News & Articles Category: Medicare
Original Medicare: What’s Covered and What Isn’t
Understanding the limits of Medicare can help you avoid costly surprises down the line.
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). It’s the foundation of most people’s health coverage after 65 — often called Traditional Medicare — but it doesn’t pay for everything. Knowing what Medicare Part A covers, what Original Medicare covers, and what Traditional Medicare is helps you plan ahead and decide if you need additional protection, like a Medigap policy or a Medicare Advantage (MA) plan.
What Medicare DOES Cover
• Part A: Covers inpatient hospital stays, skilled nursing care after a qualifying hospital stay, hospice, and some home health care. Most people don’t pay a premium if they’ve paid Medicare taxes for 10+ years. This is the core of the question, “what does Medicare Part A cover?”
• Part B: Includes doctor visits, preventive services (like flu shots and mammograms), lab work, X-rays, durable medical equipment, mental health, and some home health. You’ll pay a monthly premium for Part B.
• Optional Part D prescription drug plan: Covers many generic and brand-name drugs, depending on the plan’s formulary. Purchased separately through a private insurer.
• Medicare Advantage (Part C, private alternative): These plans must cover everything in Parts A and B, often adding extras like vision, hearing, dental, and drug coverage. Networks and costs vary.
What Medicare DOESN’T Cover
• Long-term care: Custodial stays in a nursing home or assisted living aren’t covered. It’s one of the most common and expensive gaps in Original Medicare coverage.
• Most dental, vision, and hearing: Routine check-ups, glasses, and hearing aids aren’t covered unless tied to a medical procedure.
• Prescriptions (under Original Medicare): You’ll need a separate Part D plan or MA plan for drug coverage.
• Routine foot care and cosmetic procedures: Except when medically necessary, like diabetes-related foot exams.
• Overseas care: Medicare usually doesn’t pay for care outside the U.S., except in rare emergencies.
Why This Matters
If you’re asking, “What is Original Medicare?” or “What is Traditional Medicare?” Well, Traditional Medicare benefits offer a solid base, but major costs can still fall to you. If you rely on daily prescriptions, travel abroad, or want dental and vision included, it’s wise to explore add-ons. It also pays to learn how to sign up for Medicare Part A and B or how to apply for Medicare Part A only, depending on your needs and timing.
News & Articles Category: Medicare
What CAN You Do During Medicare AEP?
Each fall, Medicare beneficiaries have an opportunity to review and adjust their coverage. Knowing your options during the Annual Enrollment Period (AEP) can help you save money and avoid surprises.
When is Medicare AEP?
The Medicare Annual Enrollment Period (also called Medicare Open Enrollment) runs every year from October 15 through December 7. Any changes you make take effect on January 1 of the following year.
What You CAN Do During AEP
• Switch from Original Medicare to Medicare Advantage (Part C): If you currently have Parts A & B, you can move into a Medicare Advantage plan, which may include extra benefits.
• Switch from Medicare Advantage back to Original Medicare: You may disenroll from your MA plan and return to Original Medicare. This may also allow you to apply for a Medigap policy, though acceptance isn’t always guaranteed outside certain periods.
• Change from one Medicare Advantage plan to another: If your current plan’s coverage, costs, or provider network no longer fit your needs, AEP is your chance to find a better option.
• Enroll in, change, or drop a Medicare Part D plan: If your drug costs have increased or your prescriptions are no longer covered, you can review and update your plan. Even if satisfied, it’s smart to check annually — formularies often change.
• Switch from one Part D plan to another: Comparing premiums, deductibles, and pharmacy networks can help reduce out-of-pocket costs.
What You CAN’T Do During AEP
• Guarantee acceptance into a new Medigap plan unless you’re in a qualifying enrollment window.
• Change employer or union retiree coverage — those plans follow separate rules and timelines.
Why AEP Matters
The Medicare Annual Enrollment Period is your main chance to ensure your coverage matches your health and financial needs. Drug prices change, networks adjust, and health needs evolve. Spending just 30 minutes during AEP could save you hundreds in the coming year.
We’re Here to Help
Call 1-855-890-2583 to connect with an Education Specialist who can guide you through your Medicare AEP options and help you choose the right plan for your situation.
News & Articles Category: Medicare
Understanding Medicare Enrollment Penalties
Missing a deadline could cost you — permanently.
Medicare has a few important enrollment periods. Miss one, and you might pay more every month for life. The good news? You can avoid these Medicare enrollment penalties if you know how the rules work.
Medicare Part B Late Enrollment Penalty
What is it? If you don’t enroll in Medicare Part B (medical insurance) when you’re first eligible and don’t have other creditable coverage, you’ll face a monthly penalty. This is one of the most common reasons people end up paying more.
How much is it? 10% of the standard Part B premium for each full 12-month period you went without coverage. This penalty lasts for life.
• Example: Delay Part B by 2 years → 20% added to your premium permanently. That’s a serious penalty for not signing up at age 65.
• How to avoid it: Enroll during your Initial Enrollment Period (IEP) — a 7-month window around your 65th birthday. Or delay safely if you have active job-based coverage. Once that ends, you get an 8-month Special Enrollment Period (SEP) to avoid a penalty for signing up late.
Medicare Part D Late Enrollment Penalty
What is it? If you go more than 63 days without creditable drug coverage after you’re first eligible, you’ll pay a Medicare drug plan penalty when you finally sign up.
How much is it? 1% of the national base premium (about $34.70 in 2024), multiplied by the number of months you went without coverage. This penalty is added to your monthly premium — for life.
• Example: 10 months without drug coverage → 10% of $34.70 = $3.47/month, permanently.
• How to avoid it: Sign up for Part D during your IEP or keep other creditable drug coverage (like VA, Tricare, or employer plans). If you lose that coverage, you usually have 63 days to avoid the penalty.
Why This Matters
Penalties may seem small monthly but add up over time — and they last as long as you have Medicare. The key to avoiding them is simply knowing your deadlines so you don’t pay more than necessary for your coverage.
We’re Here to Help
Call 1-855-890-2583 to talk with an Education Specialist about avoiding Medicare enrollment penalties.
News & Articles Category: Medicare
What Does a Dual-Eligible Special Needs Plan (D-SNP) Cover?
If you qualify for Medicare and Medicaid, a dual eligible special needs plan may offer the extra support and savings you need.
What is a D-SNP?
A D-SNP is a type of Medicare Advantage plan created specifically for people who have both Medicare and Medicaid. These plans coordinate your care, provide enhanced support, and tailor benefits for those who often face greater health or financial challenges.
Because D-SNPs bring both programs together under one umbrella, they’re sometimes called dual advantage plans or dual special needs plans. The goal is to make managing your healthcare simpler and more affordable.
What D-SNPs Typically Cover
• Full Medicare benefits (Parts A & B): Hospital stays, doctor visits, preventive services, skilled nursing, lab work, and durable medical equipment — just like other Medicare Advantage plans.
• Prescription drug coverage (Part D): D-SNPs include built-in Part D, often with no or minimal copays depending on your Medicaid level. Many also offer a broader drug list than standard Part D plans.
• Medicaid benefits (state-based): May include long-term care, personal support, transportation to medical visits, and home or community services — based on your state’s Medicaid rules.
• Routine extras: Many plans add dental cleanings, vision exams, hearing aids, and over-the-counter (OTC) allowances for items such as vitamins or pain relievers.
Care Coordination Makes a Difference
Many D-SNPs include a dedicated care coordinator or case manager who can reduce hospital stays and eliminate confusion. They can help explain how to use your benefits, schedule doctor visits and follow-ups, manage chronic conditions, and connect your Medicare and Medicaid services so nothing gets missed.
Why D-SNPs Matter
Navigating two government programs can be overwhelming. A D-SNP brings them together under one card and one team, simplifying life. If you’re eligible, you could enjoy stronger coverage, lower costs, and more confidence in your care.
We’re Here to Help
Call 1-855-890-2583 to connect with an Education Specialist about available D-SNPs in your area and find the right plan for your needs.
News & Articles Category: Medicare
How to Qualify for a Medicare Dual-Eligible Special Needs Plan (D-SNP)
These plans with extra benefits are for people who qualify for both Medicare and Medicaid.
A D-SNP Medicare plan is a type of Medicare Advantage (MA) plan made for those eligible for both Medicare and Medicaid. These dual special needs plans combine standard Medicare benefits with your state Medicaid program, adding extra support—often at no cost. If your income is limited, you may qualify. Enrollment is open year-round.
Step 1: Qualify for Medicare
• Be 65+, or under 65 with a qualifying disability (SSDI for 24+ months, ALS, ESRD).
• Must be enrolled in Part A and Part B.
Step 2: Qualify for Medicaid
• Eligibility usually depends on income and assets (not your home).
• If you qualify, you may fall into: QMB, SLMB, QI, or FBDE.
• These programs can pay Part A and B premiums, copays, deductibles, and offer extra services.
How to Confirm Eligibility
• Apply for Medicaid through your state.
• Visit Medicare.gov or talk to a licensed agent.
• Be ready to prove both Medicare and Medicaid coverage.
Why This Matters
If you qualify for a dual eligible special needs plan, you could access lower costs and extra support through a D-SNP Medicare option. These Medicare D-SNP plans are sometimes called a dual special needs plan Medicare approach because they combine your Medicare and Medicaid benefits in one. Even if you already have Medicare, adding Medicaid might open the door to Medicare dual plans like a D-SNP, giving you more coverage without extra cost.
We’re Here to Help
Call us today at 1-855-890-2583 to see if you qualify for a Medicare D-SNP plan today!
