Medicare Open Enrollment Period for 2020 – October 15, 2019 through December 7, 2019
Medicare is a Federal Health Insurance Program. To be eligible for Medicare you must be a US Citizen or Legal Resident and one of the following.
- Age 65
- Been disabled for 24 months or more
- Have End Stage Renal Disease or ALS
Medicare has four parts: Part A, Part B, Part C and Part D
Part A and Part B are known as Original Medicare. This means Medicare is the primary provider for your health insurance payments. Part C (Medicare Advantage), Part D, and Medicare Supplements are insurance plans offered by independent insurance companies. These plans cover some of the costs associated with original Medicare.
- Deductible is $400.
- Initial Coverage Stage: You pay copays until your total drug cost reaches $3,700.
- Coverage Gap: You pay a coinsurance (51% of Generics and 40% of Brands) of the prescription until your reaches $4,950.
- Catastrophic Coverage: Generics are $3.30, Brands are $8.25, or 5% whichever is greater.
If not enrolled into a Part D Prescription Drug Plan or have other creditable drug coverage when first eligible, you may have a Late Enrollment Penalty.
- Medicare is the primary provider with a Medicare Supplement being secondary. You may purchase a Medicare Supplement to cover Medicare deductibles and coinsurance amounts.
- Medicare Supplements do not cover Part D Prescription Drugs, so a Part D Prescription Drug Plan may be necessary.
- When first eligible for Medicare Part B, you can purchase a Medicare Supplement without any Medical Questions asked. This is called Open Enrollment. If you lose other coverage, you may be able to enroll into a Medicare Supplement through Guarantee Issue.
- If you are outside the Open Enrollment/Guarantee Issue Period, the insurance company will require medical questions to be completed.
Late Enrollment Penalty
For every 12 months you go without Part B or other credible coverage (employer or union plan) you will be charged a 10% penalty. You may not be able to enroll into Part B until the Medicare Open Enrollment Period which runs January 1st – March 31st every year and will become effective July 1st
A penalty assessed if you do not go onto a Part D Drug Plan when you first become eligible. You will be charged 1% of the national average of a Part D plan for each month you do not have credible coverage.
HMO: Health Maintenance Organization
PPO: Preferred Provider Organization
PFFS: Private Fee For Service
MSA: Medical Savings Account
Initial Enrollment Period: 7 Months total, 3 months before, the month of, and 3 months after your Part B effective date Open Enrollment Period: October 15th – December 7th yearly
Medicare Advantage Disenrollment Period: January 1st – February 15th
Special Enrollment Periods: Happen throughout the year (loss of employer coverage, move out of the plans service area, receive assistance from the state, etc)
(True Out of Pocket Costs)
TROOP = Deductibles + Copays + Co-insurance + Drug Company payments
Open Enrollment for Medicare Supplements is the month Part B becomes effective and the 5 months that follow.
Guarantee Issue Period
- Initial Enrollment Period: 7 Months total, 3 months before, the month of, and 3 months after your Part B effective date
- Open Enrollment Period: October 15th – December 7th yearly
- Medicare Advantage Disenrollment Period: January 1st – February 15th
- Special Enrollment Periods: Happen throughout the year (loss of employer coverage, move out of the plans service area, receive assistance from the state, etc)