Medicare ABC: Get Medicare Insurance Agents

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FAQs

Medicare ABC has the goal to make your experience with Medicare a pleasant one without the confusion of health insurance and Medicare. As a leader in the Health Insurance Marketplace, our goal is to help you achieve optimal health and financial wellness, starting with offering you a health insurance plan that meets your needs at a reasonable cost. It doesn’t stop here, After enrollment, we help people make the most out of their plan to guide you through your healthcare journey from verifying benefits, explaining claims, finding doctors/specialists, and in addition to this, we can help to set up appointments. We’re here to make sure that your experience with enrolling on a Medicare Plan is as smooth as it can be
In order to receive the 148.50 dollars from social security that you’re being deducted, when completing your health insurance enrollment, we can help you apply to different programs such as SLMB known also as Specified Low-Income Medicare Beneficiary, LIS (Low Income Subsidy), or Medicaid which help with the part b premium. However, we may only apply you for these programs if you qualify in terms of monthly income.
  • If you have worked 10 years or completed 40 quarters and reported taxes, you may obtain part a premium free but will have to pay 148.50 for part b. 
  • If you have worked 30 – 39 quarters, you may acquire a part a for 279 plus the 148.50 monthly. 
  • If you have worked less than 30 quarters, then you will have to pay 471 plus 148.50
If you have low income or resources, and you qualify for Medicare,  you may apply for the following programs which help pay for Medicare:
  • SLMB: Specified Low Income Medicare Beneficiary: Helps Pay for $148.50 Part B Premium.
  • SPAP: State Pharmaceutical Assistance Programs: Helps Pay for Prescriptions $5.00 for Generic and $7.00 for the brand name.

LIS: Low-Income Subsidy: Helps pay for prescriptions making Generic $3.70 and  $9.20 brand name.

Medicare is a federal program for people ages 65 and older,  people who are disabled,  people who have kidney failure, or Lou Gehrig’s disease. Medicaid is for families or individuals who have low income or resources. However, if you are a senior who has a low income you may apply for Medicaid.
In order to have more benefits in addition to Medicare, you may enroll in a Medicare Advantage which is a combination of part a, part b, part c, and d. With a medicare advantage plan, you may have dental and vision benefits among additional benefits depending on the insurance plan that you choose.
Here in Medicare ABC, apart from asking questions about your doctors and prescriptions, in order to give you the most appropriate Medicare Advantage plan, Supplemental Plan, or Prescription Drug Plan, our agents can help pre-qualify you for any state or federal programs that help pay for Medicare. In addition to this we will help you enroll you in the most appropriate plan you qualify and help you apply for any additional programs that help pay for Medicare costs.
 If the appointment is by phone, in person, or home appointment you need the following documents:
  • Social Security Card 
  • Medicare Card with Part A and B 
  • Drivers License or ID
The advantage of having a Medicare Advantage plan is that Original Medicare covers only 80% of your medical costs. The other 20% has to be covered by you. However, if you enroll in a Medicare Advantage plan, it helps cover the 20% that Original Medicare does not cover.
You may enroll in a medicare advantage plan during the following Inscription Periods:
    • Initial Enrollment Period (IEP): This is when you first enroll in Medicare you may enroll in a Medicare Advantage plan.
    • Medicare Advantage Open Enrollment Period (MAOEP): Runs from January 1st-March 31st. During this time you may change to another Medicare Advantage plan once.
  • Special Election Period (SEP): If you qualify for LIS you may be able to enroll in a Medicare Advantage plan. If you qualify for Medicaid, you may enroll in a Dual Special Need Plan which comes with additional benefits. 
  • Annual Enrollment Period (AEP): during this time, you may change your health insurance plan. This program runs from October 15th to December 7th 
In order to get a plan with us, you may  do any of the following options:
  • Call any of our Medicare Advisor’s agents
  • Visit any of your 10 Locations where an agent could help you to the local office closest to you. 
  • If you have a smartphone we can also enroll you using our Medicare Advisors enrollment system
If any of these options do not seem to work for you, no need to panic. In addition to these options, we have agents that can visit your house in order to complete your enrollment process at no cost to you.
When it comes to Medicare Advantage plans, you may only have one active plan. You are not allowed to have more than one medicare advantage plan.
Depending on the enrollment period you may be able to replace your plan, here are the following options that allow you to replace:
  • Medicare Advantage Open Enrollment Period: This allows you to change to another Medicare Advantage Plan once from January 1st to March 31st.
  • Annual Enrollment Period: This allows you to change your medicare advantage plan from October 15th to December 7th. 
Special Election Period: If you qualify for Medicaid or LIS you may be able to change your plan to Dual Special Need Plan or another Medicare Advantage plan.
If you are currently working and are receiving health insurance through your workplace, you may delay enrolling on Medicare. However, if your employer has less than 20 employees then you have to join Medicare Part A and B since it will be your primary insurance.
If you are disabled, you may enroll on Medicare Health Insurance after you have been in disability for at least 2 years.
In order to change my personal information such as an address change, phone number or any additional changes, you may change this information using the following methods:
  • By Creating a My Social Security Account
  • Calling Social Security 1 (800) 772-1213
Medicare comes with part a and be in its default card. However, you may acquire additional parts such as part c and part D Here is a full description of what every part offers: Part A: Hospital Insurance – which covers hospital stays and skilled nursing facilities. Part B: Medical Insurance- Covers doctor visits, labs and outpatient services.Part C: Medicare Advantage – This is provided by private companies and they are responsible for providing additional benefits such as dental, vision among othersPart D: Prescription Drug Plan: It provides for the Medicines 
Medigap, also known as Medicare Suplemental Insurance, which are known to cover the 20% that Medicare does not cover.
You may apply to Medicare by doing any of the following: 
  1. You may call Social Security 1 (800) 772-1213
  2. You can go online SocialSecurity.gov to begin enrollment
  3. If your local office is currently open, you may visit and fill out an application in person

Here is a comparison chart between Medicare Advantage Plans and Medicare Supplemental Plans



Type

Medicare Advantage Plan

Medicare Supplemental Plan

Monthly Premium

May Qualify for $0 Premium

Has a monthly Premium

Part D Coverage

Usually Covers

Not covered with a supplemental plan

Routine dental, hearing, vision

Can Cover

Does not Cover 

Part B Premium

Has to pay unless you qualify for extra help

Has to pay

Can Switch Plan

Two Times Per Year

One Period Change Allowed unless 

What Is Medicare Part A?

Medicare Part A is hospital insurance. Part A covers inpatient hospital care, limited time in a skilled nursing care facility, limited home health care services, and hospice care.

Medicare Part A typically doesn’t cover the full amount of your hospital bill, so you will probably be responsible for a share in the cost. You will also have to pay a deductible before Medicare benefits begin. Medicare will then pay 100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility. After that, you pay a flat amount up to the maximum number of covered days. Your Medicare Part A benefits cover some of the costs for a total of 90 days in a hospital and 100 days in a skilled nursing facility. Medicare also covers up to 60 “lifetime reserve days.” These are days you stay in a hospital longer than 90 days in a row. You get a lifetime total of 60 reserve days.

Medicare Part A typically doesn’t cover the full amount of your hospital bill, so you will probably be responsible for a share in the cost. You will also have to pay a deductible before Medicare benefits begin. Medicare will then pay 100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility. After that, you pay a flat amount up to the maximum number of covered days. Your Medicare Part A benefits cover some of the costs for a total of 90 days in a hospital and 100 days in a skilled nursing facility. Medicare also covers up to 60 “lifetime reserve days.” These are days you stay in a hospital longer than 90 days in a row. You get a lifetime total of 60 reserve days.

Medicare Part B

Medicare Part B is medical insurance. Part B benefits cover certain non-hospital medical expenses like doctors’ office visits, blood tests, X-rays, diabetic screenings and supplies, and outpatient hospital care.

You pay a monthly premium for this part of Original Medicare. The fee can be higher for people with high incomes. A different government program, Medicaid, can help cover Medicare Part B premiums for low-income beneficiaries.

Medicare Part B beneficiaries are usually responsible for a portion of their health care costs. You’ll have to pay a small deductible each year before your Medicare Part B benefits kick in, and then you’ll generally pay 20% of the bill when you go to a participating Medicare doctor. Medicare pays the full cost of many lab tests and services requested by your doctor.

Medicare Part C

Medicare Part C, or Medicare Advantage, insurance often includes every type of Medicare coverage in one health plan. It’s offered by private insurance companies contracted through CMS to provide a Medicare benefits package as an alternative to Original Medicare. Medicare Advantage is optional, but to obtain this private insurance, you must also have Original Medicare, Part A and Part B. You also continue to pay your Part B premium if you have a Medicare Advantage plan. Browse Medicare Advantage plans

While Medicare Advantage plans are required to provide all Medicare Part A and Medicare Part B benefits (except hospice care), plans can also include different additional benefits, which vary among the individual private health insurers. Many Medicare Advantage plans include prescription drug coverage. Some plans might have a lower deductible, while also allowing you to pay a smaller share of the remaining costs. Medicare Advantage plans may even cover certain health care services that Original Medicare, Part A and Part B, does not cover, like eye exams, hearing aids, dental care, or health care received while traveling outside the United States.

Medicare Part D

Medicare Part D is optional prescription drug coverage. Medicare Part D is available as a stand-alone plan through private insurance companies, and the monthly fee varies among insurers. You will share in the costs of your prescription drugs according to the specific plan in which you’re enrolled. Those costs can include a deductible, a flat copayment amount, or a percentage of the full drug cost (called “coinsurance”).

Browse Medicare Part D plans If you want prescription drug coverage, you can get it through a Medicare Advantage plan if there’s one in your area that offers this coverage. You can use the simple form on this page and enter your zip code to view a list of Medicare Advantage plans in your area. If you have limited income and cannot afford your medications even though you receive Medicare Part D benefits, you may qualify for the Extra Help program, which offers financial assistance for your monthly premium, deductible, copayment, or coinsurance.