Real Senior Management
Medicare Eligibility
As an agent, you need to assist and advise seniors in every way possible. This means helping them learn the coverage provided by each part of Medicare and helping them understand the eligibility and enrollment process.
There are several parts of the Medicare plan; each has its own eligibility criteria. The parts of Medicare include:
• Part A – Inpatient Hospital Coverage Plan
• Part B – Outpatient Medical Coverage Plan
• Part C – Medicare Advantage Plan
• Part D – Prescription Drug Coverage Plan
Beneficiaries can also enroll in plans that are known as Medicare Supplements.
Enrollment Periods
Before we get into eligibility, let’s first discuss the importance of the Medicare enrollment periods. Making sure your clients understand which enrollment period could benefit them is crucial in helping them get the coverage they need and avoid paying any extra costs, like late enrollment penalties.
These enrollment periods include:
• Initial Enrollment Period: This period is the first enrollment period to occur as it means the individual is now eligible to enroll in Medicare. It will start three months before their 65th birthday and will end three months after their 65th birthday. Missing this period is not recommended.
• General Enrollment Period: This period becomes available if they do miss their initial enrollment. It will start on January 1st and ends on March 31st. They can enroll in Original Medicare during this period, but it will result in late enrollment penalties, and their coverage will not start until July 1st.
• Special Enrollment Period: This period becomes available if they miss their initial enrollment because they already had health coverage, lost their current coverage, moved out of a plan’s service area, and more. This period basically grants the chance to enroll in Medicare or switch to a new plan without paying penalties, but they must qualify for this period by experiencing one of the circumstances listed above.
• Annual Enrollment Period: This period is available once they’re enrolled in Medicare and begins October 15th and ends on December 7th. During this period, they can review their current coverage and make changes if necessary. For example, suppose they’re enrolled in a Medicare Advantage plan without drug coverage. In that case, they can switch to a new Advantage plan with drug coverage.
• Medigap Open Enrollment Period: As soon as they are enrolled in Original Medicare and are 65, they will have six months to enroll in a Medicare Supplement (Medigap) plan. Waiting past these six months to enroll in a Medigap plan could result in an insurer denying them coverage or charging them more in premiums because of their health.
Original Medicare Eligibility (Part A and Part B)
To be eligible for Medicare, the individual must be:
• A US citizen or permanent resident (who has lived in the US for five years)
• 65 years of age or older
• Permanently disabled
• Suffering from ESRD (End-stage Renal Disease)
Most people are also automatically enrolled in Original Medicare, but for those who are not, they will have to enroll during the Initial Enrollment Period.
Medicare Advantage (Part C)
Medicare Advantage (Part C) is an alternative to Original Medicare (Part A and Part B) coverage. However, Part C is only offered by private insurers who contract with Medicare.
To enroll in Part C, they must be enrolled in Medicare Part A and B. This means they have to meet all the eligibility criteria of Part A and B. They must also be a resident of the same service area from where they want the Medicare Advantage Plan.
Prescription Drugs Coverage Plan (Part D)
Medicare Part D is a drug coverage plan. To be eligible to enroll in a PDP, the individual must:
• Be enrolled in Medicare Part A and/or Part B.
• Live in the service area in which you want to enroll.
• Be eligible to enroll in a Medicare Advantage plan with prescription drug coverage (MAPD).
