No todo el mundo es elegible para los beneficios de Medicare. Usted llega a ser elegible para inscribirse en Medicare solamente bajo circunstancias particulares:

Una vez que alcances los 65 años de edad
Después de dos años de la recepción de los pagos de la discapacidad de la Administración del Seguro Social
Después de un diagnóstico de la enfermedad de Lou Gehrig o después de un diagnóstico de Enfermedad Renal en Etapa Terminal (es decir, insuficiencia renal permanente, que requiere un trasplante o diálisis)

Lo ideal es que se inscriba en Medicare cuando se convierta elegible por primera vez, lo que se denomina Período de inscripción inicial. Si no se inscribe en Medicare en ese momento, puede inscribirse posteriormente durante otros períodos de inscripción específicos. Sin embargo, la inscripción tardía a veces significa que usted tendrá que pagar primas más altas por la cobertura de Medicare.

Muchas personas se inscriben automáticamente en la Parte A de Medicare o en la Parte B de Medicare o en ambas. Si cobra beneficios de jubilación de la Administración del Seguro Social o de la RRB, se inscribirá automáticamente en la Parte A y en la Parte B el primer día del mes en que cumpla 65 años. Si cobra beneficios de incapacidad de la Administración del Seguro Social o de la RRB, se inscribirá automáticamente en las Partes A y B el primer día del mes 25 en que reciba los beneficios. Un diagnóstico de la enfermedad de Lou Gehrig también lo calificará para la inscripción automática. Si se inscribe automáticamente en la Parte B bajo cualquiera de las circunstancias anteriores y no desea conservar la Parte B, debe notificar a Medicare inmediatamente para evitar una factura por las primas mensuales.

Una vez que su Período de inscripción inicial haya terminado, hay varios períodos de inscripción adicionales durante los cuales puede inscribirse en Medicare.

El Período de Inscripción General, que se extiende del 1 de enero al 31 de marzo de cada año. Durante el Período de Inscripción General, puede inscribirse en las Partes A y B de Medicare. Su cobertura comenzaría el 1 de julio de ese año.
Un período de inscripción especial suele ser un período de ocho meses que comienza cada vez que usted (o su cónyuge) pierde la cobertura de salud ofrecida a través de su empleador o union. También hay algunas otras circunstancias en las cuales usted puede ingresar un Período de Inscripción Especial, como un movimiento calificado u otra pérdida de cobertura. Durante el Período Especial de Inscripción puede inscribirse tanto en la Parte A como en la Parte B sin penalización.
Si desea inscribirse en la Parte C de Medicare (también conocida como Plan Medicare Advantage) o en la Parte D de Medicare, debe inscribirse durante su Período de inscripción inicial (que es cuando se convierte elegible para Medicare por primera vez), en determinadas circunstancias calificaría para un Período de Inscripción Especial, o durante los Períodos de Elección Anuales. También puede inscribirse en un Plan Medicare Advantage si tiene la Parte A de Medicare y se inscribe en la Parte B de Medicare durante el Período de Inscripción General de la Parte B discutido anteriormente.

El Período de Elección Anual es un fecha cada año durante el cual usted puede revisar sus beneficios de Medicare y hacer cambios a su cobertura de Medicare. Para los planes de Medicare Advantage y la cobertura de medicamentos prescritos de la Parte D de Medicare, el Período de Elección Anual se extiende del 15 de noviembre al 31 de diciembre. (El Período de Elección Anual de 2012 está programado para comenzar más temprano en el año para darle más tiempo para revisar su plan y los cambios en los beneficios de Medicare y cobertura de Medicare del año). Durante el Período de Elección Anual, usted puede:

Cambiar a un plan Medicare Advantage desde Medicare Original
Cambiar de nuevo a Medicare Original de un plan de Medicare Advantage
Cambiar los planes de Medicare Advantage, incluyendo de un plan sin cobertura de medicamentos a un plan con cobertura de medicamentos o viceversa
Haga cambios en su cobertura de medicamentos prescritos, tales como: afiliarse a un plan de cobertura de medicamentos, dejar su plan de cobertura de medicamentos actual o cambiar de un plan a otro

Es aconsejable aprovechar al máximo el Período Anual de Elección de cada año. Los Planes de Medicare Advantage cambian anualmente y la diferencia en primas, deducibles, coseguro y copagos año a año puede significar que usted tiene que hacer cambios significativos en sus finanzas. Además, los diferentes proveedores del plan añaden o dejan médicos y hospitales a sus redes o desde sus redes todo el tiempo. Los servicios cubiertos también cambiarán a menudo. Debe revisar su plan cada año para asegurarse de que tanto su médico como los servicios médicos que usa más continúan cubiertos bajo su plan.

Otra razón para pasar el tiempo revisando los diferentes planes de Medicare durante el Período de Elección Anual de este año es la nueva ley de atención médica. El proyecto de ley de reforma de salud de este año incluye muchos cambios en los beneficios de Medicare y la cobertura de Medicare durante los próximos años. Algunos de estos cambios afectarán directamente a sus planes de Medicare Advantage y pueden cambiar los costos asociados o el tipo de servicios ofrecidos por su plan. ¿Cuál fue el plan perfecto para usted en los últimos dos años que ya no puede competir con un plan nuevo y más barato que ofrece más de los servicios que usted necesita médicamente. Algunos planes de Medicare Advantage ofrecen servicios preventivos gratuitos, mientras que otros no. Además, algunos planes ofrecen deducibles anuales más bajos o copagos de medicamentos menos costosos que otros planes. Es importante comparar las diferentes opciones de cobertura de Medicare disponibles durante el Período de Elección Anual de Medicare para que pueda asegurarse de tener el mejor plan para satisfacer sus necesidades médicas y su presupuesto.

Para obtener más información sobre los beneficios de Medicare, los suplementos de Medicare o el Periodo de Elección Anual de Medicare, visite www.medicare.gov o llame al 1-800-MEDICARE.

Medicare Supplement Plan A

Medicare Supplement Plan A is also referred to as Medigap Plan A. This plan is sometimes overlooked because it has fewer benefits than other Medigap insurance plans.

What does Medicare Plan A cover though? It still covers the most important benefit, which is the 20% of outpatient medical care that Medicare doesn’t cover.

Make no mistake. Medicare Plan A pays this, so it is still a very good plan.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	❌
Medicare Part A deductible	❌
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan B

Medicare Supplement Plan B, also called Medigap Plan B, offers the same benefits as Plan A. In addition, it will also pay your Part A hospital deductible for you. This is a significant benefit as the deductible in 2017 is $1,316, and tends to go up slightly each year. Having Medigap Plan B means that you will never have to worry about that deductible going up.

Your hospital deductible is a per-incident deductible, not an annual one, so this is an important benefit. Medicare Plan B will pay the deductible even if you incur it more than once in the same year.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	❌
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan C

Medicare Supplement Plan C is a policy which covers nearly all of the Medicare gaps that you would usually be required to pay. The only exception is the Part B excess charges.

Excess charges are surcharges that your doctor can charge above and beyond what Medicare will reimburse. They are limited to 15% beyond what Medicare pays. Many doctors do not charge excess charges, but occasionally they do. If this concerns you, the Medigap Plan F or G might be a better choice for you than Medicare Plan C. Those two plans cover excess charges, so you won’t have to worry about asking.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	✔
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan D

Medicare Supplement Plan D is one of the ten Medigap options you can purchase to supplement your Original Medicare benefits. (It is not to be confused with PART D, which is for prescription drugs. You can read about Part D drug policies here.)

A Medigap Plan D policy covers most of the gaps in Medicare for you, with the exception of the Part B deductible and also any excess charges. An excess charge is an additional amount you will pay if a provider charges more than the Medicare allowed amount. You will pay out of pocket for these two minor items if you purchase a Medicare Plan D. However, the policy does cover all of the most important things, like the 20% of outpatient services that you would otherwise owe.

It’s important to compare pricing between Medigap Plan D and Plans F or G, which have richer benefits. This will help you determine if the savings is worth the additional financial exposure to you. Some people would rather pay more for their supplement if they know that all the gaps will be covered. Others don’t mind a little cost-sharing to get lower premiums.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan F

Medicare Supplement Plan F has also been the #1 seller with The Benefit Link for many years. According to a report from America’s Health Insurance professionals, about 57% of all Medigap policies in force were a premium Medicare Plan F policy. (In recent years, Plan G has been the second most popular Medicare supplement plan, and you can read more on that below.)

A Medigap plan, or Medicare Supplement, pays after Medicare to help cover your deductibles, copays, and coinsurance that you would otherwise be responsible for. Medigap plans do not replace your Medicare Part B. You must be enrolled in both Part A and Part B first, then you are eligible to enroll in Medicare supplement Plan F.

When you add a Medicare Supplement Plan F or G to your Original Medicare benefits, your coverage will be quite comprehensive. By definition, Medigap Plan F is the Medicare supplement with the most benefits.

Medicare – Plan F

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	✔
Medicare Part B excess charges	✔
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan G

Did you know that Medicare Supplement Plan G is the second most popular Medicare supplement (next to Plan F) with our Baby Boomer clients? Today we’re going to tell you why. Everyone has heard of Plan F, but what is Medicare Supplement Plan G? What does Plan G cover?

Medicare Plan G coverage is very similar to Plan F. It offers great value for beneficiaries who are willing to pay a small annual deductible. After that, Plan G provides full coverage for all of the gaps in Medicare. It pays for your hospital deductible, copays and coinsurance. It also covers the 20% that Part B does’t cover.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	✔
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan K

Medicare Supplement Plan K offers you the same basic benefits as other supplements, but with lower premiums. For example, this plan will still cover preventive care services and give you an extra year in the hospital. However, you split the cost-sharing with the insurance carrier on certain items like the Part A deductible. You also agree to pay the Part B deductible and any excess charges.

Medicare Plan K also includes a cap on your spending called an out-of-pocket maximum. For instance, let’s say you have a year with a lot of medical treatments. If your out-of-pocket spending reaches the maximum limit, then your Medigap K policy will kick in to pay all of the rest for that year.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	50%
Blood (first three pints)	50%
Hospice Care coinsurance or copayment	50%
Skilled Nursing Facility Care coinsurance	50%
Medicare Part A deductible	50%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan L

Medicare Supplement Plan L policy also includes a cap on your expenses. This is referred to as your out-of-pocket limit or maximum. Medicare sets this limit annually, and in 2018, the limit for Plan L is $2,620. This means that if in any one calendar year your spending reaches $2,480 in Medicare-approved covered expenses, then the Medigap insurance carrier pays the rest. The cap makes it much easier to agree to share in 25% of the costs on the items listed because you know that even if a year of bad health occurs, you won’t have more exposure than the maximum cap figure.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	75%
Blood (first three pints)	75%
Hospice Care coinsurance or copayment	75%
Skilled Nursing Facility Care coinsurance	75%
Medicare Part A deductible	75%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan M

Medicare Supplement Plan M is one of the new supplements created by the Medicare Modernization Act. It first hit the Medicare insurance market in the summer of 2010. (Sometimes we hear people call it Medicare Part M or Medigap Part M, but the correct term is Plan M.)

Medicare Plan M provides the same basic benefits as other supplements. However, it has a slightly reduced monthly premium in exchange for your willingness to pay half of your hospital deductible and all of your annual outpatient deductible. By sharing in these deductibles as well as excess charges, you get the benefit of reduced premiums.

Plan M could be a good fit for someone who doesn’t expect to visit the hospital often and feels he can afford the occasional cost-sharing. However, it’s important to have a licensed agent who specializes in Medicare supplements to help you. He or she will evaluate the differences in premiums and make sure that the savings are worth the risk of some expenses.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	50%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan N

Medicare Supplement Plan N has been popular since it was first introduced in 2010. Also called Medigap Plan N, this option was created for consumers who like the idea of paying a lower premium in exchange for taking on a small annual deductible and some copays.

All Medicare supplement Plan N policies are the same, no matter which insurance company you choose. You can find Plan N available in many states from various well-know insurance companies.

In 2015, AHIP reported that Plan N enrollment grew by 33% between 2013 – 2014.

(You will find that sometimes people refer to Plan N as Part N, but the proper term is Plan N. Medicare itself has Parts, but when you are referring to supplemental insurance, use the word Plans.)

Medicare Part A coinsurance and coverage for hospital benefits	$20 copay for office visits; $50 copay for ER
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

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