Medicare &
Senior Plans

Medicare may be one of the best insurance plans you ever have! It is important to know that not all Medicare plans are alike.  We specialize in finding the right plan that fits your unique situation.  We are independent agents which means we can shop around and compare costs with multiple plans while not being limited to one particular plan.  Medicare requires a small degree of education to understand it.  By taking the time to learn about Medicare, you will feel more peace about the options available and the plans you can choose for your area.

Am I eligible for Medicare?

Seniors Age 65+

  • 10+ years work history
  • Long term lawful presence in US

Disabled

  • 24+ months of social security disability
  • Long term lawful presence in US

End Stage Renal Disease

  • Have ESRD and kidneys do not work
  • Regular kidney dialysis / have had a kidney transplant
  • SS/RRB requirements met

Unmarried Disabled Child (over 20)

  • 24+ months of social security disability
  • 1 parent with SS benefits
  • Got disabled prior to age 22

Enrollment periods for Medicare


IEP
Medicare
Enrollment Periods

  • 65th Birthday
    3 months before to 3 months after enroll in Part A, Part B, Medigap, Medicare Advantage and/or Part D.


OEP/AEP
Open Enrollment Period (Annual Election Period)

  • October 15 – December 7
    Enroll or change Medicare Advantage, Medigap, and/or Part D.


GEP
General
Enrollment Period

  • January 1 – March 31
    Enroll in Part A and Part B if you did not enroll when first eligible. Late enrollment fees apply.


SEP
Special
Enrollment Period

  • Up to 8 months after employment coverage ends
    Enroll in Part A and Part B or Medicare Advantage.

The basics of Medicare

When am I eligible? 

For most people Medicare eligibility begins at age 65.  For most folks who are on disability including unmarried children under over 20, it begins after two complete years after first receiving your disability payments (usually the 25th month).  Most applicants who have End Stage Renal Disease will qualify for Medicare.  All eligibility requires lawful presence inside the United States.

Is there an enrollment time period to follow? 

Yes.  In order to avoid payment penalties, you must enroll in Medicare within 3 months before your 65th birthday, the month of your 65th birthday, or 3 months after your 65th birthday, unless you stay on creditable employee sponsored coverage.  After your employee sponsored coverage ends you will have 8 months to enroll in Medicare without incurring penalties.  

Can I delay getting Medicare if I am already covered by my work or my spouse’s work? 

Yes, of course.  So long as you have both creditable health coverage and creditable drug coverage through the employer you can delay signing up for Medicare.  You can also stay working AND go on Medicare; especially if you work for a small business or are self employed. 

Can I have Medicare and Medicaid (State health insurance for low income applicants)? 

Absolutely!  There are great plans which merge both your Medicare and your Medicaid (Medi-Cal) benefits and we specialize in these types of Dual Special Needs Plans.   

Do I need a Medicare card? 

Yes.  Like a social security card, a Medicare card is your unique number which is used to apply for the various Medicare products available.  While some people find this part stressful, we would be happy to help you in this process. It is not as hard as other people may have told you.

  • Step 1: 3-6 months before your 65th birthday, go to www.ssa.gov (or call 1-800-772-1213), and create a Social Security/Medicare profile.  There is an application, but it walks you fairly clearly through the details.  
  • Step 2: 2-3 months before your 65th birthday, check on the status of your Medicare card as it can take weeks to get it.  Once you get your Medicare card, re-read the options down below and reach out to a CalHealth Medicare specialist for assistance in applying for the “right” plan for you.  This service is totally free to you.  
  • Step 3: 1-2 months before your 65th birthday, schedule a phone appointment (or in office appointment) with a certified CalHealth Medicare agent and apply for either a Medicare Advantage plan, or a Medicare Supplement/Part D prescription drug plan.

I already have Medicare, when can I make changes?

Everybody can make changes once a year during the Annual Enrollment Period from October 15th to December 7th.  For Medicare Advantage subscribers, there is also an “open” enrollment from January 1st to March 31st where you can make certain changes as well.  If you move, you have 60 days and you can select a new policy to match your new area.

Understanding the 4 parts of Medicare

The Medicare system has 4 main parts that are labeled using the first four letters of the alphabet – A, B, C, and D.


PART A
Hospital/Hospice

  • Premium: Usually Free
  • Inpatient hospital care Skilled nursing care Hospice care Home health care


PART B
Doctors/Medical

  • Premium: $164.90 (or higher)
  • Your doctor Outpatient care Durable equipment Preventative


PART C
Privatized Medicare

  • Premium: $164.90 (or higher)
  • A combination of Parts A, B, and D.


PART D
Rx Drug Coverage

  • Premium: $10-$100
  • Helps cover costs of prescription drugs including vaccinations.

The 3 paths of Medicare

Note: You must be entitled to Part A and enrolled in Part B to apply for a Medicare Advantage Plan.


PATH 1
Original Medicare – PPO

  • What it is?
    You can simply apply for and stay on Original Medicare and see any doctor who takes Medicare, or go to any hospital which takes Medicare.
  • Advantages
    Works like a PPO.  You can go to any doctor or hospital that takes Medicare.  The only premium is the Part B premium.
  • Disadvantages
    There is no limit on how much you may spend for medical services.  There is no annual out of pocket maximum.  Medicare only pays 80% while you would be on the hook for 20%.  If you have a procedure that is billed for $100,000, you will pay $20,000.
  • Advice
    Staying on Original Medicare is a huge risk to your personal finances at a time when most people transition to a fixed income.  We DO NOT recommend staying on Original Medicare.
  • Cost
    $164.90 (or higher depending on your income)


PATH 2
Medicare Supplement – PPO

  • What it is?
    Depending on which plan you select, Medicare Supplement plans (sometimes called Medigap plans) cover the costs that Original Medicare does not (The 20% gap), minus a $233 deductible.
  • Advantages
    Works like a PPO.  You can go to any doctor or hospital that takes Medicare.  Works great for major illnesses where you see multiple physicians in different networks.  Supplemental plans are also great for people who travel often.  Supplements provide more freedom of choice.
  • Disadvantages
    Medicare Supplements have an additional premium (starting at around $120.00).  You must also get a separate Part D prescription drug plan.  Must carry all three cards (Medicare, Supplement, and Rx drug)
  • Advice
    Supplements provide the best coverage because of both the freedom of choice and comprehensive financial coverage in the event of a major illness.  The additional premium simply may not make sense for everybody.
  • Cost
    $300 – $500 (depending on age)


PATH 3
Medicare Advantage – HMO
(with some PPO options)

  • What it is?
    Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits.  The plan will provide all of your Medicare Part A (Hospital), Medicare Part B (Medical) coverage, and in most cases your Part D (drug) coverage.
  • Advantages
    Works like an HMO.  If you like a fixed network, and having your primary doctor take care of all of your referrals, then MA plans can take some of the thinking out of it.  Also, you usually only have to carry one card for all of your coverage.  MA plans usually carry extra benefits such as dental, vision, and hearing coverage.
  • Disadvantages
    In many cases, you will need to use doctors who are in the plan’s network.  There is no out of network coverage.  MA plans usually have an out of pocket maximum (which is still safer than Original Medicare) which can be as high as $8,300, but is usually around $2000-$3000.  Also, MA plans do not typically have great travel coverage outside of emergency services. 
  • Advice
    Medicare Advantage Plans carry a lot of different options.  Some special needs plans work great for chronic diseases, Medicare-Medicaid, or Medical Savings Account plans.  The additional benefits are a factor to consider, as is the convenience of one card to carry.  If you are comfortable working with referrals from your doctor, this would work just fine. 
  • Cost
    $164.90 (or higher)(some Medicare Advantage plans do have additional premiums)

If you are not already a CalHealth client

We like to use the personal touch when it comes to navigating Medicare. There are many factors and nuances that affect what might be considered the “best” coverage for your personal situation. If you would like a real live human being to walk you through the process, please contact us. There is no cost to you and we will only discuss what you want to discuss. We’ll make it as easy and clear for you as possible. 

If you are already a CalHealth client

It is our mission to make the transition to Medicare as easy and clear as possible when you transition to or work with a CalHealth Medicare agent.

  • We already have the basic information we need (minus your personal Medicare ID number) to begin your transition.
  • We will reach out at the appropriate time (3-6 months before your 65th birthday or 3-6 months before your 25th month of disability).
  • We can recommend the best plans for your area and which ones your doctor accepts.