Plans for Medicare-Eligible Individuals

NOTE:  This page is included for educational purposes ONLY and no carrier-specific benefits or details are provided.

Please contact 877-734-3884 for more information about Medicare Supplement (also called “Medigap”), Medicare Advantage (Part C) and Medicare Prescription Drug (Part D) plans. We sell Medicare Supplement plans from many carriers who offer these types of plans in Florida.  We are also appointed to sell Medicare Advantage and Part D Prescription Drug plans offered by many carriers, but in accordance with Federal regulations can  meet to discuss these with you only if you complete a Scope of Appointment form (see next paragraph).

You must initiate the request for an agent to discuss a Medicare Advantage and/or Part D Prescription Drug plan with you, and, if you desire a face-to-face meeting, must complete a Scope of Appointment Form (also called a Sales Appointment Confirmation Form or other name by some carriers) before an agent can meet with you to discuss a Medicare Advantage and/or Part D Prescription Drug plan. Please call us at 877-734-3884 to request an applicable Scope of Appointment form.

In addition, we offer a policy for those between 64 1/2 and age 85. This is NOT a Medicare Supplement or Medicare Advantage plan but it can be used to help defray out-of-pocket costs for deductibles, co-payments and coverage limits. This policy comes with optional coverage levels. Please call 877-734-3884 for additional details and to obtain information about any requirements that must be met before an agent can discuss this plan with you.

You can learn more about Medicare at www.medicare.gov, which is the official site of the Center for Medicare and Medicaid Services (the agency that administers Medicare). You can also use this site to apply for Medicare online.

Please click here for a copy of Medicare & You 2012, which is the official government handbook with information including the following:

• What’s New (page 4)
• What Medicare Covers (page 31)
• Your Medicare Choices [health and prescription drug plans] (page 55)
• Your Medicare Rights (page 105)

Click here for Medicare Part B premiums (the standard premium is $99.90); Part A ($1160) and B ($140) deductible, copay , and coinsurance ($20%) amounts; and here for information about additional premiums required to be paid by high-income individuals for Part B premiums and Part D Prescription Drug plans for 2012.

You may qualify to save money on health care and/or drug costs if you are eligible for any of these programs. Click here for more information about applying for Medicaid

Please click here to learn more about Medicare Advantage (also called “Part C”) plans.

The primary times to enroll for Medicare Advantage or Medicare Part D prescription drug plans are

• during your initial enrollment period which is the seven month period before and after your 65th birthday month (if you apply during the first three months and your birthday is after the first of the month, enrollment is effective as of the first of the month of your 65th birthday month; otherwise enrollment is effective the first of the following month; if your birthday is the first of the month the entire seven month period starts and ends one month earlier—your 65th birthday month is considered as the first of the preceding month); or

• during the annual enrollment period which starts October 15 and ends December  7; effective date of enrollment is the following January 1.  This is the time to review your present plans and coverages and decide if you want to make any changes.  Unless you have a special election period this is the only other time you can enroll in or change to a different Medicare Advantage or Part D Prescription drug plan.

Medicaid beneficiaries; individuals on low income subsidy (help in paying for prescription drugs); people with chronic conditions like diabetes, chronic heart failure, COPD, and dementia (if a plan specializing in their condition exists in their service area); people moving out of a plan’s service area; and those affected by other situations (including plan termination or insolvency) are eligible for special election periods that permit them to enroll in a Medicare Advantage plan outside of the Annual Enrollment Period (October 15—December 7) throughout the year.  Please call us at 877-738-1544 for additional details including eligibility, available enrolment dates and help in enrolling.

Beginning December 8, 2011, a special enrollment period has been established that will permit eligible beneficiaries to enroll in a five-star plan at any point during the year. Enrollment is the first of the month following the month the enrollment request is received and the special election can be used only one time during the year.

Medicare Supplement plans aren’t Original Medicare (Part A or B) or a Medicare Advantage plan (Part C) because they’re not a way to get Medicare benefits, and prescription drug plans (Part D) must be purchased separately. Medicare Supplement plans are identified by letters (such as Plan C) except in Massachusetts, Minnesota, and Wisconsin. Each Medicare Supplement plan (e.g. Plan C) must offer the same basic benefits, no matter what insurance company sells it.  Medicare supplement policies sold by insurance companies  differ by cost, underwriting criteria, extra services (value added), and customer service.  Medicare supplement insurance companies must follow federal and state laws.  A Medicare Supplement policy covers only one person.  If a married couple wants Medicare Supplement coverage, they must buy separate Medicare Supplement policies.

Medicare Supplement (“Modernized”) Plans

New laws have brought many changes to Medicare Supplement (Medigap) insurance policies, and individuals buying Medigap policies on or after June 1, 2010 have new choices.  The former plans E, H, I and J are no longer offered. Plans D and G bought on or after June 1,2010 have different benefits than D or G plans bought before that date.  Note:  you can keep your old Plan D, E, G, H, I or J supplement bought before June 1, 2010 and in many cases there should be no need for you to change plans.  Plans M and N are new choices not previously offered.

Click here for a chart that compares all of the Medicare Supplement policies available.

Click here to obtain the 2012 version of Choosing a Medigap Policy:  A Guide to Health Insurance for People with Medicare, the official government publication that explains Medigap policies.  This guide includes the following information:

• What a Medigap (Medicare Supplement Insurance) policy is
• What Medigap policies cover
• Your rights to buy a Medigap policy
• How to buy a Medigap policy

Part D Prescription Drug Plans

Although they must meet minimum Federal guidelines, Part D plans differ markedly between carriers, and one of the most important differences is which drugs are covered and which are not. This is a particularly important consideration for individuals who have been prescribed expensive medications. Each carrier provides a formulary that lists which drugs are covered under the offered plan and which copay tier the drug falls into. Subscribers should always check the formulary to determine if their drugs are covered—and at which copay—before purchasing a plan.

Medicare publishes a formulary finder that permits you to enter your medications and then lists the carriers that cover these medications in their formulary. Click here to access the formulary finder.

Federal law has changed how medications are covered in the coverage gap . The coverage gap begins in 2012 when all amounts, excluding premiums, paid by both the beneficiary and the carrier total $2,930 (note that some plans have voluntarily raised the $2,930 limit and the coverage gap starts at a higher amount) and ends when the beneficiary's true out-of-pocket costs (TrOOP) (including the coverage gap discount for generic and brand-name drugs) total $4,700. In 2012 you will pay 50% of the cost of brand-name drugs (you may also be required to pay a small dispensing fee) and 86% of the cost of generics. Some available Part D plans offer coverage in the coverage gap for certain medications.

Click here to find charts showing how the generic and brand-name drug discounts increase between 2011 and 2020.

You may owe a late enrollment penalty if, at any time after your initial enrollment period is over, there is a period of 63 or more days in a row when you don't have Part D or other creditable prescription drug coverage.

Besides Medicaid, there are four other ways to save on Medicare Part D prescription drug costs. Click here for instructions on how to apply for extra help online.