Your Medicare Advantage plan maximum out of pocket limit has steadily increased from 2020 to 2023.  

During 2020, $6,700 is the Maximum Out-of-Pocket (MOOP) limit for HMO type Medicare Advantage plan (have defined networks members must use).  During 2023, this figure is $8,300.

The MOOP for PPO and HMO/POS plans is figure is $10,000 for 2020; the 2023 figure is $13,300.  These are key figures people interested/enrolled in a Medicare Advantage plan need to know.  Not all Medicare Advantage plans bump this key figure to the Medicare permitted maximum. 

Changes to your MOOP can affect your financial planning forecast. This is something people should consider discussing with their financial planners. We feel this change makes the Medigap Plan F-hi deductible and G Hi-deductible plan look even more attractive. The deductible amount for both of these plans is $2,700 in 2023.  This figure is often 50% lower than the HMO plans available in Idaho. One of the key advantages of a Medigap plan is any doctor/hospital in the US that ‘accepts Medicare insurance’ is available to you…no more network issues often associated with HMO and PPO plans. 

Call us if you have questions.

 

Be aware any PPO plan you may consider may not be accepted by all physicians and hospitals in the US. 

Check out chapter 4 of the EOC of any plan you are considering.  Look for the language which discusses a provider/hospital can deny offering services to an out-of-network PPO plan member.  

Also be aware Mayo Clinics stopped accepting individuals enrolled in Medicare Advantage plans unless their specific hospital/doctor is in-network for the person’s plan.   Read this announcement is here.  

You can drop your current Medicare Advantage plan between October 15 and December 7 AND between January 1 and March 31 annually.

During these time periods you can change Medicare Advantage plans OR return to Original Medicare and enroll in a Medigap Plan. There are steps you must follow to ensure you have continuous health care coverage. Please do not change plans without knowing the process. Call us if you want help.

 

Check to see how much your Part B monthly premium AND other deductibles/copays will change next year.

Medicare announces next years figures in late October to early November.  Check this out here. 

Next years Part B premium, deductible and other cost sharing information for Part A and B covered services are contained in this document.  If you are keeping a ‘retirement’ spreadsheet, update your Part B monthly premium, Part B deductible and IRMAA (if applicable).  Note the IRMAA applies to both the premium on Medicare Part B and Part D.

If you are enrolled in a Medicare Advantage plan, be sure and review your ‘Annual Notice of Change’, ‘Evidence of Coverage’ (EOC) and the estimated cost of your prescription medications between 10/15 and 12/7.  If you have a ‘surprise’ in your share of costs for next year, call us.  There may be other plans available with lower cost sharing. 

Be sure and review chapter 4 of next years version of your EOC.  This points out the specifics of the plan’s coverage for services and your responsibilities when using them.

Also review next years version of your plan’s ‘Provider Directory’.  This lists the doctors, hospitals, dentists, pharmacies plan members should use.  The EOC should point out your responsibility if you use providers which are not in your plan’s network. 

If you see surprises in any of these documents and want to compare next version of your current plan to your other choices, call us. 

Plans targeted for Military Veterans

Several insurance companies have added Medicare Advantage plans specifically for Veterans. The Vet should continue to get their prescription meds from the VA as these plans do not offer prescription drug coverage. If a Vet does need prescription drug coverage thru Medicare, they should be focusing on regular Medicare Advantage plans which include this service.

These plans can be quite attractive as an alternative or supplement for VA health care. These plans are available in select Idaho Counties and do require the veteran to be enrolled in Medicare Part A and Part B.

One of the key features in these plans is the ‘Part B buyback’.  This monthly ‘buyback’ ranges from $0 to $100 (in 2023).  This ‘rebate’ shows up as a reduction on the Part B monthly premium.  The insurance companies offering Medicare Advantage plans without prescription drug coverage are using this attention getting benefit as a key competitive differentiator.

Why would a veteran want one of these plans?

Most all of the insurance companies offering Idaho Medicare Advantage plans have a plan specifically carved out for veterans. 

The ideal candidate for one of these plans would be a Veteran that gets some/all of their health care (and prescription medications) through the VA. 

Vets select one of these plans because several have a $0 monthly premium and include ‘extra no cost services’. This could include dental, vision, hearing aides, gym memberships, offer ‘credits’ you can use to get items typically found in drug stores (non-prescription products), etc. Getting a ‘rebate’ on some of your Monthly Part B premium may also be available.

We feel all Idaho Veterans enrolled in Medicare should take advantage of this plan type.  You still have the option to get your health care from the VA.  

 

These plans vary in their no cost options as well as your share of the cost when you use billable plan services. We suggest you work with a broker licensed with all plans so you will understand plan differences and help you enroll in the plan you choose.

 

You can change Medicare Advantage plans between January 1 and March 31

Learn more about this enrollment period here.

Why would you consider changing plans during this timeframe?  Because this years plan(s) are more attractive to you than the plan you had on December 31 of last year.   

Parts of the Idaho Medicare Advantage market is very competitive (typically higher population Idaho Counties). Some insurance companies offering this type of plan want your business more than others. This shows up in the details of their plan offering. People enrolled in an Idaho Medicare Advantage plan may be able to improve their plan coverages, lower their out of pocket costs and keep the same doctors and hospitals by simply changing plans.  Not all insurance companies do this to each of their plan offerings. 

We suggest you have a ‘plan review’ with a broker that specializes in Medicare AND is licensed with most/all of the plans available in your County residence.  If you want to change plans, they will help you do so.  There is no cost to you for using their services. 

If you would like help thinking this through, call us.  We will explain the differences between your current plan and your other choices.  We will answer your questions and help you enroll in the plan you choose.

Once you are a customer, we will do annual plan audits with you.  This means we keep you up to date with the market place changes. If you feel you will be better off by changing plans, we will help you with this too.   

 

This page was last modified on Jun 13, 2023 @ 10:26 PM

Your Medicare Advantage plan maximum out of pocket limit has steadily increased from 2020 to 2023.  

During 2020, $6,700 is the Maximum Out-of-Pocket (MOOP) limit for HMO type Medicare Advantage plan (have defined networks members must use).  During 2023, this figure is $8,300.

The MOOP for PPO and HMO/POS plans is figure is $10,000 for 2020; the 2023 figure is $13,300.  These are key figures people interested/enrolled in a Medicare Advantage plan need to know.  Not all Medicare Advantage plans bump this key figure to the Medicare permitted maximum. 

Changes to your MOOP can affect your financial planning forecast. This is something people should consider discussing with their financial planners. We feel this change makes the Medigap Plan F-hi deductible and G Hi-deductible plan look even more attractive. The deductible amount for both of these plans is $2,700 in 2023.  This figure is often 50% lower than the HMO plans available in Idaho. One of the key advantages of a Medigap plan is any doctor/hospital in the US that ‘accepts Medicare insurance’ is available to you…no more network issues often associated with HMO and PPO plans. 

Call us if you have questions.

 

Be aware any PPO plan you may consider may not be accepted by all physicians and hospitals in the US. 

Check out chapter 4 of the EOC of any plan you are considering.  Look for the language which discusses a provider/hospital can deny offering services to an out-of-network PPO plan member.  

Also be aware Mayo Clinics stopped accepting individuals enrolled in Medicare Advantage plans unless their specific hospital/doctor is in-network for the person’s plan.   Read this announcement is here.  

You can drop your current Medicare Advantage plan between October 15 and December 7 AND between January 1 and March 31 annually.

During these time periods you can change Medicare Advantage plans OR return to Original Medicare and enroll in a Medigap Plan. There are steps you must follow to ensure you have continuous health care coverage. Please do not change plans without knowing the process. Call us if you want help.

 

Check to see how much your Part B monthly premium AND other deductibles/copays will change next year.

Medicare announces next years figures in late October to early November.  Check this out here. 

Next years Part B premium, deductible and other cost sharing information for Part A and B covered services are contained in this document.  If you are keeping a ‘retirement’ spreadsheet, update your Part B monthly premium, Part B deductible and IRMAA (if applicable).  Note the IRMAA applies to both the premium on Medicare Part B and Part D.

If you are enrolled in a Medicare Advantage plan, be sure and review your ‘Annual Notice of Change’, ‘Evidence of Coverage’ (EOC) and the estimated cost of your prescription medications between 10/15 and 12/7.  If you have a ‘surprise’ in your share of costs for next year, call us.  There may be other plans available with lower cost sharing. 

Be sure and review chapter 4 of next years version of your EOC.  This points out the specifics of the plan’s coverage for services and your responsibilities when using them.

Also review next years version of your plan’s ‘Provider Directory’.  This lists the doctors, hospitals, dentists, pharmacies plan members should use.  The EOC should point out your responsibility if you use providers which are not in your plan’s network. 

If you see surprises in any of these documents and want to compare next version of your current plan to your other choices, call us. 

Plans targeted for Military Veterans

Several insurance companies have added Medicare Advantage plans specifically for Veterans. The Vet should continue to get their prescription meds from the VA as these plans do not offer prescription drug coverage. If a Vet does need prescription drug coverage thru Medicare, they should be focusing on regular Medicare Advantage plans which include this service.

These plans can be quite attractive as an alternative or supplement for VA health care. These plans are available in select Idaho Counties and do require the veteran to be enrolled in Medicare Part A and Part B.

One of the key features in these plans is the ‘Part B buyback’.  This monthly ‘buyback’ ranges from $0 to $100 (in 2023).  This ‘rebate’ shows up as a reduction on the Part B monthly premium.  The insurance companies offering Medicare Advantage plans without prescription drug coverage are using this attention getting benefit as a key competitive differentiator.

Why would a veteran want one of these plans?

Most all of the insurance companies offering Idaho Medicare Advantage plans have a plan specifically carved out for veterans. 

The ideal candidate for one of these plans would be a Veteran that gets some/all of their health care (and prescription medications) through the VA. 

Vets select one of these plans because several have a $0 monthly premium and include ‘extra no cost services’. This could include dental, vision, hearing aides, gym memberships, offer ‘credits’ you can use to get items typically found in drug stores (non-prescription products), etc. Getting a ‘rebate’ on some of your Monthly Part B premium may also be available.

We feel all Idaho Veterans enrolled in Medicare should take advantage of this plan type.  You still have the option to get your health care from the VA.  

 

These plans vary in their no cost options as well as your share of the cost when you use billable plan services. We suggest you work with a broker licensed with all plans so you will understand plan differences and help you enroll in the plan you choose.

 

You can change Medicare Advantage plans between January 1 and March 31

Learn more about this enrollment period here.

Why would you consider changing plans during this timeframe?  Because this years plan(s) are more attractive to you than the plan you had on December 31 of last year.   

Parts of the Idaho Medicare Advantage market is very competitive (typically higher population Idaho Counties). Some insurance companies offering this type of plan want your business more than others. This shows up in the details of their plan offering. People enrolled in an Idaho Medicare Advantage plan may be able to improve their plan coverages, lower their out of pocket costs and keep the same doctors and hospitals by simply changing plans.  Not all insurance companies do this to each of their plan offerings. 

We suggest you have a ‘plan review’ with a broker that specializes in Medicare AND is licensed with most/all of the plans available in your County residence.  If you want to change plans, they will help you do so.  There is no cost to you for using their services. 

If you would like help thinking this through, call us.  We will explain the differences between your current plan and your other choices.  We will answer your questions and help you enroll in the plan you choose.

Once you are a customer, we will do annual plan audits with you.  This means we keep you up to date with the market place changes. If you feel you will be better off by changing plans, we will help you with this too.   

 

This page was last modified on Jun 13, 2023 @ 10:26 PM

We see annual improvements in Medicare. 

An easy to keep up with these is to check out the frequent news releases on the Centers for Medicare and Medicaid (CMS) website (here), by reading the annual publication titled ‘Medicare and you’ (available here), reading the ‘annual notice of change’ which is published by the insurance company offering Medicare Advantage plan(s), AND by reading information published by the insurance company of your plan.   

Below are a few key items that caught our attention.  These include: 

Your Medicare Advantage plan maximum out of pocket limit has steadily increased from 2020 to 2023.  

During 2020, $6,700 is the Maximum Out-of-Pocket (MOOP) limit for HMO type Medicare Advantage plan (have defined networks members must use).  During 2023, this figure is $8,300.

The MOOP for PPO and HMO/POS plans is figure is $10,000 for 2020; the 2023 figure is $13,300.  These are key figures people interested/enrolled in a Medicare Advantage plan need to know.  Not all Medicare Advantage plans bump this key figure to the Medicare permitted maximum. 

Changes to your MOOP can affect your financial planning forecast. This is something people should consider discussing with their financial planners. We feel this change makes the Medigap Plan F-hi deductible and G Hi-deductible plan look even more attractive. The deductible amount for both of these plans is $2,700 in 2023.  This figure is often 50% lower than the HMO plans available in Idaho. One of the key advantages of a Medigap plan is any doctor/hospital in the US that ‘accepts Medicare insurance’ is available to you…no more network issues often associated with HMO and PPO plans. 

Call us if you have questions.

 

Be aware any PPO plan you may consider may not be accepted by all physicians and hospitals in the US. 

Check out chapter 4 of the EOC of any plan you are considering.  Look for the language which discusses a provider/hospital can deny offering services to an out-of-network PPO plan member.  

Also be aware Mayo Clinics stopped accepting individuals enrolled in Medicare Advantage plans unless their specific hospital/doctor is in-network for the person’s plan.   Read this announcement is here.  

You can drop your current Medicare Advantage plan between October 15 and December 7 AND between January 1 and March 31 annually.

During these time periods you can change Medicare Advantage plans OR return to Original Medicare and enroll in a Medigap Plan. There are steps you must follow to ensure you have continuous health care coverage. Please do not change plans without knowing the process. Call us if you want help.

 

Check to see how much your Part B monthly premium AND other deductibles/copays will change next year.

Medicare announces next years figures in late October to early November.  Check this out here. 

Next years Part B premium, deductible and other cost sharing information for Part A and B covered services are contained in this document.  If you are keeping a ‘retirement’ spreadsheet, update your Part B monthly premium, Part B deductible and IRMAA (if applicable).  Note the IRMAA applies to both the premium on Medicare Part B and Part D.

If you are enrolled in a Medicare Advantage plan, be sure and review your ‘Annual Notice of Change’, ‘Evidence of Coverage’ (EOC) and the estimated cost of your prescription medications between 10/15 and 12/7.  If you have a ‘surprise’ in your share of costs for next year, call us.  There may be other plans available with lower cost sharing. 

Be sure and review chapter 4 of next years version of your EOC.  This points out the specifics of the plan’s coverage for services and your responsibilities when using them.

Also review next years version of your plan’s ‘Provider Directory’.  This lists the doctors, hospitals, dentists, pharmacies plan members should use.  The EOC should point out your responsibility if you use providers which are not in your plan’s network. 

If you see surprises in any of these documents and want to compare next version of your current plan to your other choices, call us. 

Plans targeted for Military Veterans

Several insurance companies have added Medicare Advantage plans specifically for Veterans. The Vet should continue to get their prescription meds from the VA as these plans do not offer prescription drug coverage. If a Vet does need prescription drug coverage thru Medicare, they should be focusing on regular Medicare Advantage plans which include this service.

These plans can be quite attractive as an alternative or supplement for VA health care. These plans are available in select Idaho Counties and do require the veteran to be enrolled in Medicare Part A and Part B.

One of the key features in these plans is the ‘Part B buyback’.  This monthly ‘buyback’ ranges from $0 to $100 (in 2023).  This ‘rebate’ shows up as a reduction on the Part B monthly premium.  The insurance companies offering Medicare Advantage plans without prescription drug coverage are using this attention getting benefit as a key competitive differentiator.

Why would a veteran want one of these plans?

Most all of the insurance companies offering Idaho Medicare Advantage plans have a plan specifically carved out for veterans. 

The ideal candidate for one of these plans would be a Veteran that gets some/all of their health care (and prescription medications) through the VA. 

Vets select one of these plans because several have a $0 monthly premium and include ‘extra no cost services’. This could include dental, vision, hearing aides, gym memberships, offer ‘credits’ you can use to get items typically found in drug stores (non-prescription products), etc. Getting a ‘rebate’ on some of your Monthly Part B premium may also be available.

We feel all Idaho Veterans enrolled in Medicare should take advantage of this plan type.  You still have the option to get your health care from the VA.  

 

These plans vary in their no cost options as well as your share of the cost when you use billable plan services. We suggest you work with a broker licensed with all plans so you will understand plan differences and help you enroll in the plan you choose.

 

You can change Medicare Advantage plans between January 1 and March 31

Learn more about this enrollment period here.

Why would you consider changing plans during this timeframe?  Because this years plan(s) are more attractive to you than the plan you had on December 31 of last year.   

Parts of the Idaho Medicare Advantage market is very competitive (typically higher population Idaho Counties). Some insurance companies offering this type of plan want your business more than others. This shows up in the details of their plan offering. People enrolled in an Idaho Medicare Advantage plan may be able to improve their plan coverages, lower their out of pocket costs and keep the same doctors and hospitals by simply changing plans.  Not all insurance companies do this to each of their plan offerings. 

We suggest you have a ‘plan review’ with a broker that specializes in Medicare AND is licensed with most/all of the plans available in your County residence.  If you want to change plans, they will help you do so.  There is no cost to you for using their services. 

If you would like help thinking this through, call us.  We will explain the differences between your current plan and your other choices.  We will answer your questions and help you enroll in the plan you choose.

Once you are a customer, we will do annual plan audits with you.  This means we keep you up to date with the market place changes. If you feel you will be better off by changing plans, we will help you with this too.   

 

This page was last modified on Jun 13, 2023 @ 10:26 PM

 

We help you find the Idaho Medicare insurance plan that meets your needs and budget.

If you prefer a broker that specializes in Medicare, has been helping people like yourself for over 10 years, are licensed with most of the Medicare Advantage (Part C), Prescription Drug, and all of the Medicare Supplement (Medigap) plans, you came to the right place. 

We help new Idaho residents no matter which of Idaho’s 44 Counties to move to.  

If you are new to Medicare or already have a Medicare Advantage or a prescription plan and are planning to move to or recently arrived in Idaho, you have some Medicare imposed timelines to select your Idaho equivalents. 

If you are already enrolled in a Medigap plan, be aware Idaho uses ‘Community Rating’ AND has a birthday window.  This means you can change insurance companies and get the same plan (or a less comprehensive plan) WITHOUT GOING THROUGH UNDERWRITING.  You would do this to get the same plan at a lower premium (if an Idaho licensed company offers such).  There are some other rules you need to be aware of and we can help you understand this law.  

Learn more about Idaho Medicare Supplement plans here. 

Do you want access to the top hospitals and physicians in the US?

If you want the flexibility to budget with confidence for your healthcare costs and have any doctor/hospital in the USA available to you (including such top-rated facilities as the Mayo Clinic), a Medigap plan is a good choice.  

Learn more about the top 50 hospitals and which type of surgery they excel at by clicking here. 

 

If you are moving to Idaho and have a Medicare Advantage plan

A County by County review of Idaho Medicare Advantage plans is available here.

Call us with your questions. We will help you understand plan differences and enroll in the plan you choose.

 

An overview of the recent changes in the Idaho Medicare Advantage market.

Insurance companies offering Idaho Medicare Advantage plans have been going after each others market share since day one. This activity picked up in 2018. This is when Idaho’s population growth took off.  This means more plans are available with lower monthly premiums, copays, and a ‘maximum out of pocket limit’. Some plans have ‘extra’ benefits that Medicare does not cover. The depth and value of these ‘extras’ can vary between plans.

In our opinion, the Idaho plans are not comparable to the plans available in the largest population Counties in the US….like Los Angeles County. What does this mean? If you are moving from a large population County (like Los Angeles County), you may be paying far less for your plan covered services than you fill find in Idaho Medicare Advantage plans.  Call us if you have questions about this. 

Be aware some lower population Idaho Counties have no or few Medicare Advantage plans. 

Idaho’s largest population Counties have multiple plans available (over 35) with larger provider networks.  These Counties include Ada, Canyon, Twin Falls, Bonneville, Bannock, and Kootenai.

 

Enroll in a Hi-deductible Medigap plan if you move to an Idaho County with few or no Medicare Advantage plans.

Medigap plans F and G hi-deductible have a feature like the ‘maximum out of pocket limit’ found in Medicare Advantage plans. The hi-deductible Medigap plans start paying 100% of the leftover Part A and B costs after the plan’s ‘deductible’ has been paid. The ‘deductible’ is a Medicare controlled figure and can change annually. This year the figure is $2,800, which is about 50% lower than any Medicare Advantage plan’s ‘maximum out of pocket limit’.

If you share of your health care costs are more than this plan’s deductible, you may be a candidate to consider these plans.

Remember, all physicians/hospitals in the US which ‘accept Medicare’ insurance are available to you when you have an Idaho Medigap plan.

We can help you think this through.

 

If you had a Medicare Advantage plan when you moved to Idaho, you are entitled to enroll in a Medigap plan without going through underwriting.

If you want access to the top doctors/hospitals in the US which ‘accept Medicare’, switching to a Medigap plan  may be a good option.  The most comprehensive Medigap plans are Plan F, G and N. They pay all/most of your leftover costs that Medicare does not completely cover. Learn more about Idaho Medigap plans and carrier differences here.

Read pages 6 – 24 of the document found here if you need a refresh on Medigap plans. The chart on page 11 helps you understand the differences between the different Medigap plans. Pages 21-24 review the conditions when a ‘guaranteed issue’ applies.  

 

Idaho also implemented the birthday rule for people already enrolled in a Medigap plan.

This change in Idaho law is a blessing to Idaho residents already enrolled in a Medigap plan. You can change Medigap insurance companies and get the same plan without going through underwriting. You would do this to lower your monthly premium.

 

Were you already enrolled in a Medigap plan when you moved to Idaho?

There is a good chance you can get the same plan you presently have with a meaningfully lower monthly premium. For example, if you are paying more than $270 for a Plan F, $230 for a Plan G, or $165 for a Plan N you are paying too much. These products cover the same leftover costs which Medicare Part A and B do not cover.

Call us as we are licensed with all plans and can guide you through the process of switching plans.

 

Our help with your Idaho Medicare insurance includes your Prescription Drug Plan.

Idaho has 20 prescription drug plans available to people staying with Original Medicare.

After you move to Idaho, you have 63-days to enroll in a prescription drug that is available to Idaho residents. We can help you with understanding your options. Call us if you want help with this task.

If you are entitled to Medicaid.

Before you move to Idaho, please contact the Idaho Department of Health and Welfare to learn about your options. The information found here will be helpful.

If you want help with Idaho Medicare insurance, call us. 

We are here to help.

 

This page was last modified on May 24, 2025 @ 12:28 PM

Medigap plans are available for pre-65 Idaho beneficiaries enrolled in Medicare Part A and B!

The Medigap open enrollment period and guaranteed issue rules apply to those interested.  These can be found on pages  14-16 and 21-24 of the document found here.   We recommend people read pages 7-24 of this document to learn more about Medigap plans. Read the rest of the document when you have time.

Idaho code for insurers offering Medigap plans in the state can be found here.  Reference docket 18-01-54 for the details.

Exclusive Monthly premiums for pre-65 Medicare beneficiaries wanting Idaho Medigap plans

 Current monthly premiums for all insurance companies offering Medigap plans in Idaho are available here.  There is a different monthly premium chart for people under age 65. This is the chart for you to review. Notice monthly premiums are 50% higher when compared to the same plan for people age 65. Why? Because statistically speaking people eligible for Medicare under age 65 have higher health care costs. The Idaho Legislature permitted insurance companies offering Medigap plans to have higher monthly premiums than people age 65.

When you turn 65 get lower rates

During the 3-month period before you turn 65, you should consider re-enrolling in a Medigap plan of your choice and start getting the ‘age 65’ rates.  We encourage you to look at other companies offering these plans in lieu of your current insurance company.  Why?  The Idaho market place changes each year. More companies enter our market and existing one’s leave. You should be able to get lower age 65 monthly premiums than the company you are presently with.  We can help you navigate your way through this process.

Medigap plans for pre-65 Medicare Beneficiaries

Bring up the pre-65 rate chart for Idaho Medicare beneficiaries mentioned above. Study the chart for a few moments. Notice the premiums for the same plan (Plan G for example) vary between 200 and 300% between companies. Why such a wide variance? Because the companies that have been offering their plans in Idaho longer have felt the compounding affect of annual rate increases. Companies new to the Idaho market have had fewer, if any, increases. Further information on this subject can be found here. Be sure and read this.

How we can help you

We specialize in helping Idaho residents understand Medigap plans and differences between the companies offering them. We actually recommend fewer than 30% of the companies offering these products.

Why? Because they did not pass the 8 criteria we use to screen these companies. Remember, after the 6-month time period from your Part B effective date, you have to answer the health history questions on all companies applications. Your application can be denied depending on your answers. We feel it makes sense to do business with an experienced, high quality company.

We are here to help you understand Medigap plans, company differences, and answer your questions. Enrollment is the next step and we help with that too.

Call us when you are ready. We are here to help.

This page was last modified on Aug 23, 2021 @ 5:46 AM

Parents and Siblings on Medicare … a guide to help you

The information below should help guide you if you are now responsible for parents and siblings on Medicare.

We have helped family members that have taken the responsibility for the health and prescription drug coverage for parents and siblings on Medicare for several years.  We are here to help you.  Learn more about us here.

If your family member moved to Idaho from out of state they may have a time frame to get enrolled in plan(s) available to Idaho residents.  If your family moved from one Idaho County to another, you may have the same issue (depending on what plan your family member presently has).  After you know what plan(s) your family member has and have located their Medicare card, call us.  We will help you define the action plan and lay out the steps you should follow.

Parents and siblings on Medicare … a general road map

Can I Cancel My Medicare Plan after the Annual Election Period?

Cancel My Medicare Plan … what you need to know if you have a Medigap Plan

Cancel my Medicare plan is something we occasionally hear from people.  Why do they want to change?  More often than not, we have found they were surprised to learn how their plan actually worked when compared to their other choices.

Other issues that can come up include:  all of the persons medications are not covered by the plan; their preferred doctors/hospitals are not in the plan’s network; they were not aware of other Medicare Advantage plans available to them with lower premiums and/or copays for covered services AND they were not aware of Medigap plans.

If the initial choice was a Medigap plan you have a 30-day review period after you receive your policy to get this done.  Call us for guidance.

If you have had your Medigap (Medicare Supplement plan) for more than 30-days, it is an easy process to change plans.  If you simply want to return to Original Medicare, just notify your insurance company of your wishes and they will cancel your plan.  If you want to enroll in a different Medigap or Medicare Advantage plan call us.  We can guide you through the process.  Do not cancel your existing Medigap plan before you know what you want to do and are aware of the enrollment period rules for the plan you wish to join.

Cancel My Medicare Plan … Be aware of Medicare’s New Open Enrollment Period (OEP); this is exclusively for people with a Medicare Advantage plan.    

 

Medicare and You

Answers to the ‘When to enroll in Medicare Part A and Part B’ question are available by downloading the document found here.   This document is published by the US Government and is updated annually. 

Please take the time to read this book.   

If you do this now, you will separate yourself from your peers by having a solid understanding of Medicare. 

Call us if you have questions about this document.  We have been helping Idaho residents for over 10 years solidify their understanding of this important information.

Notice Medigap (page 75), Medicare Advantage (page 61) and prescription drug plans (page 79) have rules you need to be aware of/understand. 

What happens if I miss my enrollment period?

You may be liable for a lifetime of late enrollment penalties when you decide to enroll.

Learn about late enrollment penalties for Part A, Part B, and Part D here.

We suggest you start to learn about enrollment periods and Medicare at least 6 months before you plan to enroll in Medicare.  Why?  Because the rules for Medicare are different from your pre-Medicare insurance and if you miss key enrollment dates you may have to wait for your next Medicare specified enrollment period.  This could mean you are without health and prescription drug coverage.

If you miss your initial enrollment period

You can still apply for Medicare Part A and/or Part B during the Medicare General Enrollment Period (between January 1–March 31) if both of these conditions apply:

• You didn’t sign up when you were first eligible.
• You aren’t eligible for a Special Enrollment Period.

Your coverage will start July 1.  

If you didn’t sign up for Part A and/or B and recognize your error in March, you can be insured in July if you complete enrollment by March 31.  If you figure it out in April (or later), you can’t enroll until the following January and coverage wouldn’t begin until July of the following year.

That could mean a coverage gap of well over a year, depending on when you discover the problem.

 

How to enroll in Medicare Part A and B

Use the resource found here.

Social Security Administration is responsible for enrolling people in Medicare (and providing the means to get a replacement card). 

Depending on the time of year and the volume of people applying for Medicare it may take a few days to a few weeks for them to complete the enrollment process and get you your Medicare card.   

The key piece of information you need on your Medicare card is your Medicare Beneficiary Identifier (MBI).  This is a 11 character string of alpha/numeric characters which identifies you in the Medicare system. 

When Medicare has finished processing your application, you will receive an ‘Entitlement Letter’ with your Medicare information.   This letter may arrive before your Medicare card does. 

If you need your MBI before either your card or entitlement letter arrives, you can access/print a copy of your entitlement letter by signing on to your account at socsec.gov and looking for the hotlink ‘Entitlement Letter‘.  Click on this to view your letter as it will have your MBI and start dates for Part A and B (if you are enrolled in Part B). 

 

What are my options for paying the Part A (if necessary) and Part B premiums?

You have options which range from having the premium come out of your Social Security check (if you are drawing Social Security) to pay by check or money order.  Learn more here.

 

 If I just stay with Original Medicare (Part A and B) what should I be aware of.