Seniorstar Insurance Group

Category: Original Medicare

  • Things Medicare Beneficiaries Should Do After the Annual Election Period (AEP) 

    Things Medicare Beneficiaries Should Do After the Annual Election Period (AEP) 

    Things Medicare Beneficiaries Should Do After the Annual Election Period (AEP) 

    During the Medicare Annual Enrollment Period or AEP, you can change your Medicare coverage to adjust to your ever-changing coverage needs. You can change your Medicare Advantage (Part C) plan to a new Medicare Advantage plan, end your Medicare Advantage plan and reenroll in Original Medicare, and change your Medicare Part D Prescription Drug plan. 

    When the Annual Election Period (AEP) ends on December 7th, there are still some things Medicare beneficiaries should take the time to consider. Here are some key things Medicare beneficiaries should do after the end of the Annual Election Period (AEP). 

    Look Into Your Medicare Advantage (Part C) Plan and Decide if Changes are Needed 

    If you are one of the millions of Americans who enrolled in a Medicare Advantage Plan during Annual Election Period (AEP), and you conclude that it doesn’t fit all your needs, don’t worry! The Medicare Open Enrollment Period (OEP) begins on January 1st and ends March 31st. During Open Enrollment Period (OEP), beneficiaries can swap to a different Medicare Advantage Plan.  

    It is important during the Open Enrollment Period (OEP) that you review your plan’s costs & benefits for the upcoming year and ensure that your Medicare Advantage plan meets your medical and financial needs. 

    It is important that you review your plan’s out-of-pocket costs & check to see if your doctors accept your new Medicare Advantage Plan. If there are any issues or you feel that this plan will not meet your needs or budget for the upcoming year, it is a good idea to schedule an appointment with a licensed insurance agent, like the team at Seniorstar Insurance Group. An agent can help you find and enroll in a Medicare Advantage plan that meets your needs. After reviewing everything, if you decide you don’t want to be enrolled in a Medicare Advantage plan, you can switch back to Original Medicare and enroll in a standalone Medicare Part D Prescription Drug Plan during the Open Enrollment Period (OEP).  

    Review the costs of your Medicare Part D Prescription Drug Plan 

    Prescription drugs can become costly without the correct insurance plan to cover them. If you enrolled in a Medicare Part D Prescription Drug Plan during the Annual Enrollment Period, take the time to check the coverage to ensure all your medications are covered by your plan. If this isn’t the case, and you find holes in your coverage, you can sign up for a Medicare Advantage plan or a different Medicare Part D Prescription Drug Plan during the Open Enrollment Period. If you are someone who needs over-the-counter medications, it is important to note over-the-counter drugs aren’t covered by Medicare Part D Prescription Drug Plans or Original Medicare. However, some Medicare Advantage plans offer over-the-counter benefits.  

    Filing Appeals 

    Filing an appeal with the help of your agent can also be a good way to mitigate unwanted drug costs but be sure to check with your provider to see if an alternative drug might fit better with your coverage. 

    If you do choose to file an appeal, there are a few things you should know. First, you should get a coverage determination document from your Medicare Part D Prescription Drug Plan. This document will allow you to see if a certain drug is covered, the costs associated with the drug, the qualifying factors you must meet to get the drug, and if your plan will make an exception. If your doctor decides to give you a drug that isn’t on your plan’s formulary or an alternative drug doesn’t work in place of the drug you think you need, ask for an exception from your Medicare Part D Prescription Drug Plan. Once you ask for the exception, your Medicare Part D Prescription Drug Plan will make a decision on the exception. When you view this decision, if you don’t agree with it, you can then file an appeal with Medicare.  

    There are five different places your appeal can reach once you file. The first is your Medicare Part D Prescription Drug Plan. They will look at your appeal again and send another decision. If you disagree with this second decision, you can send the appeal to a third party. Then, the Office of Medicare Hearings and Appeals will handle all disagreements with third-party issued decisions and deliver their own decision. If this decision is inadequate for you, or they don’t respond quickly, you are able to send the appeal up to the Medicare Appeals Council. They will review the appeal and make a final decision unless your appeal meets a high enough dollar threshold, in which case this appeal will be sent to the Federal district court for judicial review. 

    Review Medicare Supplement Plans 

    If you were deciding on coverage with a licensed agent during the Medicare Annual Election Period (AEP), they may have suggested a Medicare Supplement plan that can help you cover the costs of Original Medicare. You cannot have both a Medicare Advantage plan and a Medicare Supplement simultaneously, so you must choose between the two. However, after the AEP, during the Open Enrollment Period (OEP), you can choose to cancel your Medicare Advantage Plan and return to Original Medicare and enroll in a Medicare Supplement. Whether or not this is a good option for you depends on the costs associated with each plan, such as copays or doctors not accepting your plan. Medicare Supplements are more equipped to cover things related to out-of-pocket costs associated with Original Medicare, such as copays & coinsurance but sometimes have a higher premium or underwriting. In general, Medicare Advantage plans can be a good option for those with fixed incomes or needing a lower monthly premium. It is important that you learn more about your Medicare Advantage plan after the Annual Election Period (AEP) so you know if you need to review or change anything. 

    In addition to ensuring your Medicare coverage will meet your needs in the new year, after the Annual Election Period (AEP) can be a great time to review additional insurance products such as life insurance, final expense, or ancillary products. If you are interested in learning more about your options, or more about how to know if your Medicare plan meets your needs, contact Seniorstar Insurance Group today at 732 658 5100.  

  • Should I Delay Medicare Enrollment if I Have Employer-Sponsored Insurance?

    Should I Delay Medicare Enrollment if I Have Employer-Sponsored Insurance?

    Should I Delay Medicare Enrollment if I Have Employer-Sponsored Insurance?

    If you still have employer-sponsored health insurance coverage through your or your spouse’s employer when you turn 65, you can delay Medicare enrollment without penalties. Whether your employer-sponsored coverage will pay primary or secondary, will determine if it might still be in your best interest to enroll in Medicare. Most of the time, you should delay Medicare Part B enrollment only if your employer-sponsored coverage is the primary payer.

    Which Coverage is Primary?

    Employer-Sponsored

    It will be the primary payer if your employer-sponsored coverage is from an employer with more than 20 employees. This means that Medicare will be secondary, and delaying enrollment in Medicare Part B might be beneficial to avoid an additional monthly premium.

    Medicare

    Medicare will be the primary payer if your employer-sponsored coverage is from an employer with less than 20 employees. This makes employer-sponsored coverage secondary. Your employer-sponsored coverage may not provide much coverage if you delay enrollment in Medicare Part B. In this case, it’s usually best to enroll in Medicare Part B to avoid high out-of-pocket costs for care.

    Enrolling in Medicare After Delaying Enrollment

    When it comes time to enroll in Medicare after delaying enrollment, ensure you have kept proof of enrollment for your employer-sponsored coverage. You will be eligible for a Special Enrollment Period to enroll in Medicare once you no longer have employer-sponsored coverage. Still, you will need proof of enrollment from your employer-sponsored coverage. Proof includes:

    • Written notice from your employer/plan
    • Documents that show health insurance premiums were paid
      • W-2
      • Pay stub
      • Tax returns
      • Receipts
      • Health insurance cards with relevant effective dates

    Notes: There are different rules for those who became Medicare eligible due to a disability or ESRD. There are also separate rules for those who have COBRA or retiree insurance.

  • Medicare Savings Programs for Beneficiaries in New Jersey

    Medicare Savings Programs for Beneficiaries in New Jersey

    Medicare Savings Programs for Beneficiaries in New Jersey

    There are programs across the United States, both state-specific & national available to help Medicare beneficiaries on a fixed income and low incomes afford the health insurance coverage they need.

    In New Jersey, multiple Medicare Savings Programs are available for beneficiaries who meet the requirements. Two of the main eligibility requirements are the Medicare beneficiary must be a New Jersey resident & they are not financially eligible for the New Jersey Care program under NJ Medicaid.

    Here, you can find brief details about each program and how to apply for financial assistance from the NJ Medicare Savings Programs.

    Qualified Medicare Beneficiary (QMB)

    The Qualified Medicare Beneficiary program helps Medicare beneficiaries pay for Part A Premiums, Part B Premiums, coinsurance, & copayments for services and products covered by Medicare. To be eligible for this savings program, the Medicare beneficiary must be within the income and asset limits. You can find this year’s information on the State of New Jersey’s Department of Human Services website.

    Specified Low-Income Medicare Beneficiary (SLMB)

    The Specified Low-Income Medicare Beneficiary program helps eligible Medicare Beneficiaries pay for their Medicare Part B premium. To qualify for this savings program, the Medicare beneficiary must be within the income and asset limits; you can find this year’s information on the State of New Jersey’s Department of Human Services website.

    Qualifying Individual (QI)

    The Qualifying Individual program helps eligible Medicare beneficiaries pay their Medicare Part B premiums. To qualify for this savings program, the Medicare beneficiary must be within the income and asset limits. You can find this year’s information on the State of New Jersey’s Department of Human Services website.

    NJSave

    To apply for the above Medicare Savings Programs in New Jersey, you apply NJSave. NJSave is an online application that helps those with disabilities and seniors apply to save money on Medicare premiums, prescription drug costs, and living expenses. Below we have linked some resources to help Medicare beneficiaries or caretakers easily access NJSave.

    NJSave Video Tutorial

    NJSave Instructions

    For more assistance, contact your county’s Area Agency on Ageing or State Health Insurance Assistance Program (SHIP).

    How NJSave Helps Beneficiaries

    NJSave helps streamline the application process for Medicare Savings Programs or other savings programs for individuals with disabilities and seniors by submitting their application to multiple financial assistance programs, including:

    If a beneficiary meets the eligibility requirements, their information can also be forwarded to:

    We know that navigating the ins and outs of Medicare & Medicare Savings Programs can be stressful and a heavy lift. If you have any questions or would like any assistance, please feel free to reach out to the team at Seniorstar Insurance Group by calling 732 658 5100.

  • What is the Medicare Part B Late Enrollment Penalty

    What is the Medicare Part B Late Enrollment Penalty

    What is the Medicare Part B Late Enrollment Penalty

    Suppose you don’t enroll in Original Medicare Part B during your Initial Enrollment Period (IEP) and do not have credible coverage through you or a spouse’s employer or are eligible for a Medicare Savings Program. In that case, you will have to pay the Part B premium penalty. This penalty is 10% of the Part B Premium for each 12-month period that you delay enrollment in Medicare Part B.

    You will have to pay this penalty monthly as long as you are enrolled in Medicare. However, if you are enrolled in Medicare because of a disability and are under age 65 when you turn 65, the penalty will go away.

    Calculating the Penalty

    Calculating the Part B Late Enrollment Penalty can be simple. Let’s do an example:

    In this example, let’s say you have delayed enrollment for five years and did not have employer-sponsored coverage. This would make your monthly premium 50% higher ( 5 years x 10%).

    In 2023, the Medicare Part B Premium will be $164.90.

    Base Premium + ((.10 x Years of Delayed Enrollment) x $164.90) = Your Total Monthly Premium

    $164.90 + ((.10 x 5) x $164.90)

    $164.90 + (0.50 X $164.90)

    $164.90 + $82.45

    $247.35

    So, you would pay $247.35 each month, with $82.45 as the penalty.

    If you need help choosing Medicare coverage, feel free to reach out to Seniorstar Insurance Group at 732 658 5100. We can help you evaluate your options like Original Medicare Parts A & B, Medicare Advantage (Part C), Medicare Part D Prescription Drug Plans, and Medicare Supplements.

  • The Medicare Annual Election Period (AEP) – Explained

    The Medicare Annual Election Period (AEP) – Explained

    The Medicare Annual Election Period (AEP) – Explained

    Commonly referred to as AEP, the Medicare Annual Election Period (AEP) is the time each year when you can change your Medicare coverage if you choose. The Medicare Annual Election Period (AEP) lasts from October 15 to December 7 every year, with plan changes going into effect on January 1 of the new year.

    Changes You Can Make to Your Coverage During AEP

    Depending on your coverage, you can make various changes during the Medicare Annual Election Period (AEP). Here are some tips based on the coverage you are currently enrolled in:

    I am Enrolled in…

    Original Medicare Parts A & B

    If you are currently enrolled in just Original Medicare Parts A & B, you can do the following during the Medicare Annual Election Period (AEP):

    • Join a Medicare Advantage (Part C) plan with built-in drug coverage.
    • Join a Medicare Advantage (Part C) plan without built-in drug coverage. Note: You may be charged a penalty if you do not have other creditable drug coverage
    • Join a stand-alone Medicare Part D Prescription Drug Plan. Note: You may also be charged a penalty if you are not currently enrolled in creditable drug coverage.

    You also have the option to make no changes; your coverage will remain as-is.

    Original Medicare Parts A & B with a Stand-Alone Medicare Part D Prescription Drug Plan

    Suppose you are enrolled in Original Medicare Parts A & B with a Stand-Alone Medicare Part D Prescription Drug Plan. In that case, you can do the following during the Medicare Annual Election Period (AEP):

    • Join a Medicare Advantage (Part C) plan with built-in drug coverage.
    • Join a Medicare Advantage (Part C) plan without built-in drug coverage.
    • Enroll in a new Medicare Part D Prescription Drug Plan and change your coverage from your existing plan
    • Drop Medicare Part D Prescription Drug coverage altogether. Note: If you decide to enroll in drug coverage in the future, you may be charged a penalty.

    You also have the option to make no changes; your coverage will remain as-is.

    Medicare Advantage (Part C) with a Stand-Alone Medicare Part D Prescription Drug Plan

    If you are enrolled in a Medicare Advantage (Part C) plan with a stand-alone Medicare Part D Prescription Drug Plan, you can do the following during the Medicare Annual Election Period (AEP):

    • Enroll in a different Medicare Advantage (Part C) plan with built-in drug coverage.
    • Enroll in a different Medicare Advantage (Part C) plan without built-in drug coverage.
    • Enroll in a new Medicare Part D Prescription Drug Plan and change your coverage from your existing plan
    • Drop Medicare Part D Prescription Drug coverage altogether. Note: If you decide to enroll in drug coverage in the future, you may be charged a penalty.
    • Leave your current Medicare Advantage (Part C) plan and return to Original Medicare.

    You also can make no changes, and your coverage will remain as-is.

    Medicare Advantage (Part C) with Built-in Drug Coverage

    If you are enrolled in a Medicare Advantage (Part C) plan with built-in drug coverage, you can do the following during the Medicare Annual Election Period (AEP):

    • Enroll in a different Medicare Advantage (Part C) plan with built-in drug coverage.
    • Enroll in a different Medicare Advantage (Part C) plan without built-in drug coverage.
    • Enroll in a stand-alone Medicare Part D Prescription Drug Plan if you enroll in a Medicare Advantage (Part C) plan that does not include drug coverage or if you go back to Original Medicare Parts A & B.
    • Drop Medicare Part D Prescription Drug coverage altogether. Note: If you decide to enroll in drug coverage in the future, you may be charged a penalty.
    • Leave your Medicare Advantage (Part C) plan and return to Original Medicare.

    You also have the option to make no changes; your coverage will remain as-is.

    Review Your Coverage with a Licensed Agent

    The Medicare Annual Election Period (AEP) is a great time to review your current coverage and ensure that you are enrolled in the Medicare coverage that meets your needs – medically and financially. At Seniorstar, we offer no-cost, no-obligation coverage reviews. We will help you evaluate your Medicare options, including Original Medicare Parts A & B, Medicare Advantage (Part C), Medicare Part D Prescription Drug Plans, and Medicare Supplements (Medigap).

    Click here to schedule an appointment, or call 732 658 5100