The Camacho Agency - Licensed Medicare and Health Insurance Agent

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Most people become eligible when they turn 65, but eligibility may begin earlier if you qualify due to disability or certain medical conditions.

Medicare has specific timeframes that dictate when you can sign up for or make changes to your coverage:

IEP (Initial Enrollment Period): A 7-month period that starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. Enrolling during your IEP helps you avoid late enrollment penalties.

AEP (Annual Enrollment Period): Runs from October 15 to December 7 each year. During AEP, you can switch between Medicare Advantage plans, move between Original Medicare and Medicare Advantage, or change Part D plans.

OEP (Medicare Advantage Open Enrollment Period): Runs from January 1 to March 31 for individuals already enrolled in a Medicare Advantage plan. You can switch to a different Medicare Advantage plan or return to Original Medicare and join a Part D plan.

SEP (Special Enrollment Period): You may qualify for a Special Enrollment Period if you experience certain life events, such as moving out of your plan's service area or losing other health coverage.

Medicare costs vary depending on which parts you enroll in:

Part A (Hospital Insurance): Most people pay $0 for Part A if they or their spouse paid Medicare taxes for at least 10 years (40 quarters). If you don't qualify for premium-free Part A, the monthly premium is $285 (30-39 quarters of coverage) or $518 (fewer than 30 quarters).

Part B (Medical Insurance): The standard monthly premium is $185, with an annual deductible of $257. Higher-income beneficiaries pay an additional income-related monthly adjustment amount (IRMAA).

Part C (Medicare Advantage): Premiums vary by plan. Many plans have $0 monthly premiums, though you still pay your Part B premium.

Part D (Prescription Drug Coverage): Premiums vary significantly by plan and location. We can review specific plan costs during your consultation.

Medicare Supplement (Medigap): This is secondary insurance that works with Original Medicare Parts A and B. It pays for the "gaps" that Medicare doesn't cover, like deductibles and 20% coinsurance. You can see any doctor or visit any hospital in the U.S. that accepts Medicare. You pay a monthly premium to the insurance company, and many out-of-pocket costs are covered. Drug coverage requires a separate Part D plan.

Medicare Advantage (Part C): This is a private health plan that replaces your Original Medicare. It bundles Part A, Part B, and usually Part D into one plan. You must use the plan's network of providers to get the lowest costs. Many plans have $0 monthly premiums, and you pay for services as you use them through copayments and coinsurance, up to a yearly maximum out-of-pocket limit.

It depends on your employer coverage. If you or your spouse work for an employer with 20 or more employees and have group health coverage through that employer, you can delay enrolling in Part B without penalty. You'll have a Special Enrollment Period to sign up once your employer coverage ends. However, if your employer has fewer than 20 employees, Medicare becomes primary, and you should enroll in Part B when you're first eligible to avoid gaps in coverage and potential penalties. It's important to review your specific situation, as the rules can be complex.

Yes, you can be denied a Medigap plan. The ability to purchase depends on when you apply.

Medigap Open Enrollment Period: The best time to buy is during your 6-month Medigap Open Enrollment Period, which begins on the first day of the month you're both 65 or older AND enrolled in Part B. During this period, you have guaranteed issue rights. Insurance companies must sell you any plan they offer, regardless of pre-existing conditions, and cannot charge you more due to health status.

Outside Open Enrollment: Once this period ends, companies can use medical underwriting in most states. They can review your health history and may charge higher premiums or deny your application.

Exceptions: Federal law provides guaranteed issue rights in specific situations, such as when your Medicare Advantage plan leaves your area, you lose employer coverage, or you exercise certain trial rights. Some states have additional consumer protections that may allow you to buy a Medigap plan at other times.

If you do nothing, your plan will usually roll over to the next year. However, Medicare Advantage plans are only valid for one calendar year, and companies can make significant changes annually.

What can change:

• Your doctor network: Providers could leave the network, requiring you to find new doctors or pay higher out-of-network costs.

• Your drug formulary: Medications could be dropped or moved to more expensive tiers.

• Your costs: Copayments, deductibles, and maximum out-of-pocket limits can increase.

• Extra benefits: Dental and vision benefits can change significantly.

An annual review during the Annual Enrollment Period (October 15 to December 7) ensures you won't face costly surprises and confirms you're still on the best plan for your needs.

Coverage depends on the specific plan you choose. Each Part D plan and Medicare Advantage plan with drug coverage maintains a formulary, which is a list of covered medications. Drugs are typically organized into different tiers, with different cost-sharing amounts for each tier. During our consultation, we will review your current prescriptions and check which plans cover your medications at the lowest cost. It's important to verify coverage before enrolling, as formularies can change from year to year.

For Medicare Advantage plans, provider networks are specific to each plan. We can check whether your doctors and preferred hospitals are in-network during our consultation. You can also verify this information directly with the insurance company or by checking the plan's online provider directory. If you have Original Medicare with a Medigap policy, you can see any doctor or visit any hospital in the United States that accepts Medicare, so network restrictions do not apply.

Yes, moving often affects your Medicare insurance. Moving triggers a Special Enrollment Period, giving you a limited window to make changes.

Medicare Advantage or Part D plans: These plans are area-specific. When you move out of the plan's service area, you will be disenrolled and must use your SEP to enroll in a new plan available in your new location.

Original Medicare with Medigap: Original Medicare works nationwide, and your Medigap plan is portable across state lines. You can continue to see any doctor in the U.S. who accepts Medicare. However, you must still enroll in a new Part D drug plan that serves your new area.

No matter your coverage type, inform both Social Security and your insurance plan(s) of your move to avoid gaps in coverage and potential penalties.

If you are eligible for both Medicare and Medicaid, you are considered "dual-eligible" and may qualify for a Dual-Eligible Special Needs Plan (D-SNP). These plans coordinate your Medicare and Medicaid benefits into a single plan.

Key features often include:

• Low out-of-pocket costs: Most D-SNPs feature $0 monthly premiums, $0 medical deductibles, and $0 copayments for most services.

• Benefit coordination: The plan handles communication between Medicare and Medicaid.

• Extra benefits: May include dental, vision, transportation, and over-the-counter item credits.

• Care coordination: Many provide a care coordinator to help manage your health needs.

Eligibility for D-SNPs can be specific. Some require a certain level of Medicaid eligibility. Always verify your eligibility for the specific D-SNP you're interested in before enrolling.

There is no cost to you for my services. My advice and assistance are completely free. If you decide to enroll in a plan through my agency, I receive a commission from the insurance company. This means you get expert guidance and ongoing support at no charge, while I earn compensation for helping you find the right coverage.