needs and helps avoid unexpected costs.

Stick with Your Insurance Broker

Beware of unsolicited calls claiming to offer Medicare plans. Stick with trusted insurance brokers at Ember Advisory Group who can provide personalized, accurate information and assistance.

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Your insurance broker is your trusted advisor. They know your individual needs and can help you navigate the complexities of Medicare. By sticking with your broker, you ensure you receive unbiased advice tailored to your situation.

Scope Of Appointment

A Scope of Appointment (SOA) form is a document that specifies the types of Medicare plans and services an insurance agent will discuss with a potential client during an appointment. This form is essential because it ensures that both the agent and the client are clear about what will be covered in the meeting, helping to protect the client's interests and maintain compliance with Medicare regulations.

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Key Reasons for Its Importance:

  1. Regulatory Compliance: Medicare requires SOA forms to prevent unsolicited marketing and ensure that beneficiaries are only presented with information they have agreed to receive. This helps protect seniors from being overwhelmed with information they did not request.

  2. Transparency and Trust: The form builds trust by making it clear what topics will be covered, ensuring that there are no surprises during the appointment. This transparency is crucial for maintaining a trustworthy relationship between the agent and the client.

  3. Protection Against Fraud: The SOA form helps prevent fraudulent practices by documenting the scope of the discussion. This record can be referenced if there are any disputes or misunderstandings about what was agreed upon or discussed.

  4. Efficiency and Preparedness: By outlining the topics in advance, both the client and the agent can prepare adequately for the appointment, making the meeting more productive and efficient.

  5. Documentation and Accountability: The form serves as a documented agreement that can be used to hold both parties accountable. It ensures that the agent sticks to the agreed-upon topics and that the client understands the focus of the meeting.

 

Overall, the SOA form is a critical tool in the Medicare enrollment process, safeguarding beneficiaries' interests and ensuring that the discussions stay relevant and within the agreed scope.

Medicare & You

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Check out the Medicare & You Guide!​

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The "Medicare & You" handbook is an official guide published by the Centers for Medicare & Medicaid Services (CMS). It is provided to all Medicare beneficiaries annually and serves as a comprehensive resource for understanding Medicare. Here’s a brief overview of what it includes:

 

What is the "Medicare & You" Handbook?

The "Medicare & You" handbook is an annual publication from the Centers for Medicare & Medicaid Services (CMS) that provides detailed information about the Medicare program. It is designed to help beneficiaries understand their Medicare benefits, coverage options, and any changes to the program.

 

Key Contents of the "Medicare & You" Handbook:

  1. Introduction to Medicare:

    • Explanation of Medicare Parts A, B, C, and D.

    • Eligibility requirements and enrollment information.

  2. Coverage Details:

    • Detailed descriptions of what is covered under each part of Medicare.

    • Information on costs associated with Medicare, including premiums, deductibles, and copayments.

  3. Plan Comparisons:

    • Information on Original Medicare vs. Medicare Advantage (Part C) plans.

    • Guidance on how to choose between Medicare Supplement (Medigap) plans and Medicare Advantage plans.

  4. Enrollment Periods:

    • Key dates and timelines for enrolling in Medicare.

    • Information on the Initial Enrollment Period, General Enrollment Period, Special Enrollment Periods, and the Annual Election Period (AEP).

  5. Updates and Changes:

    • Any changes to Medicare benefits, costs, and coverage for the upcoming year.

    • New policies or updates affecting Medicare beneficiaries.

  6. Resources and Contacts:

    • Contact information for Medicare and other important resources.

    • Information on how to get help with Medicare questions and issues.

  7. Rights and Protections:

    • Information on beneficiaries' rights and protections under Medicare.

    • Guidance on how to file complaints and appeals.

  8. Additional Benefits:

    • Information on extra benefits that might be available through Medicare Advantage plans, such as dental, vision, and hearing coverage.

 

Importance of the "Medicare & You" Handbook:

  • Educational Resource: It helps beneficiaries understand their Medicare options and make informed decisions about their healthcare.

  • Annual Updates: Provides the latest information on any changes to the Medicare program, ensuring beneficiaries have up-to-date knowledge.

  • Decision-Making Aid: Assists beneficiaries in comparing plans and choosing the best coverage to meet their needs.

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