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Special Enrollment Periods & Medicare Advantage
Special Enrollment Periods & Medicare Advantage

Outside of the Annual Election Period (AEP), there are circumstances where you can make changes to your Medicare Advantage (Part C) & Medicare Part D Prescription Drug plans. These circumstances are known as Special Enrollment Periods or SEPs. The regulations on when and what changes you can make differ by SEP.

Changes in Residence

My new address is not in my current plan’s service area

You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Return to Original Medicare (Note: If you do not enroll in a new Medicare Advantage (Part C) plan during the required time frame, you will be enrolled in Original Medicare when you lose coverage from your former plan).
When:

Notify your plan before you move, and your SEP begins the month before you move and lasts for a full two months post-moving.

If you tell your plan after moving, your SEP begins the month you tell your plan and lasts for a full two months after.

I am still in my current plan’s service area, but there are new plan options at my new address

You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Return to Original Medicare (Note: If you do not enroll in a new Medicare Advantage (Part C) plan during the required time frame, you will be enrolled in Original Medicare when you lose coverage from your former plan).
When:

Notify your plan before you move, and your SEP begins the month before you move and lasts for a full two months post-moving.

If you tell your plan after moving, your SEP begins the month you tell your plan and lasts for a full two months after.

I am returning to the US after living abroad

You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:

SEP begins the month you move back and lasts for two months post-moving.

I just moved into/out of or currently live in an institution like a long-term care hospital or skilled nursing facility

You Can:
- Join a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Return to Original Medicare
- Drop your Medicare Prescription Drug Plan
When:

This SEP will last as long as you live in the facility and for two months once you leave the facility.

I was just released from jail.

You Can:
- Join a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:

You have a full two months post-release to enroll in a plan if you kept paying for your Original Medicare Part A & B. If you have never enrolled in Medicare, you have to do that before enrolling in a Medicare Advantage (Part C) plan.

Loss of Coverage

I am no longer eligible for Medicaid

You Can:
- Join a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
- Return to Original Medicare
- Drop your Medicare Prescription Drug Plan
When:

This SEP will last for three whole months once you are no longer eligible or notified, whichever is later.

I just left my employer-sponsored coverage or COBRA

You Can:
- Join a Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:

This SEP will last two full months after the month your coverage ends.

I involuntarily lost my other creditable drug coverage, or my coverage has changed to no longer be creditable.

You Can:
- Join a Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:

This SEP will last a2 full months after you lose your creditable coverage or you’re notified your current coverage is not creditable, whichever is later.

I left my Medicare Cost Plan

You Can:
- Join a Medicare Prescription Drug Plan
When:

This SEP will last two full months after you drop your Medicare Cost Plan.

I dropped my PACE (Program of All-Inclusive Care for the Elderly) plan coverage.

You Can:
- Join a Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:

This SEP will last a2 full months after you lose your creditable coverage or you’re notified your current coverage is not creditable, whichever is later.

Opportunity for Other Coverage

I have the opportunity to enroll in employer or union coverage.

You Can:
- Drop your Medicare Advantage (Part C) or Medicare Part D Prescription Drug Plan to enroll in the private plan
When:
- When your employer or union allows you to make changes or enroll in the private plan
I am enrolling in other creditable coverage such as TRICARE or VA Coverage

You Can:
- Drop your Medicare Advantage (Part C) or Medicare Part D Prescription Drug Plan
When:
- Anytime
I enrolled in a PACE plan.

You Can:
- Drop your Medicare Advantage (Part C) or Medicare Part D Prescription Drug Plan
When:
- Anytime
Plan Changes Its Contract with Medicare

Medicare took a sanction because of a problem with the plan that affected me.

You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- Medicare determines your ability to switch on a case-by-case basis
My plan’s contract with Medicare has been terminated/ended.

You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- Your chance to switch begins two months before the contract ends and lasts until one entire month after
Medicare did not renew the contract with my Medicare Advantage (Part C) Plans/Medicare Part D Prescription Drug Plan/Medicare Cost Plan.

You Can:
- Switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- December 8 until the last day of February
Other Special Circumstances

I am now eligible for Medicare and Medicaid.

You Can:
- Join, drop, or switch to a new Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- Once during each of these periods: January – March, April – June, July – September
- Changes you make will take effect on the first day of the following month. You cannot use the SEP in October – December. However, the Medicare Annual Election Period (AEP) lasts from October 15 – December 7, with changes occurring on January 1.
I qualify for Extra Help for my Medicare Part D Prescription Drug Coverage.

You Can:
- Join, drop, or switch Medicare Prescription Drug Plans
When:
- Once during each of these periods: January – March, April – June, July – September
- Changes you make will take effect on the first day of the following month. You cannot use the SEP in October – December. However, the Medicare Annual Election Period (AEP) lasts from October 15 – December 7, with changes occurring on January 1.
I am enrolled in or lost eligibility for SPAP (State Pharmaceutical Assistance Program)

You Can:
- Join a Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- Once during each calendar year
I dropped a Medigap (Medicare Supplement) plan when I joined a Medicare Advantage (Part C) plan for the first time

You Can:
- Drop your Medicare Advantage (Part C) plan and Enroll in Original Medicare. You will be eligible to enroll in a Medigap policy
When:
- You can drop your Medicare Advantage (Part C) plan within the first 12 months of enrolling for the first time
A Medicare Chronic Special Needs Plan (SNP) is available for individuals with my severe or disabling condition.

You Can:
- Join a Medicare Chronic Special Needs Plan
When:
- Anytime, but your opportunity to make changes ends for this SEP
I no longer have the condition that qualified me for a Special Needs Plan.

You Can:
- Switch from a Special Needs Plan to a Medicare Advantage (Part C) or Medicare Prescription Drug Plan
When:
- Your opportunity begins when you lose your special needs status and lasts up to 3 months after your Special Need Plan’s grace period is over
I joined/did not join a plan due to an error by a federal employee.

You Can:
- Join a new Medicare Advantage (Part C) plan with drug coverage or Medicare Prescription Drug Plan
- Switch to a new Medicare Advantage (Part C) with drug coverage or Medicare Prescription Drug Plan
- Return to Original Medicare
- Drop your Medicare Prescription Drug Plan
When:
- Your SEP lasts two full months after the month you receive the notice of error from Medicare
I was not appropriately told that my private drug coverage was not creditable coverage.

You Can:
- Join a Medicare Advantage (Part C) plan with drug coverage or Medicare Prescription Drug Plan
When:
- Your SEP lasts two full months after the month you receive the notice of error from Medicare or your plan
I was not appropriately told the private drug coverage I lost was creditable coverage.

You Can:
- Join a Medicare Advantage (Part C) plan with drug coverage or Medicare Prescription Drug Plan
When:
- Your SEP lasts two full months after the month you receive the notice of error from Medicare or your plan
November 10, 2022
Frequently Asked Questions About Medicare & Telehealth

Frequently Asked Questions About Medicare & Telehealth

As it is becoming increasingly popular in recent years, telehealth refers to healthcare services provided to patients by providers remotely. Before the COVID-19 pandemic, telehealth utilization in Medicare beneficiaries was low but increased 63-fold throughout the pandemic. During the first 12 months of the pandemic, over 28 million Medicare beneficiaries utilized telehealth services, including almost half of Medicare Advantage (Part C) enrollees and nearly 40% of those enrolled in Original Medicare.

With the emerging utilization of telehealth, we wanted to provide some answers to questions you may have regarding telehealth & Medicare.

What services can I get through telehealth?

Pre-pandemic Medicare covered approximately 100 services via telehealth, such as office visits, psychotherapy, and preventative health screenings. This has expanded to include emergency visits, physical and occupational therapy, and other services during the pandemic. Some services can be provided by audio-only telephone, including behavioral health, evaluation and management services, and patient education.

The Centers for Medicare and Medicaid Services (CMS) extended coverage for a subset of these expanded services under telehealth until December 21. 2023 (or the end of the year when the public health emergency ends. Whichever is later). This final rule was introduced to give both CMS and stakeholders time to decide if these services should be included permanently as telehealth services covered by Medicare.

Are mental health services available for Medicare beneficiaries via telehealth?

Telehealth was hugely important in ensuring that older adults received access to mental health care in 2020. Through the first year of the pandemic, many of the Medicare beneficiaries’ appointments were conducted through telehealth.

Policymakers have permanently expanded telehealth coverage for diagnosis in the Consolidated Appropriations Act of 2021, evaluation, or treatment of mental health disorders after the COVID-19 public health emergency. Medicare beneficiaries can use telehealth for mental health services in their homes; those who cannot use real-time two-way audio and video for telehealth mental health services can use audio-only devices to access their services. Beneficiaries are, however, required to have an in-person service within six months of their first telehealth service.

What are the costs of telehealth under Medicare?

Cost sharing for telehealth services has not changed during the pandemic. Telehealth services are covered under Original Medicare Part B, so those with Original Medicare are subject to the Part B deductible and 20% coinsurance. Many beneficiaries enrolled in Original Medicare also have a Medicare Supplement (Medigap) plan that covers some of the cost-sharing associated with telehealth. As long as it meets the standards of actuarial equivalence set by CMS, Medicare Advantage (Part C) plans have the flexibility to change their cost-sharing requirements.

What devices can be used for telehealth services?

Interactive audio-video systems and smartphones can conduct telehealth services with real-time audio-video capabilities. Some services can be provided on a telephone or smartphone via audio only.

Does my Medicare Advantage (Part C) plan cover telehealth services?

It is required that all Medicare Advantage (Part C) plans to cover all of the benefits covered by Original Medicare Parts A & B. Medicare Advantage (Part C) plans have also been able to offer telehealth services not usually covered under Original Medicare since 2020. Medicare Advantage (Part C) plans are now allowed to include costs associated with additional telehealth benefits in their bids for basic benefits.

If you have any questions about Medicare or telehealth benefits, don’t hesitate to get in touch with a licensed insurance agent at SEniorstar Insurance Group today. Click here to schedule an appointment.

October 24, 2022
When Will I Know if My Medicare is Approved?

When Will I Know if My Medicare is Approved?

What is Medicare?

Medicare is a government-run health insurance program available to United States citizens and permanent residents aged 65 or older, as well as those younger than 65 with certain disabilities. To be eligible for Medicare, you must be a U.S. citizen or permanent resident and have been paying Medicare taxes for at least ten years.

When you become eligible for Medicare, it’s important to know the process of how to get approved.

How do I sign up for Medicare?

First, you’ll need to gather some information about yourself and your spouse (if you have one). This includes your social security number, date of birth, and citizenship status. You will also need to provide information about your current health insurance plan.

The process of getting approved for Medicare can seem daunting, but it’s not too difficult. The first step is to contact the Social Security Administration (SSA) and apply for Medicare. You can do this online, or by calling SSA at 1-800-772-1213 or in person at your local Social Security office in New Jersey.

Once you’ve applied, SSA will review your application and let you know whether you’ve been approved for Medicare. If you’re approved, SSA will send you a letter telling you what your Medicare coverage will be and when your coverage will start. If you’re not approved, SSA will tell you why and give you information about how to appeal the decision.

If you’re already receiving Social Security benefits when you turn 65, you’ll automatically be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). You don’t need to do anything to enroll — SSA will take care of it for you. If you’re unsure if you’ve already been enrolled in Medicare, Senior Star and Jamie Sholom can help you review your current health coverage.

What happens after I am approved for Medicare?

Once you’re approved for Medicare, there are a few things you need to do to start receiving benefits.

First, make sure your Medicare card arrives in the mail. Your Medicare card is commonly known as your red, white, and blue card. Once you have your Medicare card, visit the doctor or hospital of your choice, and show them your card as proof of insurance. You’ll also need to start paying premiums for Part A and Part B if you haven’t been doing so already.

Medicare approval can seem like a long process, but it usually only takes a few weeks from the time you apply until you receive your card in the mail.

Still, concerned about how to sign up for Medicare? If you’re unsure of where to get started and aren’t certain about your enrollment dates, you don’t have to submit your Medicare application alone!

Jamie Sholom and Seniorstar can help you register for Medicare. Jamie Sholom is a licensed insurance agent in New Jersey and has been helping people with Medicare for nearly two decades.

If Medicare will be your primary health insurance, and you’d like personal guidance on applying for Medicare and how to set up your Medigap policy and Part D plans, Jamie Sholom is your resource. Contact Jamie at Seniorstar Insurance Group by calling 732 658 5100.

October 4, 2022
Lower Costs for Original Medicare Part B Coming in 2023

Lower Costs for Original Medicare Part B Coming in 2023

Part B Changes

The Centers for Medicare & Medicaid Services (CMS) stated on September 27, 2022, for the first time in over a decade, there will be a decrease in the standard Medicare Part B premium; it is falling from $170.10 in 2022 down to $164.90 in 2023. The Part B deductible for all Medicare Part B beneficiaries is also decreasing from $233 in 2022 to $226 in 2023. CMS also announced the premiums would drop for those Medicare beneficiaries who pay higher premiums due to their income. For example, a beneficiary filing an individual tax return with an income of $97,000 – $123,000 will pay a Medicare Part B Premium of $230 monthly. CMS estimates only about 7% of Medicare beneficiaries pay above the standard monthly premium.

Medicare Part B coverage includes doctors’ office visits, outpatient services at the hospital, some home health services, durable medical equipment, and certain other services not covered by Medicare Part A. Most Medicare beneficiaries have to pay the Part B premium regardless of whether or not they are enrolled in Original Medicare or a Medicare Advantage (Part C) plan. Some Medicare Advantage (Part C) plans cover the beneficiary’s monthly premium through a “giveback” benefit. Deductibles, however, vary across Medicare Advantage (Part C) plans.

Part A Costs

While most Medicare beneficiaries don’t pay a premium for Medicare Part A (which covers inpatient stays, skilled nursing facilities, hospice, and some home health), there is a deductible for each hospital stay. The deductible is increasing $44 in 2022 to $1,600 per stay in 2023. For Medicare beneficiaries who did not work long enough to qualify for premium-free Medicare Part A, the full premium will increase to $506 monthly in 2023. If someone has to pay the full premium is dependent on their or their spouse’s work history. For Medicare Advantage (Part C) plans, check with the plan for hospital charges.

To learn more about these changes, visit: https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly

For more information on your Medicare options or to set up a no-cost, no-obligation coverage review, contact Seniorstar Insurance Group at 732 658 5100 or click here to schedule an appointment.

September 28, 2022
What do Snowbirds Do about Medicare?
What do Snowbirds Do about Medicare?

Many New Jersey residents head south before winter hits! Snowbirds, as they are called, travel to warmer weather while New Jersey experiences our cold climate.

Generally, most snowbirds stay where it is warmer for several months, favoring Florida and other warmer areas. This can be a bit tricky with health insurance regarding extended stays in other states and away from your permanent residence in New Jersey.

Seniorstar Insurance works with snowbirds to help them find the right Medicare coverage. Some of the common questions regarding Medicare and extended stays include:
- “What is the best Medicare plan for snowbirds?”
- “How does Medicare work for snowbirds?”
- “Do snowbirds have to switch Medicare plans?”
If you are a New Jersey snowbird looking for a Medicare plan, Jamie Sholom, a licensed insurance agent in Middlesex County, is here to help you. He is also licensed to help individuals and snowbirds flock to Florida!

Where do snowbirds sign up for Medicare?

You may have two homes during the year, you should use your permanent resident address that Social Security has on file when applying for Medicare. You won’t need to change your address every time you travel temporarily, even if it is several months at a time. If your permanent residence stays the same with Social Security, it will stay the same with Medicare.

You can change your temporary mailing address when traveling for an extended period of time. Changing your temporary mailing address is something you should do if you are not receiving your Social Security benefits and you receive a quarterly bill for your Part B premium. You never want to miss a bill for your Part B premium because it could lead to a lapse in your coverage. You can also pay your Part B premium online.

Remember that you must reside in your “home residence” for at least half the year to consider New Jersey your resident state.

Can snowbirds purchase a Medigap policy?

When you purchase a Medigap policy, you will want to list your permanent resident address that is on file with Medicare and Social Security. This means you will choose a Medicare Supplement insurance plan based on what is available in your home zip code. The good news is that you can use that Medicare Supplement or Medigap policy anywhere in the country, so your coverage should be the same no matter where you are!

How do snowbirds sign up for Part D?

Like other Medicare plans you can purchase, you must choose a stand-alone Part D prescription drug plan based on your permanent resident address. When it comes time to enroll in a drug plan, you will use your home zip code and county to choose a plan that best fits your needs. For example, if you are a resident of Middlesex County, New Jersey, then you would select a stand-alone Part D prescription drug plan available in Middlesex County, New Jersey, regardless of if you stay in Mantee County, Florida for extended periods of time.

Each Part D Prescription Drug Plan has a network of pharmacies. Preferred, standard, and out-of-network pharmacies vary with each plan. If you visit a preferred pharmacy, you will pay the most cost-effective prices compared to standard. If a pharmacy if out of network with your plan, you will pay the entire prescription cost and won’t have coverage.

Part D plans also have national coverage. A great example of national coverage in a Part D plan is if CVS Pharmacy is one of your plan’s preferred or standard pharmacies, you can go to any CVS Pharmacy in the United States and fill your prescription. By using a national chain pharmacy in your Part D plan’s network, you do not have to change your Part D plan when traveling to your second home.

How do snowbirds know which Medicare plan to choose?

The most important things snowbirds should consider is their potential out-of-pocket costs and monthly premiums. You will want to ensure you have coverage no matter where you are. Luckily, Seniorstar Insurance offers plans in New Jersey and Florida to help snowbirds make a transition when the time comes to make a permanent residency in Florida.

If you have any questions about how your Medicare coverage works when you’re a snowbird, be sure to talk to your insurance company or an authorized agent. They can help answer any questions you have and help make sure you have the best coverage possible.
September 19, 2022
How do I know which Medicare plan is right for me?
How do I know which Medicare plan is right for me?

When it comes to choosing a Medicare health plan, there are many things to consider. Some people choose to keep Original Medicare Part A & Part B and purchase a Medigap policy and stand-alone prescription drug coverage. Other people choose to receive their Medicare benefits through a Medicare Advantage plan. Not all plans are the same! It’s important for Medicare eligibles to know the difference in the plans and their options in receiving their Medicare benefits.

If you decide to switch to a Medicare Advantage plan, you need to decide which plan is right for you. There are many different types of plans, so it’s important to compare the plans and see what fits your needs. Some things you may want to consider include the cost, the covered services, and the provider network. Working with a licensed insurance agent is helpful because they can help you with side-by-side plan comparisons to quickly identify which plans may be a good fit for your financial and medical needs.

When it comes to choosing the right Medicare plan, it’s important to understand all of your options. Original Medicare, or Part A and Part B, is the traditional way to get your Medicare benefits. You can choose to keep Original Medicare and purchase a Medigap policy to help with out-of-pocket costs, or you can choose a Medicare Advantage plan.

It’s important to remember that not all plans are the same. Make sure you do your research and ask lots of questions before making a decision on which plan is right for you.

What should I consider before choosing a Medicare plan?

When it comes to choosing the right Medicare plan, there are many important factors to consider. The first step is understanding the difference between Original Medicare, Medicare Advantage (Part C), and Medigap plans. Original Medicare is made up of Part A (hospital coverage) and Part B (medical coverage). You can add a Medigap policy to help cover some of the costs that are not covered by Part A and Part B.

Medicare Advantage plans are offered by private companies and usually include hospital and medical coverage as well as prescription drug coverage. It’s important to know that not all Medicare Advantage plans are the same! You should compare the plans in your area and ensure you understand what is included in each one.

What questions should I ask before choosing a Medicare plan?

The best way to decide which plan is right for you is to ask yourself some questions. First, do you want to keep Original Medicare or switch to a Medicare Advantage plan? If you want to keep Original Medicare, do you want to add a Medigap policy or purchase a stand-alone prescription Medicare Part D Prescription Drug Plan? If you want to switch to a Medicare Advantage plan, what is important to you? Do you want hospital and medical coverage as well as prescription drug coverage? Or does prescription drug coverage only matter to you? Do you need a plan with dental or vision benefits? These are all important things to consider when making your decision.

The bottom line is there are many choices when it comes to Medicare health plans, and it’s important for people to know their options. Talk to friends and family who have Medicare and ask them about their experiences with the different types of plans. Work with a Seniorstar licensed insurance agent to help you compare plans. And most importantly, ask questions! The best way to find the right plan for you is to ask questions until you understand everything about the plan.

So how do you decide which plan is right for you?

The best way to start is by asking yourself some questions:
- How much can I afford to pay each month in premiums?
- What kind of health services do I need?
- Do I want prescription drug coverage?
- What kind of extras would be nice to have, like dental or vision coverage?
- How often do I go to the doctor?
- Is my current doctor covered by the plan I’m considering?
- Do I mind having restrictions on the doctors and hospitals I can visit?
Once you’ve answered these questions, you can start looking at plans that fit your needs. Be sure to compare premiums, copays, coinsurance, and the providers that are covered by each plan. Working with an insurance agent at Seniorstar can help you get answers to questions regarding premiums, copays, coinsurance, and what prescription drugs may be covered.

Jamie Sholom is a licensed insurance agent in New Jersey and helps people with Medicare! If you’re ready to start the process of looking at your options, contact 732 658 5100 and speak with Jamie Sholom or another licensed insurance agent at Seniorstar.
September 14, 2022
Medicare Myths You Must Know…

Hi everyone,

Time and again, I’m on the phone with a client of mine answering questions like “Am I automatically enrolled in Medicare when I turn 65?” or “Can I get a Medigap plan at anytime?”.

Let’s clear things up. Check out the most wide-spread Medicare Myths below.

Myth: All Medicare Options are Provided by the Government
No. Medicare is a federal health insurance program, and you can get original (aka, Traditional) Medicare, Parts A and B from the government, but that doesn’t cover all of your medical costs. You can also buy your own Medicare plan from a private company to supplement or replace original Medicare. In either case, most people start the enrollment process when Social Security kicks in.

Myth: The Government Pays for Medicare
Not really. Most people will be eligible for Part A (hospital coverage) without incurring a monthly premium, but Part B (outpatient coverage), has one. The amount of the Part B premium can vary depending on income level and it will be deducted from your Social Security check if you receive one. If you’re not on Social Security, you will receive a bill.

Myth: You’re Enrolled Automatically at 65
Not always true. Being eligible for Medicare upon turning 65 does not mean you are automatically enrolled. The automatic enrollment into Medicare only happens if you have Social Security when you turn 65. If not, you have to enroll through the Social Security Administration.

Myth: You Can’t Apply Until Your 65th Birthday
Incorrect. When you age into Medicare, your initial enrollment period includes a seven-month period that includes the three months before your 65th birthday, the month of your 65th birthday, and three months after your 65th birthday. If you enroll in the months before you turn 65, your coverage will begin the first day of the month you turn 65.

Myth: You Have to Be 65 Years Old to Receive Medicare
Not completely true. Some people under 65 who have certain disabilities and who have been eligible for Social Security Disability Insurance for at least 24 months as well as with permanent kidney failure, also qualify for Medicare benefits.

Myth: You Have to Wait Until You Retire
False. If you are still working past age 65, it may be beneficial and, in some cases, even required to sign up for Medicare. Even if you will be keeping your employer coverage until you retire, getting Medicare part A makes sense for additional hospital coverage. The decision to enroll in part B as well, depends on the size of your employer and whether you feel that your options in Medicare are better and less costly than your existing employer coverage.

Myth: Medicare Insurance Pays for Every Medical Cost
Not even close. Medical services are subject to copayments, coinsurance and/or deductibles, and original Medicare does not cover vision, dental, or hearing services. Original Medicare also does not have maximum out of pocket limit protection on potential costs, nor does it cover prescription medications. For that reason, it makes sense to consider either a Medigap plan with a stand-alone drug plan or a Medicare Advantage Prescription Drug plan, in order to limit your risk and to maximize your coverage.

Myth: You Don’t Need Drug Coverage
False. Even if you are not taking any prescription medications you should seriously consider enrolling in a Medicare prescription drug plan if you do not have a creditable drug plan already in place. Drug plans are not covered by original Medicare so you can either enroll in a stand-alone, (Part D) drug plan or enroll in a Medicare Advantage plan that includes drug coverage. If you are not enrolled in a Medicare prescription plan of one kind or another, when you are eligible to be on Medicare, without other creditable drug coverage, you will be charged a penalty. That penalty triggers when you do finally enroll in a Medicare drug plan, and it will grow bigger over the period of time you were eligible for it but did not enroll. What’s worse is that it will never go away. This is a permanent penalty that will last as long as you stay on a Medicare Part D prescription plan.

Myth: You Can Get a Medicare Supplement plan (Medigap) Anytime
Sort of true but with a BIG stipulation. Enrollment in Medigap plans is not limited enrollment periods such as the AEP so you can apply at any time throughout the year, but you run the risk of being denied coverage. Medigap carriers can ask medical questions when you are not in your initial enrollment period and they will take into effect any pre-existing medical conditions you have, in deciding whether to approve coverage. For this reason, the best time to enroll in a Medicare supplement plan is during your initial enrollment period (IEP), that runs three months before, the month of, and three months after your eligibility (often your 65th birthday). During that window you will get the best rate possible, and they cannot ask any health questions or take preexisting conditions into consideration. That does not mean you can’t get a Medigap plan outside of your IEP if your health allows for it. Many people regularly shop for a better rate in Medigap plans and they switch when and if they can.

Myth: You Are Allowed to Be Under Your Spouses Medicare Plan, Just Like an Employer Plan
Nope. Medicare is individual and if one partner loses health coverage because a spouse moves to Medicare from an employer plan, then that individual needs to secure their own coverage. Sometimes that may mean enrolling in their Medicare plan depending on age and eligibility and sometimes it requires another option altogether.

Myth: Preexisting Conditions Always Disqualify You From Medicare Plans
Mostly no. Original Medicare and Medicare Advantage plans do not restrict coverage for preexisting conditions and Medigap carriers cannot deny you coverage during your initial enrollment period, (IEP). However, if you want to enroll in a Medigap plan outside of your IEP, you will have to answer medical questions and may be denied coverage. If the Medigap carrier deems that your preexisting conditions will be too costly for them, they can either deny you coverage or charge you much higher rates.
Myth: You Only Get One Chance to Pick a Medicare Plan
Completely false. You can switch amongst or switch to a Medicare Advantage plan every year from Oct. 15 to Dec. 7, which is called the annual enrollment period, AEP. In addition, if you are already in a Medicare Advantage plan and you didn’t switch during the AEP for any reason, you can switch to a different Medicare Advantage or drop your plan and go to original Medicare or a Medigap plan, from Jan. 1 to March 31 every year. Moreover, you can apply for a Medigap plan at any point throughout the year but your acceptance may be dependent on your health.

Myth: You Don’t Qualify for Medicare If You Didn’t Work
That depends. If either you or your spouse paid federal payroll taxes for a minimum of 40 quarters (10 years), you are eligible for Part A with no monthly premium which means you can also enroll in Part B and the other coverage options. If you and/or your spouse paid federal payroll taxes for LESS THAN 40 quarters, are over age 65, and a citizen or permanent resident of the United States, you may be able to enroll in Medicare by paying a premium for part A.

Myth: Dental and/or Vision and/or Hearing (DVH) is Covered by Medicare
It’s all in the wording. Original Medicare (parts A and B) doesn’t cover DVH. That said, many Medicare Advantage plans provide this coverage at no additional cost and if you have original Medicare with a Medigap plan, you can always secure a stand-alone DVH plan with a private carrier to help complete your coverage package.

Myth: I Will Have to Deal with a Provider Network
Not always. Medicare supplement plans are secondary to original Medicare and having original Medicare as your primary insurance means that you can see ANY Medicare provider in the entire country. It’s not going out on a limb to say that most medical providers and facilities in the US take Medicare. Moreover, Medicare providers cannot refuse to accept your Medigap plan as your secondary insurance, no matter who the carrier is, even if they have never heard of the company or don’t take them in a network capacity. On the other hand, most Medicare Advantage plans are HMO’s or PPO’s and/or will otherwise require some adherence to local, regional, or national provider networks.

June 15, 2021
The Cost Of Cancer

Did you know that May is melanoma skin cancer detection and Prevention Month?

Now, of course, you didn’t, most people don’t, but it is and it had me thinking about cancer and the fact that we don’t talk about cancer when we discuss Medicare coverage enough, it’s a very important topic.

It’s one that can cost an enormous amount of money besides the medical toll it can take. It’s a subject I wanted to touch on. This is Jamie Sholom from SeniorStar Insurance Group.Welcome to the SeniorStar Minute.

Everybody knows somebody personally that’s been affected by cancer.In fact, according to the CDC and the American Cancer Society, it’s the second leading cause of death in the United States right behind heart disease.

What’s worse for my population that I serve the seniors is that eighty seven percent of all diagnosis of cancer in the US are from 50 year olds are older. Forty one percent of all males and thirty eight percent of all females will have a diagnosis of cancer at some point in their lives. Now, the good news is that cancer survival rate is thirty one percent higher than it used to be, but along with those higher survival rates are the costs.

The treatments are better and the costs are going higher. Now, why am I telling you this? If you’re covered by Medicare, if you have a great Medicare coverage package or even an average Medicare coverage package, it’s going to cover cancer, isn’t it? Well, yes and no cancer has two open holes that affect a lot of people that didn’t think they were going to be affected by it financially. The first is the enormous cost of cancer, prescription drugs.

The second are the untold costs that are indirect with cancer treatments. I’m going to talk about them both a little bit. The drug costs were studied by the Kaiser Family Foundation recently.

They did a study of 13 popular, for lack of a better word, drugs that were for various forms of cancer. These were Medicare recipients that had Medicare drug coverage. What they determined was that the average cost for these drugs, the out-of-pocket costs for Medicare beneficiaries, was between eight thousand and sixteen and a half thousand dollars. You heard that right. Medicare beneficiaries with a Medicare drug plan had to spend an additional eighty one hundred dollars to sixteen and a half thousand dollars out of their own pockets each year because of that cancer drug that they were on unplanned for.

And it’s enormous. There are studies that come out every year that talk about how people can’t afford their cancer medications.

They also go through their retirement funds and deplete them at a much higher rate than they thought they were going to. There are also studies that show how indirect costs of cancer affect people in ways that they didn’t expect. Downtime from work counseling, getting family help for the family members that you took care of. Home health aides travel and lodging for cancer treatments, all of these add up to forty two percent of cancer costs. That’s right. Indirect costs are costing you forty two percent of your overall cancer costs.

Now, the reason I’m letting you know this, there is a solution.

There are cancer protection and critical care policies out there that can give you coverage and protection from a diagnosis of cancer. These plans are fairly low monthly premium plans that will give you a lump sum payment, typically between fifteen thousand dollars and seventy five thousand dollars, with which you can do whatever you want. If you get a diagnosis of cancer, you get a lump sum of an amount that you can afford the premiums for and you can choose if you need to use them on cancer drugs, on some of the indirect costs or in any other way that you choose.

If you’re interested in getting more information about this very important product, please contact me Jamie Sholom at SeniorStar Insurance Group. My contact information is on the screen. I hope to speak to you soon. Thank you for listening.

May 8, 2021
Do You Have to Sign Up for Medicare?

Do You Have to Sign Up for Medicare?

Many people look forward to the day when they finally can sign up for Medicare but not everyone feels that way. This is an important question for anyone approaching 65 but it really breaks down into two smaller questions: Are you eligible for Medicare and, are you required to enroll in Medicare if you are?

Eligibility:
You are eligible for premium-free Part A (hospital coverage) and Part B (outpatient coverage usually with a premium attached) if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can also get Medicare at 65 if you are receiving retirement benefits from Social Security or the Railroad Retirement Board, you are eligible to receive Social Security or Railroad benefits but you have not yet filed for them or you or your spouse had Medicare-covered government employment. If you are under age 65, you can get Medicare if you have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months or you are a kidney dialysis or kidney transplant patient. But if you’re turning 65 and you are eligible, Medicare often provides the least expensive and most comprehensive protection available.

Requirements:
You are not required by law to enroll in Medicare but if you do not enroll when you become eligible, without having other “creditable” insurance, you will likely be penalized for the delay when it comes times for you to eventually enroll in Medicare. Creditable coverage includes many retirement health and many employer group plans but COBRA and the ACA individual plans are not considered creditable by Medicare standards. The late enrollment penalty, (LEP) imposes a higher monthly premium for Part B benefits and/or Part D (Medicare prescription drug plan) benefits. The longer the delay in enrollment in Medicare without other creditable coverage, the higher the penalty will be and it never goes away. For that reason, it is very important to find out if the coverage you have now is considered “creditable”, by Medicare standards to help guide your decision. If you are receiving social security benefits when you turn 65, you will be enrolled in Medicare automatically and your Medicare card will be mailed to you around three months prior to the month of your 65th birthday.

Penalties:
Part B has a monthly premium which for most people in 2021, is $148.50 but it can be higher depending on income. The LEP for Part B is 10% of the standard premium for each 12-month period that you could have had Part B but didn’t and you’ll have to pay this penalty on top of your premiums for life or disenrollment. For example, if you delay enrolling in Part B for 2 full years you will have an additional 20% to pay on top of the $148.50, which equals $29.70.
For Part D, Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($33.06 in 2021) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $0.10 and added to your monthly Part D premium. In this case, the same 2 year delay would result in a an additional $8.00 per month above the premium you pay for your drug plan.

There is no penalty for not enrolling in a Medigap plan or a Medicare Advantage plan but not doing so when you are first eligible for Medicare could also have negative implications for you. For example, preexisting health conditions may be considered, or you might have to wait for the annual enrollment period to obtain coverage if you do not obtain coverage during your initial election period.
So, should you sign up? Well, if you don’t have a qualified employer group plan or you’re not covered under a spouse’s plan, then it makes a lot of sense to get on Medicare. Health insurance is a great idea at any age, but it is vital for seniors who may have fixed incomes and have ever increasing medical needs.

Bottom line?
Navigating your entry into Medicare can be tricky and confusing but making the wrong decisions could cost you money and limit your coverage at a time when you can least afford either. For a FREE one-on-one review from a Medicare expert call (732) 658-5100, email jamie@seniorstarig.com or go to our website at www.seniorstargroup.com.

May 3, 2021
Can You Afford In-Home Elderly Care?

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April 14, 2021