Are You Turning
65 This Year?
You are eligible to
sign up for Medicare.
Medicare 101
As a family medicine practice, Internal Medicine and Pediatrics of West Michigan takes care of patients of all ages. We understand that cost is often a barrier to getting care. Choosing the right health coverage for you can keep you healthy by making it easier to get the care and medicine you need. That’s why we want to help our senior patients understand how Medicare works, so you can choose the best type of plan for your needs.
ABCDs of Medicare
Medicare Part A
As the hospital insurance part of Original Medicare, Part A helps cover inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, and home health care.
Medicare Part B
As the medical insurance part of Original Medicare, Part B helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and many preventive services like vaccines and wellness visits.
Medicare Part C
Medicare Advantage plans are often referred to as Medicare Part C. These plans are offered by private companies that agree to follow the rules set by Medicare. They cover everything Medicare Parts A and B cover, and often include Part D benefits as well. They may also include benefits for vision, dental, and hearing care, plus extra benefits like transportation to medical appointments, over-the-counter health items, and fitness programs.
Medicare Part D
Original Medicare doesn’t include coverage for prescription drugs, so you need to buy a Part D plan. You can join a Medicare drug plan in addition to Original Medicare or by joining a Medicare Advantage plan with drug coverage.
And then, there’s Medigap
People who choose Original Medicare often buy extra insurance, called supplemental or Medigap, from a private company. Sometimes this is offered as part of a retirement plan from your employer. This coverage helps pay for deductibles and co-insurance, which is the percentage of costs you are responsible for after Medicare pays its share. It may also cover care while you travel out of the U.S.
Enrollment Periods
There are four types of enrollment periods. It’s important to understand them and enroll on time. If you don’t, you could miss your opportunity or be penalized with higher premiums.
Initial Enrollment Period:
You are eligible to sign up for Medicare during the seven-month period beginning three months before the month you turn 65 and ending three months after your birthday month. With some exceptions, such as if you or your spouse are still working and have health insurance through your employer*, you must enroll during this period. If you don’t enroll on time, you will have to pay higher premiums each month for the rest of your life.
Annual Enrollment Period:
The annual enrollment period takes place from October 15 through December 7 of each year. During this period, you may enroll in a Medicare Advantage plan if you currently have a different type of Medicare.
Open Enrollment Period:
The open enrollment period takes place January 1 through March 31 each year. During this period, you may switch from one Medicare Advantage plan to another, or from a Medicare Advantage plan to an original Medicare plan plus a Medicare Part D plan.
Special Enrollment Periods:
Outside of the initial, annual, and open enrollment periods, you can only change plans if you meet certain
criteria, such as:
• You move to a different county where there are different choices of plans available.
• You recently returned to the U.S. after being a permanent resident in a different country.
• You had a change in your income or assets that changed your Medicaid or Extra Help eligibility.
• You lost other coverage due to your plan losing its contract with Medicare, or you are no longer receiving employer or union coverage.
• Your eligibility for a Special Needs Plan that offers help for specific medical conditions changed.
Know The Difference
Internal Medicine and Pediatrics of West Michigan accepts Original Medicare and is in-network with Medicare Advantage plans offered by Blue Cross and Blue Shield of Michigan, Blue Care Network, Humana, and Priority Health.
We encourage you to compare the differences between Original Medicare and Medicare Advantage to make the best choice for you, whether you are approaching your initial enrollment period or are in the annual or open enrollment periods or are eligible for a special enrollment period.
How to Choose
The good news is that although Medicare can be tricky to navigate, there are many resources available to help.
• You can search for and compare plan options available where you live on Medicare.gov.
• You can talk to a local licensed benefit consultant who can help you understand your options. If you don’t already have a relationship with an insurance broker who sells Medicare plans, Larri Luthy at Lighthouse in Grand Rapids is available to educate our patients on Medicare.
Have Questions?
Larri Luthy at Lighthouse in Grand Rapids is available to educate our patients on Medicare.
616-698-7373 • lluthey@lighthousegroup.net
* To delay signing up for Medicare without a penalty, insurance from your employer must be comprehensive enough to be considered “creditable.” COBRA and most retirement benefits do not count toward this exemption.