Those 65 or older AND eligible for Social Security. *Anyone at any age who has been on Social Security Disability for 24 months then Medicare begins on the 25th month. *Those with End Stage Renal Disease (ESRD) or *Those with Lou Gehrig’s Disease (ALS)

At age 65 and older Yes you do unless you are covered by a creditable Group or Retiree health plan. Individual health or COBRA are not considered creditable coverage. Failure to maintain creditable coverage could result in both Part B & Part D Late Enrollment Penalties.

The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage. Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.37 in 2022, $32.74 in 2023) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium. The national base beneficiary premium may change each year, so your penalty amount may also change each year.

Part D is prescription drug coverage. In 2006 it became law that Medicare Beneficiaries were required to maintain their own Part D coverage. Failure to Maintain creditable prescription drug plan will result in a penalty as follows: Medicare, not the plan, calculates the late enrollment penalty when a person subject to the penalty first joins a Medicare drug plan. The late enrollment penalty amount typically is 1% of the national base beneficiary premium (also called “base beneficiary premium”) for each full uncovered month that the person didn’t have Part D or other creditable coverage. The national base beneficiary premium for 2020 is $32.74. The monthly penalty is rounded to the nearest $0.10 and added to the monthly Part D premium. As an Example: Mr. Brick joined a Medicare drug plan before the end of his Part D Initial Enrollment Period in February 2017. However, he disenrolled from that Medicare drug plan effective December 31, 2017. He later joined another Medicare drug plan in December 2019 during the Open Enrollment Period and his coverage with his new plan was effective January 1, 2020. Since leaving his last Medicare drug plan and joining the new Medicare drug plan, there was a period of 24 full months in which he didn’t have creditable coverage (January 1, 2018–December 31, 2019). Therefore, starting January 1, 2020, he has to pay 24% (1% for each full, uncovered month that he was without creditable coverage since leaving his first Medicare drug plan and joining his current drug plan) of the base beneficiary premium for 2020 ($32.74). Mr. Brick’s penalty amount is $7.86 each month. Since the monthly penalty is always rounded to the nearest $0.10, he’ll pay $7.90 each month in addition to his plan’s monthly premium in 2020.

Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $4,430 on covered drugs in 2022 ($4,660 in 2023), you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap. Once you reach the coverage gap, you'll pay no more than 25% of the cost for your plan's covered brand-name prescription drugs. You'll pay this discounted rate if you buy your prescriptions at a pharmacy or order them through the mail. Some plans may offer you even lower costs in the coverage gap. The discount will come off of the price that your plan has set with the pharmacy for that specific drug.

There is no one plan for everyone. There may not even be one plan for two members of the same household! Finding the right plan requires knowledge of your current situation. How many doctor’s visits do you make a year? What prescription medications are you on? Does your recent past include multiple hospital stays? Do you travel the United States? Have a second or vacation home? These and many other factors come into play to determine what is best for you. The only way to get as close to a perfect plan as possible is allowing someone like me, Medicare Mike, to help you by asking the right questions, and then be able to give you your options.

There is a place for both types of plans. Medicare supplements (Medigap) are the most known way of supplementing original Medicare. It is also the most expensive way of supplementing Original Medicare. A Typical Medicare Supplement will cover the costs for hospital and medical services eligible for, but not paid for by Medicare. You are required to also purchase a Prescription drug Plan. The one true Plus about Medicare Supplements is that you can see any doctor you like if they accept Medicare. This route is best served for those that require many services from providers like certain hospitals and doctors that do not accept anything but Medicare. Medicare Advantage Plans are not Supplements at all. They take over the Original Medicare Parts A & B and often include Part D with monthly premiums starting at zero dollars. They work like traditional health insurance, in such, as they have co-payments, deductibles, co-insurance. They also come with a Max Out of pocket to protect you from extreme healthcare costs. Some plans even have in and out of network options. Nationwide networks so you can visit in Florida as an example and see a doctor while there for the same cost as you would here. Medicare Advantage Plans also give you coverage you can not get when going with Medicare Supplements such as Hearing, Vision, Dental, Annual Physical (Not just an annual wellness checkup).

Without something called a Special Enrollment Period (SEP) you may not be able to switch plans till Annual Enrollment Period (AEP). Each year, from October 15th-December 7th you can choose your plan that will be effective January 1st. If you do not make the choice by December 7th, then either you will keep the plan you have or be out of luck if you do not have a plan unless you have a special Enrollment Period. Some SEP’s are: *If you move from county to county you can switch plans. *If you move from one state to another you need to switch plans. *If you have Medicare and have, obtained or lost full Medicaid you can switch a few times. *If you obtain, have or lose Extra Help (Low Income Subsidy) from the federal government. *If you are institutionalized, you can switch monthly. *January 1st-March 31st is Open Enrollment Period where one available option would be, if you currently have a Medicare Advantage Plan, you can switch from one to another. *A big one here in NY is called EPIC. If qualified, (Qualifications are easy for most NY seniors) You can use Epic to join or switch plans 1 time a year for any reason. These are just some of the ways you may be able to switch plans.

My job is to work for you. I represent various different companies representing over 40 different plans. Regardless of which plan you choose; I get paid the same amount. There is no incentivizing to steer you in the direction of any plan over another solely for financial gain. I want to be your Plan Advisor for as long as you are on Medicare. The average person is on Medicare for 18 years. I only want what is best for you. I will gather all the information needed to do the proper research to show you what are the best options for you to choose from for your specific needs. A wife could need a different plan from a different company than her husband. All that matters is what works for you! I am here to navigate Medicare with you! I also do not charge one penny for my services ever!

I can offer to assist you without you leaving the comfort of your home and I from my home! I can assist you with Department of Social Security and signing up for Medicare! I can do what I need to do to be compliant at the same time, by doing everything over the phone/computer with you. I can help you sign up for original Medicare Parts A & B. I can even assist you with getting a My social security Account online. Once you get your Medicare Card in the Mail, I can then compliantly take care of finding you the best plan to have. Once I have it narrowed down, I will get you an enrollment kit for each plan we will discuss again over the phone/computer, hold a compliant sales presentation and proceed to writing your plan once you approve. All this at no cost to you and Risk Free.