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Strategic Benefits One Group
With convenient locations in Philadelphia, King of Prussia, and the Lehigh Valley, we’ve helped employers, employees, and retirees find the perfect health insurance solutions to meet their needs. Medicare can be complicated. We would love to sit down with you and guide you through the options available to make these the best years of your life.
We are an independent brokerage so we offer customers a variety of plans from multiple insurers in order to compare features and prices.
Options to Enhance Medicare
Medicare Supplement (Medigap) Plans
Medigap is Medicare Supplement Insurance that helps fill “gaps” that Original Medicare does not cover and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance policy or Medigap policy can help pay the remaining health care costs, like:
Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here’s what happens:
- Medicare will pay its share of the Medicare-approved amount for covered health care costs.
- Then, your Medigap policy pays its share.
- You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
- A Medigap policy only covers one person, so if you have a spouse and you both want Medigap coverage, you’ll each have to have your own policy. Some insurance carriers offer household discounts if there are two members of a household enrolled with the same company.
- You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
- Medigap policies are guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
Are you struggling to understand Medicare? Contact us today at (610) 844-9759 for a no-cost, no-obligation consultation with one of our Medicare insurance experts.
Medicare Part C Advantage Plans
Part C plans are typically known as Medicare Advantage or MA plans. If the plan includes Part D coverage for prescription drugs, it is called a Medicare Advantage/Part D or MA-PD plan.
Medicare Advantage Plans are a Medicare-approved alternative for the delivery and receipt of Original Medicare, it is not a separate benefit. Think of it as “bundling” the coverages and benefits of Parts A and B—and often Part D as well—into an all-in-one plan in which an individual can enroll.
Part C plans are offered by private insurance companies that contract with the federal government to deliver Medicare services, through networks of hospitals, physicians, and health care providers that contract with the insurance company. The private insurance carriers must follow the rules set by Medicare.
In many cases, you’ll need to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans work like individual insurance or group insurance in that you will have a Maximum Out-of-Pocket amount for which you’ll have to pay towards each year for covered services. Some plans offer out-of-network coverage, but typically at a higher cost.
You will have to continue paying your Medicare Part B premium in addition to any premium you may have with your Part C plan. You must use the card from your Medicare Advantage Plan to get your Medicare-covered services because you will not be receiving your coverage through Medicare. However, you’ll want to keep your red, white, and blue Medicare ID card in a safe place because you’ll need it if you ever switch back to Original Medicare or change plans during one of Medicare’s enrollment periods.
Below are the most common types of Medicare Advantage Plans.
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Private Fee-for-Service (PFFS) Plans
- Special Needs Plans (SNPs)
Strategic Benefits One Group will work with you to find the best plan that is accepted by your providers, where you will have to pay the least amount out-of-pocket for both services and prescriptions, and help you to enroll you in it, even if it is a plan that we do not offer. We never charge anything for our services!
Medicare Part D (Prescription Drug Plan)
Medicare drug coverage helps pay for prescription drugs. Even if you don’t take prescription drugs now, you should consider enrolling in a Part D plan to avoid paying a late enrollment penalty later when you do decide to enroll in one. Medicare drug coverage is optional and is offered to everyone with Medicare.
If you decide not to purchase a Part D plan when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or the VA) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you are enrolled in a Medicare drug plan. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Plans vary by premiums and each insurance carrier classifies prescriptions differently, as well as specific drugs that are covered.
Medicare Part D can be a complicated topic. Never assume that just because a plan may work great for one person, that the same plan will work for you. You should NEVER enroll in a plan based solely on it’s premium. Also, a higher premium does NOT mean better coverage.
We have saved our clients thousands of dollars, just by reviewing prescription drug plans. You should evaluate your Part D plan on an annual basis because not only do insurance carriers change the Tier levels of the prescriptions, but they also change preferred pharmacies which can impact how much you pay for your prescriptions.
Let our experts help you to find a plan where you will have to pay the least amount out-of-pocket for your premium and prescriptions. They will even determine if you qualify for prescription assistance, either through your state or with Social Security, and will help you get connected with their services.
The best time to change prescription drug plans is during Medicare’s Annual Enrollment Period (October 15th thru December 7th). However, this is NOT the only time that you can change plans. Contact us today for a free evaluation at (610) 844-9759 to see if you are enrolled in the right plan and if not to determine if you qualify for a Special Enrollment Period to get you into a better plan to start saving money.
Dental, Vision, and Hearing Plans:
While Original Medicare will ALWAYS pay to have your eyes examined, Medigap plans do not include coverage for frames and lenses. These plans also do not include dental, and unless hearing aids are “medically necessary”, Medicare will not cover them, nor will your Medigap plan
At Strategic Benefits One Group, we offer several options for dental, vision, and hearing coverage. We have plans through the country’s largest dental insurance providers, as well as plans that combine dental benefits with vision and hearing.
You don’t have to be alone trying to navigate your way through Medicare’s maze. To get started, please contact us today at (610) 844-9759 for a no-obligation consultation with one of our licensed, Medicare insurance experts. Our services will cost you nothing!
Medicare can be very confusing, and your friends and family will each have something different to say about it. Much like you would never have your auto mechanic prepare and file your taxes, unless they’re a CPA as well, you don’t want to leave your insurance needs to someone who is not qualified. That is why you should consider using a certified, licensed insurance agent to help you with your Medicare decisions.
Medicare can be very confusing and if you enroll in the wrong plan, it could end up costing you thousands of dollars. Strategic Benefits One Group is here to help you and protect you. We’ve compiled answers to the most common Medicare insurance questions we are asked every day. Clean, simple. If you do not find your question here, please do not hesitate to contact us at (610) 844-9759.
When can I first enroll in Medicare and how do I sign up?
You first become eligible for Medicare three months prior to your 65th birthday. If you are collecting Social Security or Railroad Benefits and qualify for Medicare, you will automatically be enrolled and your card will be mailed to you. If you are not taking your Social Security benefits, you will need to enroll through Social Security. Let us help you to determine the best time that you should enroll in Medicare.
What will my Medicare effective date be?
If you enroll in Medicare the year you are turning 65, Part A will begin the first day of the month your birthday falls in. Two exceptions are; If your birthday is the first day of the month, the effective date is the first day of the prior month. If your birthday is the last day of the month, your effective date is the first day of the following month. Part B is a little trickier and that is why we are here to help you! By talking with one of our licensed, Medicare insurance agents, they can help you to enroll in Medicare Part B and find the best plan(s) that meet your needs.
What if I am not collecting Social Security, can I still receive Medicare benefits?
You may still enroll in Medicare if you are not collecting Social Security or Railroad Benefits. We will explain what you need to do until you decide to begin collecting your benefits.
What if I am covered by my group plan through work or my spouse’s group plan through work, do I have to enroll in Medicare?
If you or your spouse is actively working for a large group employer (20 or more employees) you can “opt” out of Medicare Part B until you are no longer covered by a group plan. Once you or your spouse retires, you will be eligible for a “Special Enrollment Period”. You will have up to eight months to sign up for Medicare B without incurring a Late Enrollment Period after group coverage ends. However, you will not be able to enroll in Cobra without having Medicare Part B, nor can you enroll in any other type of health insurance policy without being enrolled in Medicare Part B. Let us help you determine the best time to enroll in Part B to avoid a lapse in health insurance.
What does Medicare Part A and Part B cover?
Medicare Part A covers hospital costs, hospice, home healthcare, and skilled nursing facilities (day 1 through day 20). Medicare Part B covers doctor visits; services – such as tests, lab work, imaging, etc.; and durable medical equipment.
Can I get assistance with my prescription drug costs?
Pennsylvania has two programs called PACE and PACENET which are designed to help lower-income Medicare beneficiaries pay for their prescription medication. Social Security also offers “extra help” if you qualify. If you are not a PA state residence, you may check with your state’s Department of Aging to find out about prescription assistance programs.
Can I get help with my Medicare Part B premium?
Certain Medicare beneficiaries may be eligible for help with their Medicare B premiums. Social Security determines if you qualify for help based on the federal poverty guidelines.
What is the Initial Enrollment Period?
If you’re eligible for Medicare when you turn 65, you can sign up during your Initial Enrollment Period. This is a 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
What is the General Enrollment Period?
If you don’t sign up for Part A (if you have to buy it) and/or Part B when you’re first eligible, and you don’t qualify for a Special Enrollment Period, you may have to wait until the Medicare General Enrollment Period (from January 1st – March 31st) to enroll and your Medicare coverage will start July 1st of that year. In most cases, you’ll have to pay a late enrollment penalty for as long as you have Part B if you sign up during the General Enrollment Period.
What is a Special Enrollment Period?
Once your Initial Enrollment Period ends, you may have the opportunity to sign up for Medicare during a Special Enrollment Period (SEP). You can sign up for Part A and or Part B during an SEP if you have special circumstances.
What is the Medigap Open Enrollment Period?
This period automatically starts the month you turn 65 and lasts for 6 months. It can also begin the first time you enroll in Medicare Part B if you are coming off group insurance. For someone who is disabled, you could have two Open Enrollment Periods. The first one is when your Medicare Part B begins after receiving disability benefits for 24 months and the second is when you turn 65.
The Medigap Open Enrollment Period is the best time to buy a Medigap policy since you are protected for 6-months from having to answer health questions. You generally will get better prices and more choices among policies. During this time, you can buy any Medigap policy sold in your state, even if you have health problems. After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more due to past or present health problems.
What is the Medicare Advantage Open Enrollment Period?
The Medicare Advantage Open Enrollment Period is from January 1st to March 31st. During this time, if you’re in a Medicare Advantage Plan and want to change your health plan, you can do one of these:
- Switch to a different Medicare Advantage Plan with or without drug coverage
- Go back to Original Medicare and, if needed, also join a Medicare Prescription Drug Plan
If you switch Medicare Advantage Plans or go back to Original Medicare with or without a Medicare drug plan, your new coverage will start the first day of the month after your new insurance company gets your request for coverage. Keep in mind, if you go back to Original Medicare, you may not be able to buy a Medicare Supplement Insurance (Medigap) policy. We can help determine if you qualify for a Medicare Supplement Insurance (Medigap) policy.
I am under 65 and have a disability. Do I need to sign up for Medicare?
Social Security will automatically enroll you in both Part A and Part B after you get one of these:
- Disability benefits from Social Security for 24 months
- Certain disability benefits from the RRB for 24 months
What if I don’t want Medicare Part B?
Make sure you review the situation above that applies to you so that you understand how dropping Part B would affect you.