Medicare Open Enrollment
Oct 15th – Dec 7th
Health Insurance Open Enrollment
Nov 1st – Dec 15th
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Individual & Family Insurance Both On and Off the Marketplace
Insurance has changed a lot since the Affordable Care Act was passed. Here are some things to be aware of:
- You cannot be denied coverage based on your medical conditions.
- The Open Enrollment period for health insurance is from November 1st through December 15th each year unless there is a Qualified Life Event. A “Qualified Life Event” can be losing employer coverage, losing individual coverage due to a move, divorce, etc.
- Each insurance company has a limited list of providers, hospitals and prescriptions.
- If you apply direct to the insurance company, you cannot obtain tax credits.
- If you apply through the state Marketplace, you can obtain tax credits in advance or you can receive them when you file your taxes for the following year.
- Emergency Care is covered “as if in network” regardless of the policy you enroll in.
We have been working with the state Marketplace since it was created. Beware! There are a lot of look-alike sites that are NOT the actual Colorado Marketplace. The official state website can be a challenge. We are happy to help you at no additional cost.
Yes, you can apply on your own, but why would you?
There are a lot of ins and outs of how the system works and we can help you through the process. There is never a cost for our services. You only pay for your insurance; you do not pay us in any way.
Tax Credits are the epicenter of Obamacare/The Affordable Care Act. They are based on your Modified Adjusted Gross Income. Estimate too high, and you will get the credits back when you file. Estimate too low, and you could owe the IRS a bundle when you file. None of us like surprises at tax time.
Needless to say, applying for insurance just isn’t the same as it used to be. Taxes, Income, Tax Credits, Networks and Formularies are all things to consider, and we can help!
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Quick Start your Medicare knowledge by scheduling your personalized Medicare 101 Zoom or phone call!
Medicare does not cover everything. Original Medicare (Parts A and B) were designed to provide basic medical coverage. If you rely on Medicare alone, there is no cost to how much you could owe due to a medical event.
There is a Part A (Hospital) Deductible that is owed each “benefit period.” There is a per-day fee for hospitalizations lasting more than 60 days. There is a Part B (Medical) Deductible that is owed each year plus 20% of all remaining costs incurred outside of the hospital.
These costs add up fast!
Medicare does not cover routine dental, vision or hearing. There are additional options available to you to assist with your cost of care.
How To Cover The Expenses Medicare Doesn’t
You can get additional coverage that meets your individual needs and helps protect your finances from the rising cost of medical care.
Know Your Options
When you become eligible for Medicare Parts A and B, you can choose added coverage from a private insurance company approved by Medicare.
Medicare Supplement plans cover most of the expenses not covered by Parts A and B but they do NOT include prescription coverage.
Medicare Supplement Plans
Medicare Supplement plans help cover medical expenses Original Medicare doesn’t. Also referred to as “Gap” or “Medi-Gap” plans. The plan names are oftentimes confused with parts of Original Medicare as they are named alphabetically as well. Example: Plan G, Plan K, etc. Medicare Supplement plans NEVER include prescription drug coverage, so you need to add that to your insurance folder to be covered appropriately.
- Parts A and B are administered by Medicare; your supplemental coverage is administered by your insurance company.
- Medicare Supplement plans never include prescription drug coverage.
- Covers most potential out-of-pocket expenses.
- Multiple plan options are available to fit a wide range of budgets and needs.
- Plan benefits are standardized by the government (ex: Every Plan G is identical in coverage).
Medicare Prescription Drug Plans
Prescription drug coverage helps pay for your medications prescribed by your doctor (also known as Part D).
Prescription Drug Coverage
A prescription drug plan will help lower your out-of-pocket costs for your prescriptions. If you don’t sign up for a Prescription Drug Plan when you are first eligible, you will have a Late Enrollment Penalty (LEP) assessed every month once you are able to add one.
- Medicare Supplement plans never include prescription drug coverage.
- Most Medicare Advantage plans include Part D coverage.
Medicare Advantage Plans
Medicare Advantage plans combine coverage for Part A and Part B with added benefits and oftentimes includes prescription drug coverage (also known as Part C).
Medicare Advantage Plans (Part C)
- These “bundled” plans combine coverage for Part A and Part B with added benefits (also known as Part C).
- Many Medicare Advantage Plans include prescription drug coverage (Part D) and are referred to as “MAPD.”
- These plans are oftentimes an “all in one” alternative to Original Medicare.
- They are offered by private companies approved by Medicare.
Medicare Advantage plans frequently offer additional coverage for things Original Medicare doesn’t cover, such as: Vision, Hearing, Dental, Fitness Programs, Over the Counter Items and even Meal Delivery after hospitalization.
Frequently Asked Questions About Medicare
If I have coverage through my employer, do I need to sign up for Medicare?
If your coverage through your employer is deemed “creditable coverage,” you can keep it. However, when you do elect to go onto Medicare you need to follow the appropriate steps to ensure you are not charged a late enrollment penalty. (Do NOT accept COBRA when you are eligible for Medicare.)
How do I avoid paying a Late Enrollment Penalty?
There can be late enrollment penalties on both Part B and Part D. However, if you enroll when you are first eligible, you will not be penalized.
Can I keep my doctor when I’m on Medicare?
With a Medicare Supplement plan, you can use any doctor who accepts Medicare nationwide. With a Medicare Advantage plan, you can use any doctor who participates in your plan’s network.
Will Medicare cover my prescription drugs?
Original Medicare (Parts A and B) does not cover prescription drugs. However, private insurance companies offer prescription drug plans (Part D) that help cover the cost of generic and brand name drugs.
Can any insurance company offer additional Medicare coverage?
No, an insurance company and its rates must be approved by the state in which it sells Medicare plans. And the plans it sells must be approved by the federal government.
When can I enroll in Medicare?
You are eligible to enroll in Medicare beginning three months before your 65th birthday or 24 months after being deemed “disabled” by Social Security.
Additional Insurance Options
Additional insurance options include: dental insurance, vision insurance, hearing insurance, accident insurance, travel insurance and final expense life insurance.
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Bob and Gail are the best! They always take the time to answer my insurance questions and talk me through the process. They genuinely want to help. I’m really thankful that I found them!
Bob is always ready to answer any questions and is very knowledgeable and helpful. I trust him implicitly!
Wonderful communication! Gail clearly laid out our options, was caring and kind, and full of information. Highly recommend!
Gail is terrific. She has a great understanding of insurance and can efficiently negotiate the multitude of processes and red tape. Recently, I changed my mind on a Medicare Supplemental insurance provider and Gail was able to cancel the one provider and sign me up for the new provider in a 1-hour phone call. Could not have done this by myself. Thanks, Gail.
As always, Gail makes buying insurance fun and informative. Her knowledge about the insurance market makes our whole family feel confident in our insurance choices.
Bob provided excellent information via telephone appointment. We felt well taken care of and our questions were answered professionally and accurately.