WELCOME TO WEDGEFIELD - A Deed Restricted Community

NEWS AND VIEWS ABOUT MEDICARE by Tom Walyus

1. You first become eligible for Medicare by age when you turn age 65. There are special circumstances that you can become eligible for medicare under age 65 if you have been receiving SSI disability income for 24 months. You have to apply for Medicare under age 65 to see if you qualify.
2. Your Red, White and Blue Medicare card is called “Original Medicare” by the Federal Government to differentiate it from the various Medicare Supplements, Medicare Advantage Plans and Prescription Drug Plans.
3. CMS stands for the Center for Medicare Services. CMS and Medicare are the same entity/agency of the Federal Government under the Department of Health and Human Services.
4. Original Medicare Part “A” is called Hospital and has a zero monthly premium; this is an entitlement at no cost.
Original Medicare Part “B” is for doctors and medical services. The monthly premium varies by income. This is subject to change for new Medicare beneficiaries in the future. If someone has a financial hardship and can not afford the Part “B” premium, Social Security can evaluate if the person qualifies for Medicare to pay all or a part of the Part “B” premium.
5. One can enroll for Medicare three months prior to your birth month. Social Security will enroll you into Medicare parts A & B. You can also go onto “ medicare.gov” and follow the instructions for enrollment. The Social Security Administration will also make an appointment at a local field office to enroll you in person.
6. The IECP us the initial enrollment coverage period. This is 3 months before, the month of and three months after your birth month. This is a guaranteed issue period for Medicare Supplements. Original Medicare pays 80% of all Medicare approved expenses. The consumer is responsible for the 20% that Medicare does not pay. Medicare Supplements are also know as Gap Plans as they pay the 20% that Medicare does not pay subject to the plans terms and conditions.
7. An SEP is a qualifying event that creates a Special Election Period out side of the 45 day Annual Election Period or AEP. Moving into a new service area, moving into Florida, losing employer group insurance are all examples of an SEP. Every year CMS designates October 15 to December 7 as the 45 day annual election period where consumers are able to make plan changes and enroll in different plans.
8. Health Insurance Agents must licensed by the Florida Department of Insurance Office. Every two years health agents must complete 20 hours of continuing education with a passing score. An agent must be appointed by the Insurance Carrier to transact business and enroll consumers in plans. Every year CMS requires health agents to complete online classes and pass exams to be certified by CMS for Medicare Advantage HMO, PPO and RXPDP plans.
In addition to this the health insurance carrier has additional product specific training, seminars and final exams on products, procedures and compliance with CMS rules and regulations. Every year each health insurance agent undergoes 40 to 60 hours of training and certification.
9. For additional information feel free to contact Thomas Walyus at 407-766-4780.