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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
October 14, 2022
Is a Medigap Plan Right For You?

You’ve decided that you want to go into a Medigap plan, also known as Medicare supplement, and you’re concerned the preexisting conditions affect your coverage. Do they affect your costs? Well, it depends. It depends on whether you’re already in a Medigap plan, whether you have a Medicare Advantage plan and for how long, whether you’re coming into Medicare for the first time and you’re in your open enrollment period. I’ll give you a quick explanation. This is Jamie Sholom with Seniorstar Insurance Group. Welcome to the Seniorstar Minute.

When you’re enrolling in Medicare for the first time, when you’re turning 65, there will be no preexisting conditions that anybody can pay attention to, no matter what kind of Medicare plan you want to go into if you want to go into a supplement plan at that point. You can do it with any company or any plan that provides those policies in your area. Now, if you’re coming off of existing Medicare insurance, whether that be a different supplement plan, maybe you’re looking to lower your rate.

Maybe you’re looking to switch plans or companies. Or if you’re coming off a Medicare Advantage plan and you want to opt out of that. You may have to answer health questions now, these insurance companies can deny you coverage if you have certain criteria met, certain chronic conditions, certain combinations of conditions. If you’re on certain medications, they can say no, which will make your ability to lower your costs or save money much more difficult. Now, there are other situations where they would where insurance companies with Medigap plans would have to give you what’s called a guarantee issue, meaning they can ask your health questions, but under limited circumstances.

And you would have a limited option in terms of what type of Medigap plan and which company to go into. If you need any more information or if you have any questions about your specific situation, please give me a call. My phone number, my website there on the screen. It’s been a pleasure to talk to you. Hope to hear from you soon.

July 9, 2021
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
Is the Lowest Costing Option Always the Best One?

With Medigap Plans, Is the Lowest Costing Option Always the Best One?

Medicare Supplement plans (also known as Medigap plans) are offered by private insurers and fill many of the coverage gaps in Original Medicare. There are several plan types, all identified by a letter, but the most popular are Plans G and N. These two plans compromise the vast majority of new Medicare eligibles who elected to enroll in a Medigap plan since January of 2020.

Medicare Supplement plans of the same type which are offered by different insurers, may have significantly varying rates while providing the same basic benefits and levels of coverage. For example, a plan G that costs $140 per month with a lesser-known carrier is the same coverage as a Plan G for $172 per month with a widely-known carrier. Premiums can vary so dramatically between carriers for the same plan, because of market conditions, risk tolerance, claims ratio, management and marketing decisions, etc…

As such, wouldn’t it seem to reason that it’s always best to choose the company with the lowest rate available? NOT SO FAST…. Medicare supplement plans have rate increases every year and some insurers raise their rates higher and faster than others. That means that a carrier with the lowest costing Plan G for 65 year old’s today might be on the high side at age 71.

Although it is possible to shop for different carriers for lower rates as often as one wants, (in fact most my time is spent on helping clients find lower rates for the same coverage), there is a risk that a medical condition will arise which “locks” the beneficiary into their current plan. That’s because after the short initial enrollment period ends, Medigap applicants will have to answer health questions on the application and certain preexisting conditions may become a disqualifier for coverage.

For that reason, it makes sense for someone considering a Medigap policy, to factor in a carrier’s history of rate stability, their financial strength and their customer service record as well as their rates. Finding that balance is what we help our clients do. Please contact me for more information.

April 26, 2021
Medicare! What is it, and what does it cover?

Medicare! What is it, and what does it cover?

Medicare is a public healthcare program, funded by the government, workers and employers, and available to people at age 65 or who have qualifying disabilities. But contrary to popular belief, the program was not intended to cover all services at no cost. Generally, it provides a core set of basic medical benefits to cover inpatient and about 80% of outpatient care. Medicare beneficiaries face out-of-pocket expenses, such as deductibles copayments and/or coinsurance.

When you initially become eligible for Medicare, you can pick any plan available in the zip code of your primary residence and are not asked about preexisting health conditions. Once that initial enrollment period (IEP) ends, there are certain times during the year when you can make changes depending on the plan type you choose.

Seniorstar Insurance Group is a licensed, independent Medicare agency working with more than 20 highly rated insurance carriers in Medicare supplement, Medicare Advantage, Medicare prescription drug, dental, vision, hearing, critical care, hospital indemnity, final expense and long term care plans. Our services are completely FREE. Why not let Jamie Sholom and the team at Seniorstar become your ongoing resource for your senior benefits.

April 26, 2021