Medicare Archives - ARC Benefit Solutions

What is the Difference Between Skilled Nursing Facilities and Nursing Homes?

February 15, 2023/in Medicare/by ARC Benefit Solutions

Though they may seem similar, skilled nursing facilities and nursing homes differ in the care they provide to patients.

A skilled nursing facility is an in-patient rehabilitation and treatment center where patients may go for physical, occupational, or speech therapy after an injury or illness after a hospital stay. Typically, patients may stay at the facility for one to two weeks, sometimes longer.

Nursing homes, on the other hand, are more focused on helping someone with activities of daily living (ADLs) such as bathing, dressing, and eating, also known as “custodial care”. Nursing homes and assisted living facilities provide assistance with ADLs, but differ in the level of care provided. Those in nursing homes may require 24 hour medical supervision, while those in assisted living are mostly independent but may require assistance with ADLs.

So what can patients expect Medicare to cover when it comes to these services?

What Does Medicare Cover?

For Medicare beneficiaries, Medicare provides 100 percent coverage for skilled nursing services for the first 20 days in a facility, and then all but $200 per day from days 21 to 100. Beyond 100 days, the beneficiary is responsible for all charges.

To qualify to for skilled nursing services, Medicare beneficiaries must:

Be hospitalized with the status of “inpatient” for at least three days; if one is hospitalized with the status of “under observation” for three days, this does not qualify the beneficiary for skilled nursing care
Enter a Medicare-approved skilled nursing facility within 30 days after leaving the hospital

Medicare does not, however, cover assistance with ADLs, and therefore will not cover nursing home or assisted living stays, as these could be covered under long-term care insurance. Long-term care insurance is less expensive and easier to obtain before 70 years old as this requires a form of medical underwriting. Medicare, will, however, provide medical care for nursing home and assisted living residents.

If you have questions about skilled nursing facilities or nursing homes and what your plan does or does not cover, reach out to ARC representative today. We are happy to walk through your plan with you or review your options so that you are covered when it comes to needing these facilities.

Resources

Independent Research | HCG Secure

Difference Between Assisted Living and Nursing Home | Compare the Difference Between Similar Terms

Assisted Living Long-Term Care Insurance | A Place for Mom

What’s the difference between a skilled nursing facility and a nursing home? | UnitedHealthcare (uhc.com)

Compliance Corner: Considerations for Employees or Dependents Becoming Eligible for Medicare

January 5, 2023/in Compliance, Employee Benefits, Medicare/by ARC Benefit Solutions

As employees of companies near age 65, they become eligible for Medicare, which has a lot of implications for their health coverage. This article contains answers to frequently asked questions to help you and your employees make the best decision and stay compliant.

Can I require my employee or their spouse take Medicare instead of our group plan?

No. This is considered discrimination based on age. Employees who reach age 65 and who are still working (also referred to as “Active”) have the option to choose between Medicare products and/or supplements versus their employer’s plan at each open enrollment.

In addition, for groups with less than 20 employees, insurance companies or health plans may require the employee elect Part B with their Part A coverage. Their plans usually pay second to Medicare regardless of whether the employee has purchased Part B. This can leave employees with potential unexpected expenses if they have not enrolled in both Medicare Parts.

Why would my employee or their dependent opt to stay on my plan when they could have Medicare, Medicare Supplements, or even Medicare Advantage plans?

There are many reasons why a member may stay on their group health plan. The two most common reasons are:

They have a spouse and/or dependents who still need coverage.
If the employer pays most of the cost of coverage, it may be less expensive for them to stay on the employer’s coverage. This is particularly true for plans where the employer picks up 100 percent of the cost. Unfortunately, for a group under 20 employees, this could backfire if the employee doesn’t understand they need to also purchase Part B if required by their insurance plan.

What are common issues for employees or their spouses who reach age 65 and are automatically enrolled in Medicare Part A?

There are several issues that can come up if employees don’t have a good understanding of the Medicare Secondary Payer rules. These rules impact which insurer pays first–– Medicare or the employer plan. This is dependent on the size of the employer. For more detail, click here for a guide from Medicare.gov regarding the payment rules.
Members over age 65 must ensure their prescription drug coverage continues to be creditable for Part D (notices we ask you to distribute each October). If the plan is not creditable, the member will have to pay a higher price later for Part D coverage. We recently helped a long-time employee of a customer retiring at age 80 to find all their Part D notices for the past 15 years so that they could prove they have been covered by creditable coverage.
If you offer an HSA-qualified plan and the employee is making contributions, they’ll want to review the rules and perhaps consult their tax advisor. Once you turn 65, qualified U.S. citizens are automatically enrolled in Part A, which prevents HSA contributions to be made by both the employer and the employee. In addition, there is a six-month look-back period for which the individual may not make contributions. This may also impact spousal contributions to their HSA even if the spouse is under age 65.
If your plan is a MEWA (Multiple Employer Welfare Arrangement), additional paperwork will be needed to submit to CMS/Medicare and the insurer to get claims paid correctly. Without the proper forms, the employer plan will pay primary and typically the employer is charged a higher premium for those employees.

This can be very difficult for employers to explain to employees. We’ve prepared a document that can be shared with employees to guide them in learning what works best for themselves and their families. Click here to access.

How do I know if my plan pays secondary or primary to Medicare?

Like the 20-employee rule used for COBRA, the count includes all full-time and part-time employees from the prior calendar year.

Will it save money on my premiums if individuals aged 65 or older leave the employer’s plan?

Not necessarily. In some cases, healthy individuals can help the overall risk of your group regardless of their age. This primarily helps groups that are medically underwritten (e.g., grandmothered status, level-funded, or in a multiple-employer plan). Plans with age-banded rates such as ACA plans, are going to reduce premiums for the employer.

If there are alternative “Medicare Rates,” those are typically shown on the renewal or proposal. They are only offered if the member provides proof to the insurer that they are enrolled in Medicare A and B. Generally, ACA plans do not have a reduced premium for employees with Medicare.

Can I pay for the employee’s Medicare product or supplement?

The law considers any incentives or disincentives to be discriminatory when used to encourage Medicare aged employees, spouses and/or dependents to opt for Medicare instead of the employer’s medical plan.

If the incentive was offered to all employees who opt for other coverage, regardless of their age, this would be permitted. This is called “Cash In Lieu of Benefits.” Payments under these terms are reported as taxable income to the employee but they must be consistent regardless of the age of the employee or any dependents. The employer can choose to only offer the incentive for their employees and not spouses or children.

Can I set up a Health Reimbursement Arrangement (HRA) to pay for Medicare premiums?

There are no permissible HRAs for the reimbursement of Medicare premiums for active employees if the employer offers a group plan. They are permitted for retirees.

An option exists if the employer disbands their group coverage. The employer can offer either an Individual Coverage HRA (ICHRA) or Qualified Small Employer HRA (QSEHRA). These types of HRAs are the only vehicles available for reimbursing premiums for all eligible employees. The downside is that the employer can no longer offer a group medical plan and all employees would need to secure individual coverage. ARC Benefit Solutions has assisted clients with establishing ICHRAs to replace traditional group coverage. If you’re interested in exploring this for your group, please contact your ARC representative.

The Inflation Reduction Act and What it Means for America’s Medicare Population

November 16, 2022/in ARC Updates, Legislation, Medicare/by ARC Benefit Solutions

Between 1946 and 1964, there were 76 million births in the United States. Of those 76 million babies, we have 65.2 million surviving seniors today. As of today, this population of “Baby Boomers” are two-thirds the way into Medicare. The promise of good health care in their golden year is a constant challenge for law makers to make good on. It’s a massive undertaking delivering good health outcomes and medical cost relief for these boomers.

This year, Washington has taken some steps to bring the care that Medicare promised these Americans during their working lives. The passing of the Inflation Reduction Act of 2022 is the latest in spending bills that at least partially targets help for these citizens. So how does the inflation reduction benefit us? When can we expect from the relief and how does it improve health outcomes?

First of all, The Inflation Reduction Act of 2022, sponsored by Senators Chuck Schumer (NY) and Joe Manchin (WV), was originally part of the “Build Back Better” bill. After the bill failed to pass in Congress, the two senators met to negotiate the Inflation Reduction Act with some Medicare fixes, as well as spending for energy, climate change, tax provisions, and the expansion of the Internal Revenue Service.

Here are some of the health care highlights of the legislation:

$2,000 limit out-of-pocket cost for prescription drugs for all Americans on Medicare
Caps the cost of insulin at $35
Zero cost for most vaccinations
Continued expansion of the Affordable Care Act’s (ACA) subsidies for three more years
Direct drug price negotiations with drug manufacturers

Sounds pretty good right? However, the devil is in the details.

Some help is coming right away or at least very soon. If you’re a diabetic, you won’t have to choose between paying the mortgage or buying your insulin. This is some overdue relief and that program starts next year. Also, beginning in January, most vaccines will be free through Medicare. Furthermore, for people who buy their health insurance through the ACA Marketplace, the bill extends through 2025 the expanded federal premium subsidy. For those 50 to 64 years of age, these subsidies provide an average savings of over $950 annually, and all consumers will continue to pay no more than 8.5 percent of their income for ACA health insurance premiums.

Now for the goodies that we must wait on:

The $2,000 cap on drug costs is great, but Medicare beneficiaries will have to wait until 2025 to see the benefit.
The new law authorizes the Health and Human Services secretary to begin negotiating the prices of 10 high-cost prescription drugs in 2023. Unfortunately, the negotiated prices will not go into effect until 2026 for Part D medications and in 2028 for drugs covered under Medicare Part B.
More drugs will be negotiated on behalf of Medicare in subsequent years and by 2029 a total of 60 drugs will be subject to negotiated prices.

According to the Congressional Budget Office, Medicare will save hundreds of billions of dollars over 10 years as a result of the new law with the majority of the savings resulting from drug cost negotiations. And good news: The savings involves no cuts to Medicare.

If you are a Medicare eligible or beneficiary, we want to help you learn about the rules of Medicare and how they apply to you. Contact your Client Care Advisor today to learn more.

September is Healthy Aging Month! Follow These Three Tips to Help You Maintain Your Health and Function

September 13, 2022/in Health and Wellness, Medicare/by ARC Benefit Solutions

Journalist Betty Friedan said, “Aging is not ‘lost youth,’ but a new stage of opportunity and strength.” From taking care of your body with regular screenings to getting moving, there are many ways you can positively influence your health. Here are three habits you can add to your life to age healthily.

1) Regular health screenings.

Regular preventative screenings can help your doctor determine a baseline for your health and can help them preemptively identify symptoms of illness. It’s also important to consistently consult with your doctor about the medicines you’re currently taking to ensure they are right for you and your situation.

Did you know? Blood pressure screenings, colonoscopies, bone density scans, mammograms, and hearing tests are just a few of the many screenings that may be covered by your health insurance. Contact ARC Benefit Solutions today to find out more.

2) Challenge your mind.

Maintain your cognitive health by continually challenging your mind. According to the National Institute on Aging, changes in the brain as a person gets older, such as reduction of neuron communication and reduced blood flow, can affect mental function, even in healthy older people. Learning a new language, reading, and taking dance lessons are just a few of the ways you can improve brain health. Connecting with your family, friends, and community are also great ways to reduce your risk of cognitive impairment.

3) Stay active.

Among numerous other benefits, regular exercise can improve your health, your balance, and your mobility, and can reduce the impact of illness and chronic disease. Finding an activity that you enjoy doing on a consistent basis is a good start for maintaining a fitness routine. According to Go4Life, an exercise and physical activity campaign from the National Institute on Aging at NIH, exercise falls into four different categories: endurance, strength, balance, and flexibility. Mixing these different workouts has been proven to improve your overall health. Walking, Tai Chi, yoga, and water aerobics are just a few of the many fitness options for older adults.

Did you know? Many Medicare plans include access to the SilverSneakers® program, which is specifically designed for adults 65 and older. Contact your ARC Client Care Advisor for more information!

Consult your healthcare provider before taking on a new exercise plan, especially if you have a pre-existing condition.

Resources

How the Aging Brain Affects Thinking (National Institute on Aging) Ten Tips for Healthy Aging (Dartmouth-Hitchcock)

Healthy Aging (U.S. Department of Health and Human Services)

Health Highlights: September, Healthy Aging Month (WebMD)

5 Healthy Aging Tips for Women (U.S. Food and Drug Administration)

4 Types of Exercise (Go4Life, National Institute on Aging at NIH)

Senior Exercise and Fitness Tips (HelpGuide)

Medicare Supplement vs. Medicare Advantage: Which Plan is Best for You?

June 17, 2022/in Medicare/by ARC Benefit Solutions

I have worked with Medicare-eligible clients since 2015. A majority of people I have helped have actually enrolled in a Medicare Supplement with a separate stand-alone Part D drug plan. However, in past 18 months, there has been a trend of more and more Medicare Advantage plans.

To make an informed decision about your Medicare coverage, it is imperative to understand the differences between the two options: Medicare Supplement plans and Medicare Advantage plans.

Medicare Supplement Plans

All Medicare Supplement plans are standardized with 10 different plan designs and the varying monthly premiums, depending on how comprehensive the plan design is. For example, Plan F and Plan G are the most comprehensive of all Medicare Supplement plans so, the coverage is the same for all those plan types. However, in a given area, insurance company A might charge $150 for their plan G premiums, while insurance company B might only change $135 for the same plan G coverage. Not all plans are commercially available in all areas; the insurance company decides which plans they will offer in a given area or state.

To avoid overpaying for the supplement, it’s a good idea to speak with you agent, who can provide quotes from multiple insurance companies. You may already realize Medicare Supplement plans charge a monthly premium cost for the coverage. This premium cost will increase slightly each year as you age. For example, with a Plan G, in exchange for the monthly premium cost, the plan will pay all Medicare-eligible expenses after you meet an annual one-time $233 Part B deductible.

When considering a Medicare Supplement plan, also remember that:

You can go to any doctor or healthcare facility anywhere in the US as long as the provider or facility accepts Original Medicare.
Medicare Supplements require medical underwriting expect when first turning age 65, or first enrolling in Medicare part B after being in group health coverage. In those instances, the applicant has one-time right to a guaranteed issue policy without underwriting.

In summary, Medicare Supplement plans…

Have a monthly cost that increases with age.
Do not require members to use a network.
Pays all Medicare approved cost after a $233 annual Part B deductible so anyone who enrolls has a very predictable cost for their medical coverage for the year.
Do not include Part D prescription drug coverage, so anyone applying for a supplement will want to purchase a stand-alone Part D plan.

Medicare Advantage Plans

In comparison, Medicare Advantage offers an assortment of different plans including PFFS, HMO, PPO, or POS options. Availability of these plan types may be limited to specific geographic areas. Medicare Advantage plans can be available with or without Part D drug coverage, and anyone who enrolls in Medicare Advantage with Part D coverage will have medical and drug coverage all together in one plan; this is commonly referred to as MAPD or is sometimes referred to as an all-in-one plan or Medicare Part C.

The most commonly available Medicare Advantage plan types are the HMO and PPO. Generally, Medicare Advantage HMO and PPO plans are available with a $0 monthly premium, or if the plan does have a premium it is usually much less than the monthly cost of a Medicare Supplement plan. Anyone who selects an Advantage plan for their Medicare coverage will typically pay lower monthly cost than for a supplement.

When the member of a Medicare Advantage plan obtains medical treatment, they will be required to pay a pre-determined flat dollar co-pay amount or a coinsurance percentage for all services. These amounts are due to the provider at the time of service. To limit catastrophic medical costs, Advantage plans provide an annual max out-of-pocket amount that limits the members annual medical cost to a fixed dollar amount. Conditionally, the Advantage plan counts the members out-of-pocket medical cost toward the out-of-pocket limit. Some plans require the member to use network providers in order to count medical cost toward the out of pocket limit.

Except for a medical emergency, Medicare Advantage HMO plan members are required to obtain all of their health coverage from a network of providers. In the case of medical emergency, the member can go to the nearest hospital and the treatment will be considered as in-network according to policy terms and conditions. Medicare Advantage PPO plan members have an option to use a network provider and pay lower cost or they can go to any non-network provider of choice and pay more for services and have a higher out-of-pocket limit.

All Medicare Advantage plans are reviewed and approved by Medicare before they are offered commercially. In addition to medical and drug coverage, Medicare Advantage plans may offer various additional benefits and services such as routine dental and vision coverage, quarterly allowance for over-the-counter items, such as vitamins or medical supplies, home-delivered meals post hospital discharge, no-cost fitness club memberships, assisted devices for emergency, 24/7 nurse hot line, telemedicine, and more.

In summary, compared to the Supplement option, Medicare Advantage offers lower monthly premium cost for a good number of zero dollar premium or low monthly premium HMO or PPO plans. Medicare Advantage is a pay for services as you go option while each member has a built-in protection against high medical cost with the max out of pocket limit. Many of additional benefits and services available with Medicare Advantage are not included or available with the Medicare Supplement plans.

In summary, Medicare Advantage plans…

Offer lower or zero-dollar monthly premium cost for HMO or PPO plans
Are a pay-for-services-as-you-go option while each member has a built-in protection against high medical cost with the max out-of-pocket limit.
Offer many additional benefits and services that are not included or available with the Medicare Supplement plans.

The Medicare maze can be confusing and it can be difficult to find the right plan for you and your situation. Contact your ARC licensed health insurance representative today and we will help you find options that work well for your health and your budget.

Your Guide to Supplemental Health Insurance Products

March 18, 2022/in Employee Benefits, Individual/Family, Medicare/by ARC Benefit Solutions

Ancillary health insurance products cover what your typical health insurance plan might not, namely miscellaneous medical expenses. There are a number of ancillary products available on the market including accident, critical illness, dental, vision, and hospital indemnity. These supplemental plans are designed to help with the financial burden of expenses incurred from procedures or services that are not covered by your traditional medical plan. A basic dental cleaning, for example, will not be covered by your health insurance plan, but will be covered with a dental plan.

There are a number of supplemental products that you may consider when putting together your benefit package for the year, including:

Accident

The expenses from an accidental injury can quickly add up, and accident insurance is designed to help in those situations. The insurer will pay money directly to you to help with the costs of hospital stays, emergency treatment, medical exams, and so on.

Critical Illness

Critical illness products are designed to avoid the financial burden from extensive medical care and treatment that results from heart attack, stroke, organ transplants, coronary bypass, and cancer. The lump-sum of money provided can be used for non-medical-related costs, such as child care, transportation, etc.

Hospital Indemnity

Hospital indemnity products can help cover the cost expenses that may not be covered by your health insurance plan, like hospitalizations, intensive or critical care, and more. Your plan will make cash payments to you if you are admitted to the hospital for an injury or illness. Those funds can be used to pay for costs including health insurance deductibles, copays, coinsurance, cost-of-living expenses, and more.

Dental

Dental plans emphasize preventive care, saving you money in the long run from more major procedures that may result from not visiting the dentist on a regular basis.

Most dental plans provide coverage for routine exams, cleanings, and X-rays for limited to no out-of-pocket costs. Services that might entail a filling, bonding, veneer, extracting, crown, bridge, root canal, etc., on the other hand, are more comprehensive coverage options in which the insurance companies may only cover up to a certain annual limit.

Vision

Vision insurance is a great option to help reduce the cost of preventive eye care, glasses, and contacts. These plans tend to resemble discount plans more than health insurance. The insurance would usually pay a flat amount, while the subscriber would be responsible for the rest of the payment. Also, vision insurance usually only covers glasses or contact lenses during the same benefit period, not both.

If you are interested in adding any of these plans to your current package, contact your ARC client care advisor today. Our licensed sales agents are available to answer any questions and help you determine which products will be most beneficial for you and for your wallet.

Your Options for Submitting Your Monthly Premium Payments to Keep Your Account Updated

February 15, 2022/in Individual/Family, Medicare/by ARC Benefit Solutions

Paying your monthly health insurance premium on time is extremely important to maintain your coverage and ensure that your plan’s benefits and claims are paid in a timely manner. Health insurance companies, like other organizations, allow various methods of payment, including online, over the phone, or through the mail via check. Let’s take a look at some of the advantages and disadvantages of the payment options provided by insurance carriers:

Automatic deduction from a bank account or charge to a credit/debit card (autopay).

Pros	Cons
With automatic payments, you will never forget to pay your premium. These consistent payments will ensure the insurance company will pay claims properly and allow members to access benefits. Some insurance carriers may discount the premium if you choose autopay. Additionally, setting up autopay on a credit card every month may help with reward points on your credit card.	If you cancel a policy, sometimes the autopay may stay active for an extra month or two before it stops. Insurance companies are usually good about refunding these premiums, but you may have to call the company and contest the charges. Even with autopay, it’s still a good idea to keep an eye on your payment statements to ensure you aren’t over or underpaying.

Proactive online payment.

Pros

Cons

Making online payments each month gives you more control over your payment schedule. Based on your finances, you can make early or later payments prior to the due date.
You can make multiple months’ worth of payments at once. Some companies allow discounted premiums if you pay a full year’s premium all at once.
Once your payment is submitted, the payment information is in the company’s system, so processing can begin sooner and more efficiently than mailing a paper check.

You run the risk of missing premium payments if you don’t actively keep up with your account.
Most insurance companies have secure sites for submitting payments, but it is always a good idea to make sure.

Proactive payment over the phone.

Pros

Cons

Paying your premium through a representative allows you to document the interaction. You can keep track of the name of the representative, the time of the call, the phone number, and possibly even a confirmation number.
It is often easier to speak with a live representative rather navigating the insurance carrier’s online portal.
Rather than speaking with a representative, some companies provide an automated over-the-phone payment option.

Hold times are unpredictable.
With automated phone options, you will need to speak slowly and clearly enough to ensure the system understands you. This may be a challenge for some people.

Sending a paper check via postal mail.

Pros

Cons

This traditional method is beneficial for those who do not have computer access or who are hesitant to input their payment information online.
This is also an ideal option for those who want to bypass a phone call.
Members who write paper checks are able to make hard copies of those checks for tracking purposes.

Paper checks run the risk of getting lost in the mail.
Paper can also be easily torn and damaged.
It is possible that the insurance company may lose your paper check in the shuffle of the thousands of letters they receive.
An insurance company can choose not to process a paper check if it’s deemed illegible or if the wrong account number is mistakenly written on the check.
All of these errors can lead to your account being deemed “delinquent.”

Regardless of the pay method you choose, it’s always a good idea to keep track of your payments and question any unusual charges. If you need assistance setting up a payment routine that works well for you, please contact your ARC representative for help.

REMINDER: Employers Need to Report Part D Creditability to CMS By March 1

February 2, 2022/in Compliance, Employee Benefits, Medicare/by ARC Benefit Solutions

If your company health insurance plan renewed January 2022, CMS reporting of Part D creditability will be due March 1, 2022. Employers need to notify CMS within 60 days of their renewal of whether their plan(s) is creditable or not for Part D. Here is the information from CMS which includes a link to the notification which is done online. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage

Contact your ARC representative with any questions.

Here are the Medicare Enrollment Periods You Need to Know About

January 12, 2022/in Medicare, Open Enrollment/by ARC Benefit Solutions

When it comes to health insurance, most people don’t enjoy taking the time to sit down and unpack the intricate world of rules and regulations about when you can and cannot enroll in coverage. This becomes increasingly more complex once you hit the magic age of 65. When turning 65 and becoming eligible for Medicare, it is crucial to understand the time frames for enrollment because they can be a factor in your Medicare coverage options/decisions.

We will walk through most of the major Medicare enrollment situations and time periods that are available to you, not only when your initially eligible, but throughout the year as well.

Initial Enrollment Period

Your Initial Enrollment Period (IEP) starts three months before the month you turn 65, runs through the month of your birth month, and up to the three months following the month you turn 65. During this time, you can enroll in Medicare Part A and Part B (contact Social Security for enrollment). Once you have Part A and Part B, you are then eligible to enroll into a Medicare Advantage Prescription Drug Plan or a stand-alone prescription drug plan (usually coupled with a Medicare Supplement).

During your IEP, it is important to enroll or make a decision on your coverage to avoid penalties or delay in coverage. In the event you do not signup during this time frame, you may face late enrollment penalties if you do not have other credible coverage elsewhere (e.g., an employer based health plan).

Medicare Supplement Open Enrollment Period

While there are various Medicare Supplement plans available and every client’s budget and situation will be different, the enrollment time frame is the same. The Medicare Supplement enrollment period will start the month an individual turns 65 (assuming they have Medicare Part B in place) and continue for five months following. During this six-month window, your Medicare Supplement enrollment is considered guaranteed issue, which means that you do not have to complete a medical questionnaire to meet eligibility requirements. If you are not enrolled into a Medicare Supplement by the end of this six-month window, then there may be medical underwriting and questions to answer to determine eligibility.

General Enrollment Period

The General Enrollment Period only applies to people who meet both of the following two criteria: you did not signup when you were initially eligible and you are not eligible for for a Special Enrollment Period (which is discussed below). This enrollment period starts on January 1 and runs through March 31 every year. During this time, eligible individuals may enroll in Medicare Part A and Part B. The catch is that the plan year will not start until July 1 of that year. Along with a delayed start date, there may also be late enrollment penalties.

Annual Enrollment Period

The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year and is the time to make changes to your current coverage. Additionally, you can make these changes during AEP:

If you have only Medicare Part A and Part B, you can also pickup a Medicare Advantage plan or switch off a Medicare Advantage plan back to just Medicare Part A and Part B.
You can switch off a Medicare Advantage plan that has drug coverage to another Medicare Advantage plan that does not have drug coverage.
You can join or drop a Medicare prescription drug plan.
Beneficiaries can switch existing prescription drug coverage or Medicare Advantage plans to another plan of the same type.

Changes made during this time will take effect on January 1 of the following year. If no changes are needed or made, the insuring company will generally renew the plan automatically for January 1.

Medicare Advantage Open Enrollment

For those with a Medicare Advantage plan, from January 1 to March 31 every year, individuals can make a change to their current plan. This change can be to go to either another Medicare Advantage plan with or without prescription drug coverage or to Original Medicare. Any changes made will take effect the first of the following month in which they apply.

Special Enrollment Periods

Special enrollment periods come into play when an individual meets certain criteria or a particular event takes place. If you qualify for one of these special enrollment periods you can join, switch, or drop a Medicare Advantage or prescription plan. Below are some of the more common scenarios (see Medicare.gov for a full list)…

You move out of your plan’s service area.
You move back to the U.S. after living abroad.
You move into or out of a skilled nursing facility, psychiatric facility, rehab hospital or long-term care facility.
Your employment or your employer-provided plan ends.

Medicare can be confusing and we are here to be your translators. If you have questions about an existing plan or are looking to get started with Original Medicare, please give us a call today so our licensed agents can walk you through your options and let you know how the rules apply to you.

Resources

https://www.aetnamedicare.com/en/understanding-medicare/medicare-enrollment-periods-what-to-know.html

ARC’s Top Five Blog Posts of 2021

December 28, 2021/in ARC Updates, Employee Benefits, Individual/Family, Medicare/by ARC Benefit Solutions

2021 has wrapped up and we’re moving into 2022 with a goal of continually educating our clients so they can be empowered consumers. Here are some of our favorite blog posts from the past year that can help you this year…

Four Practical Ways to Make Your Healthy Habits Stick

We all know self care is important: exercising, eating healthy meals, meditation, etc. The internet is chock-full of information about why self care is important. However, the real head-scratcher is how to incorporate those self care habits into your daily life and make them stick. So what’s the recipe for making a habit stick? Here are our four tips…

Click here to read the post…

The Secrets to Designing an Effective Employee Benefits Program

Finding and retaining talented employees is a struggle for employers in today’s environment. A company’s employee benefits package is oftentimes a deciding factor for prospective employees looking for their perfect career and employer. Below are just a few of our most frequently asked questions along with considerations from our team…

Click here to read the post…

Getting the Most Out of Your Health Insurance

Health insurance, while necessary, can be expensive, so it is important to reap the benefits of your plan throughout the year. Aside from receiving financial help for your doctor and hospital visits, what other advantages to your health insurance plan should you think about?

Click here to read the post…

4 Healthy Ways to Manage Stress in Your Day-to-Day Life

Stress is a part of life and can’t always be avoided. It’s important to learn how to manage stress and find techniques that work for you to relax. Here are some techniques that you can use to build resilience and manage your stress in a healthy, adaptive way…

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How to Use a Health Savings Account and Why You Should Start One Today

Health Savings Accounts (HSA) have been around since 2003 to help individuals covered by high-deductible health plans (HDHP) save money for medical expenses. Though these accounts have been around for a long time, there are still many questions about them.

Click here to read the post…