Medicare Florida- Medicare Supplements Florida
Medicare Florida- Medicare Supplements Florida
Medicare can feel a little scary when it’s entirely new to you.
Most of us default to an employer-provided healthcare plan during our working years and don’t spend much time shopping and comparing coverage.
Then, once we hit 65, we discover Medicare is not one-size-fits-all and that there are dozens of plan options.
Medicare Original and Medicare Advantage Florida: Medicare Florida- Medicare Supplements Florida
There are two main ways to get Medicare: Original Medicare and Medicare Advantage. When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage.
Your Medicare health plan decisions affect what service you get, what doctors you can use, how much you pay for coverage, and your quality of care.
Learning about your Medicare coverage choices can help you understand all the options available to you.
Important Dates to Remember
Medicare benefits generally do not require annual enrollment. Key dates for enrollment and changes are highlighted below.
Initial Enrollment Period (IEP) Medicare Florida- Medicare Supplements Florida
Seven-month period: initial enrollment period begins three months prior to the month you turn age 65 and ends three months after the month you turn age 65. Individuals who do not sign up during the IEP may be subject to a late enrollment penalty.
General Enrollment Period Medicare Florida- Medicare Supplements Florida
January 1 – March 31: Those missing the Initial Enrollment Period can sign up during this period; coverage will subsequently start July 1.
Medicare Advantage (MA) Open Enrollment
January 1 – March 31 (only for individuals who already have an MA plan): If enrolled in a Medicare Advantage plan, the enrollee can:
- Switch to a different Medicare Advantage plan
- Drop Medicare Advantage plan and return to Original Medicare
- Sign up for Medicare Part D (if returning to Original Medicare)
Annual Open Enrollment Period Medicare Florida- Medicare Supplements Florida
October 15 – December 7: Individuals can join, switch, or drop a plan for coverage beginning January 1.
Special Enrollment Periods
Individuals with certain qualifying life events (losing health coverage, moving, getting married, having a baby, or adopting a child) may be eligible to sign up during a Special Enrollment Period.
New coverage begins; monthly premium adjustments go into effect.
Choosing Medicare Coverage
|Original Medicare||Medicare Advantage|
|Care Options||Visit any doctor that accepts Medicare; In most cases, no referral is needed for a specialist||Must use doctors only in plan network (most commonly HMO or PPO network); a referral May be needed to visit a specialist|
|Costs||Monthly premiums determined by income
No annual out-of-pocket maximum
Usually pay 20% of Medicare-approved amount after meeting deductible
|Still must pay Part B premium (and, if applicable, Part A premium) in addition to the plan’s premium
Varying out-of-pocket costs, but will not pay additional costs in a year after reaching plan limit
|Coverage||Part A and Part B included
Part D may be added separately
Supplemental (Medigap) coverage allowed
|Plans must cover all services Original Medicare covers and may offer additional benefits
Prescription drug coverage (Part D) is included in most plans
Cannot buy or use separate supplemental coverage
May include additional services not covered by Original Medicare such as dental, vision, and hearing care
|Additional Notes||May be preferable for those wanting greater provider choices
According to the Kaiser Family Foundation, 93% of primary physicians participate in Medicare
|May be cheaper than Original Medicare with additional Medigap coverage
May be beneficial for those with low medical usage
“Think of it as choosing between ordering the prix fixe meal (Medicare Advantage) at a restaurant, where the courses are already selected for you, or going to the buffet (original Medicare), where you must decide for yourself what you want.” – AARP
MAGI Thresholds for Additional Medicare Part B Premiums
- With higher reported Modified Adjusted Gross Income (MAGI), additional premiums are added to taxpayers receiving Medicare.
- Adjusted Gross Income (AGI) is found on the first page of a tax return. The most applicable deductions added back to calculate MAGI are; one-half or self-employment tax, passive income/loss, IRA contributions and taxable Social Security payments.
- 2019 tax return filed in 2020 determines 2021 Medicare premiums
|Single Filers||Married Filing Jointly||Part B
Monthly Premium 2021
|$0 – $88,000||$0 – $176,000||$148.50|
|$88,001 – $111,000||$174,001 – $222,000||$207.90|
|$111,001 – $138,000||$222,001 – $276,000||$297.00|
|$138,001 – $165,000||$276,001 – $330,000||$386.10|
|$165,001 – $500,000||$330,001 – $750,000||$475.20|
|$500,001 +||$750,001 +||$504.90|
Source: Centers for Medicare & Medicaid Services
Options to Lower MAGI
- Spend from taxable accounts, minimize amount withdrawn from a tax-deferred account
- Make a Qualified Charitable Distribution from an IRA
- Harvest losses in taxable account to offset realized capital gains
How To Change Or Switch Medicare Plans? Medicare Florida- Medicare Supplements Florida
Annual Election Period (AEP), October 15 and December 7, is the time each year when you can review your coverage and make changes to your plans. You can:
- Change from Medicare Part A and Part B (Original Medicare) to a Part C (private Medicare Advantage) plan
- Change from Medicare Advantage back to Original Medicare
- Join, drop or switch a Part D prescription drug plan
- Switch Medicare Advantage plans
If you are enrolled in Medicare Advantage plan you have additional opportunities to re-evaluate your coverage during the Medicare Advantage Open Enrollment Periods (MA OEP).
The first is the annual period from January 1 – March 31, anyone with a Medicare Advantage plan can change plans during this time.
The other is an individualized Medicare Advantage Open Enrollment Period that’s limited to new Medicare beneficiaries who enroll in an MA plan during the first three months they have Medicare. They have a three-month MA OEP to switch plans.
During these times you can:
- Switch to a different Medicare Advantage plan
- Switch from a Medicare Advantage plan to Original Medicare and a standalone Part D plan
Since signing up for Original Medicare, I have decided I don’t want to take Part B. Can I switch to only Part A?
If you have coverage through your job or an actively working spouse, you may not want to enroll in Part B until later. If your Medicare hasn’t started yet, there are two ways to drop Part B:
- If you were automatically enrolled in both Part A & Part B and sent a Medicare card, follow the instructions that come with the card and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.
- If you signed up for Medicare through Social Security, contact Social Security.
I’m signed up for Medicare Parts A & B. Can I sign up for Part C?
If you want to enroll in a Medicare Part C (Medicare Advantage) plan, you can only do so during specific times:
- You are new to Medicare – Initial Enrollment Period (IEP): This is the 7-month period when you are first eligible for Medicare. After you enroll in Parts A & B, you can choose to enroll in a Medicare Advantage plan.
- You have enrolled in Medicare Parts A & B already – The Annual Election/Open Enrollment Period (OEP): Each year between October 15 and December 7, you can switch from Original Medicare to a Medicare Advantage plan or vice versa.
Be aware that if you have Original Medicare with a Medigap/supplemental policy and you switch to Medicare Advantage, you most likely will not be able to get a Medigap policy again if you switch back.
The date your coverage starts depends on the period in which you enroll. Remember not to drop your existing coverage, if any, until your coverage with your Medicare Advantage plan has started.
Is Changing Medicare Advantage Plans Allowed? Medicare Florida- Medicare Supplements Florida
If you want to switch between one Medicare Advantage plan to another, you can do so each year during the Annual Election/Open Enrollment Period, which runs October 15 to December 7 and the annual Medicare Advantage Open Enrollment Period, which runs January 1 – March 31 every year.
If you are new to Medicare, you can switch MA plans during an individualized Medicare Advantage Open Enrollment Period that runs during the first 3 months you enroll in Medicare.
You may also be able to switch plans during a Special Enrollment Period based on your plans star rating.
Once you select a new plan to enroll in, you’ll be disenrolled automatically from your old plan when your new plan’s coverage begins. You do not have to contact your old plan to disenroll.
Can I switch my Part D plan?
Most people are allowed to switch plans once a year, during the Annual Election/Open Enrollment Period (October 15 – December 7).
If you are switching from a Medicare Advantage plan to Original Medicare during the Medicare Advantage Open Enrollment Period (MA OEP) which runs from January 1 – March 31, you can add a Part D plan.
The MA OEP does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans.
If you receive Extra Help with your Medicare prescription drug costs, you can switch plans as often as once per quarter during the first nine months of the year (January -September).
There are special circumstances when you can switch plans at other times:
- You move out of the area your current plan serves OR
- You enter, leave or live in a nursing home OR
- Your plan changes and no longer serves your area OR
- You get Extra Help with your Medicare prescription drug costs.
My drug plan’s formulary changed in the middle of the year. Is that allowed?
Part D plans sometimes change their formularies during the course of the year.
This happens because new drugs come on or are taken off the market, generic versions of a brand name drug become available or there are new clinical guidelines about the use of medication.
Part D plans are required to provide 60 days’ notice to all plan members about a formulary change before it happens.
What About Changing Medicare Supplement Plans?
There are many reasons you may want to switch your Medicare supplement plan (also known as Medigap).
Maybe you are paying too much for benefits you don’t need.
Or maybe your health has gotten worse, and now you need more benefits.
In most cases, you won’t have a right under Federal law to switch Medigap policies unless you’re eligible under a specific circumstance or guaranteed issue rights or you’re within your 6-month Medigap Open Enrollment Period.
We know navigating the health insurance maze is not easy; that’s why we specialize in guiding you through to make the process as painless as possible.
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