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Medicare is a health benefit you’ve worked hard to earn. It is vital that you make the right decisions at the appropriate times in order to choose a coverage plan that provides the maximum benefit to you.
That’s where we come in. Our years of experience serving mid-Atlantic communities lead us to develop PATH, Medicare Portal’s exclusive process that works to PREPARE, ASSIST, TEACH and HELP you navigate your Medicare journey. Clients trust PATH to help increase their Medicare knowledge and remove stress.
Let’s get started on your PATH to Medicare success!
Whether turning 65 or working past 65, we prepare you for your transition to Medicare. Preparation and education starts early by teaching you the fundamentals of Medicare, as well as identifying benefit options based on personal medical needs, provider access and costs.
What is Medicare?
Medicare is a federally funded program coordinated through the Center for Medicare Services (CMS) and Social Security that offers healthcare coverage to American citizens and legal residents over the age of 65 or with certain qualifying disabilities.
This program is often referred to as Original Medicare, with two main components:
- Part A: Inpatient & Hospital Coverage
- Part B: Outpatient & Medical Coverage
Once eligible to receive Medicare coverage, beneficiaries can choose how to obtain their coverage:
- Through Original Medicare (Parts A & B) provided by the federal government
- Through a Medicare Advantage plan (Part C), which is an alternative to Original Medicare and provided by private insurance companies contracted through Medicare
At age 65, you become eligible for Original Medicare if:
• You’re a U.S. citizen OR a legal permanent resident living in the U.S. for the past five years
You can also qualify for Medicare if:
• You’re younger than 65 with a qualifying disability
• You’re any age with a diagnosis of end-stage renal disease or ALS
Note: If you qualify for Original Medicare, once enrolled you’re also eligible for additional Medicare coverage options.
The answer can vary. Several factors that will determine your actual Medicare costs, such as where you live, your income, the specific plan you select, and the out-of-pocket expenses relating to your plan.
Understanding your coverage costs is an important step in your Medicare education and plan selection process. It’s crucial to choose the plan that fits your budget. At a basic level, the costs associated with Medicare plans include: premiums, deductibles and coinsurance/ copayments.
If you don’t sign up for Parts A, B and D during the appropriate enrollment period when you’re first eligible, you assume the risk of incurring a separate late enrollment penalty (LEP) for each of these Medicare parts. These LEPs can be added to your monthly premium and can be costly.
What many beneficiaries also don’t realize is that LEPs can last for as long as you keep your Medicare coverage, which, for most, is your lifetime! It’s important to make sure you understand your enrollment periods and how to comply.
Knowing when to enroll in Medicare is equally as important as choosing your Medicare benefits. Specific enrollment periods were created to accommodate various life events and changes. First, let’s identify the different enrollment period scenarios to determine which best applies to you and your situation.
Here are five key categories that guide when you enroll:
- You’re turning 65
- You’re working past 65
- You have a qualifying life event or change
- You missed your Initial Enrollment Period
- You need a plan and prescription review
Enrollment is not automatic for everyone, and it’s important to know which enrollment period best applies to your situation. If you miss your deadline to enroll, you risk incurring late enrollment fees, which is why it’s crucial to enroll on time.
We’ll assist you through every step of the Medicare enrollment process, including Medicare Parts A, B, C, D and Medigap, and ensure that you’re complying with applicable enrollment periods to avoid coverage lapses and late enrollment penalties.
Now that you’ve determined your appropriate enrollment period, it’s important to understand how to enroll in to Original Medicare (Parts A and B). Enrollment is not automatic for everyone.
Once enrolled in Original Medicare Parts A and B, you qualify for supplemental forms of coverage, as well as prescription drug benefits.
The first step is to learn about the different Medicare plans and what they cover, and then what your options are depending on your specific situation, your medical needs and your financial budget. Gaining a better understanding of the pros and cons of each plan will help you make a more informed decision regarding your healthcare coverage.
We’ll teach you how to utilize your benefits, and what your rights and responsibilities are as a Medicare beneficiary. We’ll also teach you how to avoid Medicare scams and provide important information necessary to get the most out of your new benefits.
Once you’ve enrolled, understanding how to use your Medicare is the next step for a smooth transition into your new healthcare coverage.
On this page, we cover:
- Understanding your Medicare card
- What to do if you lose your Medicare card
- Authorized representatives
- Your rights and responsibilities as a Medicare beneficiary
- How to avoid Medicare and SSA scams
- How to protect your Medicare information from identity theft and fraud
- Registering with Medicare.gov
- Medicare’s What’s Covered App for your mobile device
- Paying your Medicare premiums
Our service doesn’t end at enrollment. We offer free lifetime support to you, including claims assistance, annual plan reviews and help with relocation and life changes.
Determine if your life event and change opens a Special Enrollment Period (SEP) and allows you to enroll for coverage outside your Initial Enrollment Period.
Each year, it’s important to review your existing plan benefits along with upcoming coverage changes outlined in your Annual Notice of Changes (ANOC) to make sure you’ll still have the coverage you need at a price that you can afford.
Many beneficiaries don’t realize that CMS makes annual adjustments and changes to existing Medicare plans, which can include:
✓ Premiums, copayments and deductibles relating to Parts A, B, C, D and Medigap plans
✓ Network providers
✓ Service areas
✓ Formulary and tier changes for approved prescription drug lists
An annual plan review also gives you the opportunity to learn of alternative options for coverage to prepare for the Annual Enrollment Period (AEP).
Want to learn more about Medicare?
Join us online for any of our virtual, interactive educational webinars, where you can quickly learn the fundamentals of Medicare from the comfort of your own home.