Vision and hearing care are vital for maintaining independence, social confidence, and overall health as we age. While these benefits are often taken for granted during working years with employer-provided coverage, transitioning to Medicare requires careful evaluation of available plans to ensure your needs are met. We’re here to help you navigate the changing landscape of Medicare Advantage benefits, and today we’ll turn our attention to vision and hearing care.

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Medigap vs. Medicare Advantage: What You Need to Know

Original Medicare doesn’t provide coverage for routine vision exams or hearing aids, though it does cover certain specialist visits, including audiology, optometry, and ophthalmology.

In contrast, Medicare Advantage (Part C) plans have increasingly expanded their vision and hearing benefits to address these gaps. 

As Medicare Advantage plans continue to evolve, they are enhancing their offerings in vision and hearing care, providing more comprehensive coverage for beneficiaries. Let’s take a closer look at what’s changing for 2025 and how you can make the most of your benefits.

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Expanding Vision and Hearing Coverage in 2025

In 2025, Medicare Advantage plans will further standardize and improve their vision and hearing benefits. These updates aim to enhance access to care while potentially lowering out-of-pocket costs for beneficiaries.

• Vision Care Enhancements: Plans are expanding allowances for prescription glasses and contact lenses, as well as covering a broader range of vision services.
• Hearing Aid Benefits: New standalone hearing aid benefits will introduce increasing annual allowances, ensuring beneficiaries can access financial support as their needs evolve:
• Year 1: $500
• Year 2: $1,000
• Year 3: $1,500

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Vision Coverage: What’s Included?

Medicare Advantage plans are designed to address the vision care needs of beneficiaries, offering benefits that often include:

• Routine Eye Exams: Most plans cover annual eye exams, essential for monitoring eye health and updating prescriptions, at no additional cost when using in-network providers.
• Prescription Glasses and Contacts: Many plans offer allowances for eyeglasses or contact lenses, making vision correction more affordable.
• Corrective Eye Surgeries: Some plans provide partial coverage for procedures like cataract surgery or LASIK, helping beneficiaries manage costs for these often-expensive treatments.
• Specialized Vision Devices: Coverage may also include adaptive devices, such as magnifiers, for those with specific vision needs.

Hearing Coverage: What’s Included?

Hearing care is another critical area of focus for Medicare Advantage plans. Here’s what beneficiaries can expect:

• Annual Hearing Exams: Covered by most plans to help identify hearing issues early and provide timely support.
• Hearing Aids and Fittings: Many plans cover the cost of hearing aids, including fittings and adjustments, ensuring the right fit and optimal assistance.
• Standalone Hearing Aid Benefits: As mentioned, these new benefits offer increasing allowances, helping beneficiaries afford hearing aids over time.
• Lower Out-of-Pocket Costs: By reducing copayments and coinsurance for hearing aids and related services, plans to make these essential devices more accessible.

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Maximizing Your Vision & Hearing Benefits

To make the most of your Medicare Advantage vision and hearing benefits, consider these tips:

1. Schedule Preventive Exams Early: Ensure you use the fully covered annual eye and hearing exams provided by your plan.
2. Check Allowances for Glasses and Hearing Aids: Understand your plan’s annual allowances and plan your purchases accordingly.
3. Use In-Network Providers: Save on costs by staying within your plan’s provider network.
4. Evaluate Your Plan During AEP: Use the Medicare Annual Enrollment Period to compare plans and switch to one that better fits your vision and hearing needs if necessary.

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Look Ahead to 2025 with Emerald Medicare

Medicare Advantage plans are continually enhancing their vision and hearing benefits, making them an attractive option for beneficiaries seeking comprehensive healthcare coverage. At Emerald Medicare, we’re here to guide you through these changes and ensure you find the best plan for your needs.

If you’re ready to explore your Medicare Advantage options, our team of expert advisors is here to help. Click below to schedule an appointment with one of our brokers through Calendly, or contact us directly at the number or email below.

Contact Us:

• Phone: (888) 683-6372 or (845) 358-1220
• Email: office@emeraldmedicare.com

As your trusted Medicare experts, Emerald Medicare is committed to helping you navigate your healthcare options with ease. Medicare Advantage (Part C) plans are a popular choice among beneficiaries, offering comprehensive coverage with additional benefits not included in Original Medicare. If you’re considering Medicare Advantage, this guide will walk you through how these plans work, their benefits, and how to choose the best plan for your needs.

What is Medicare Advantage?

Medicare Advantage (Part C) is an alternative to Original Medicare (Parts A & B) offered by private insurance companies approved by Medicare. These plans bundle hospital (Part A), medical (Part B), and prescription drug coverage (Part D) into one all-inclusive plan. Many also offer extra benefits like dental, vision, hearing, and even wellness programs—making them an attractive option for those seeking added value beyond traditional Medicare.

With Medicare Advantage, all healthcare services are managed through your plan’s network of doctors, hospitals, and pharmacies. While this structure helps control costs, it’s important to understand how provider networks function before enrolling, and how this may limit your options for medical care.

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What Do Medicare Advantage Plans Cover?

Unlike Original Medicare, which requires separate coverage for prescriptions (Part D) and supplemental benefits (Medigap), Medicare Advantage plans integrate multiple types of coverage into a single, bundled plan. Here’s what’s typically included:

Hospital Coverage (Part A) – Inpatient stays, skilled nursing facility care, and some home healthcare services.
Medical Coverage (Part B) – Doctor visits, outpatient services, diagnostic tests, preventive care, and durable medical equipment.
Prescription Drug Coverage (Part D) – Most Medicare Advantage plans include built-in drug coverage, covering a range of prescription medications.

Additional Benefits – Many Medicare Advantage plans also offer:

• Dental Coverage (routine cleanings, fillings, dentures, etc.)
• Vision Coverage (eye exams, glasses, and contacts)
• Hearing Coverage (hearing exams and hearing aids)
• Fitness Benefits (gym memberships, virtual exercise programs)
• Transportation (rides to medical appointments)
• Over-the-Counter (OTC) Allowances (stipends for medical supplies and everyday wellness products)

Because benefits vary by plan, it’s essential to compare options carefully or consult a Medicare expert to find the best fit for your healthcare needs.

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Why Should I Choose a Medicare Advantage Plan?

Medicare Advantage plans combine coverage, convenience, and cost savings into a single plan, making them a great option for many beneficiaries. Here’s why they appeal to millions of Medicare enrollees:

1. Comprehensive Coverage

Unlike Original Medicare, which requires additional plans for prescriptions and supplemental coverage, Medicare Advantage offers all-in-one protection with extra benefits.

2. Lower Out-of-Pocket Costs

Many Medicare Advantage plans have low or $0 monthly premiums, and they cap out-of-pocket expenses, protecting beneficiaries from excessive costs. In contrast, Original Medicare has no limit on annual medical expenses unless paired with a Medigap policy.

3. Extra Benefits Beyond Original Medicare

With dental, vision, hearing, and wellness perks, Medicare Advantage covers services not included in traditional Medicare, making healthcare more affordable and accessible.

4. Preventive Care & Care Coordination

Many Medicare Advantage plans focus on preventive care and managed healthcare, offering case management services, wellness incentives, and telehealth options for added convenience.

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Medicare Advantage vs. Medigap: Key Differences

Understanding the distinction between Medicare Advantage and Medigap (Medicare Supplement Insurance) is crucial when choosing a plan.

Medicare Advantage is best for those who prefer bundled coverage and lower upfront costs, while Medigap is ideal for those who want broad provider access and more predictable expenses.

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How to Choose the Right Medicare Advantage Plan

When selecting a Medicare Advantage plan, consider the following:

🔹 Provider Network: Does your preferred doctor, hospital, or pharmacy accept the plan? HMOs require referrals and network providers, while PPOs offer more flexibility.
🔹 Prescription Drug Coverage: Check the plan’s formulary (covered drug list) to ensure your medications are included.
🔹 Extra Benefits: Need dental or vision care? Want access to telehealth or home fitness programs? Compare added perks to find a plan that suits your lifestyle.
🔹 Out-of-Pocket Costs: Compare premiums, deductibles, copays, and maximum out-of-pocket (MOOP) limits to determine your total expected expenses for the year.
🔹 Star Ratings: Medicare.gov rates plans on a 5-star scale based on customer satisfaction and quality of care. A higher-rated plan often means better coverage and service review from real beneficiaries.

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How to Enroll in a Medicare Advantage Plan

You can enroll in a Medicare Advantage plan during specific enrollment periods:

📌 Initial Enrollment Period (IEP) 
Starts 3 months before you turn 65 and continues 3 months after your birthday month.
📌 Annual Enrollment Period (AEP) 
October 15th – December 7th each year. You can switch, join, or drop a Medicare Advantage plan.
📌 Medicare Advantage Open Enrollment Period
January 1st – March 31st each year. If you’re already enrolled in a Medicare Advantage plan, you can switch to a different plan or return to Original Medicare during this time.

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Explore Medicare Advantage with Emerald Medicare

Choosing a Medicare Advantage plan is an important decision that requires careful consideration of your healthcare needs, provider preferences, and financial situation. At Emerald Medicare, we’re dedicated to helping you find the best-fit plan with zero-cost expert guidance.

If you’re considering a Medicare Advantage plan or need help comparing options, we’re here for you! Click below to schedule an appointment with one of our expert brokers through Calendly or contact us directly:

As your dedicated team at Emerald Medicare, we understand that navigating the Medicare enrollment process can be overwhelming. That’s why we’re here to provide clarity on one of the most valuable options available to Medicare beneficiaries: Medicare Supplement Insurance, also known as Medigap. This comprehensive guide will walk you through what Medigap plans are, how they work, and how they can benefit you by filling the gaps left by Original Medicare.

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What are Medicare Supplement (Medigap) Plans?
A Comprehensive Guide

A Medigap plan (Plan G, Plan N, etc.) is private health insurance designed to work alongside Original Medicare (Parts A & B).

While Original Medicare provides broad coverage, it doesn’t cover everything. For example, beneficiaries are still responsible for certain deductibles, co-pays, coinsurance, and out-of-pocket costs. Medigap plans help cover these “gaps” in Medicare, providing financial protection and peace of mind.

Here’s how it works:

• Original Medicare pays for its share of covered healthcare services (typically 80% of approved costs).
• Medigap plans help pay for the remaining out-of-pocket costs, like the 20% co-insurance on doctor visits or hospital stays.

What Do Medigap Plans Cover?

Medigap plans can help pay for various out-of-pocket expenses that Original Medicare doesn’t cover. Depending on the Medigap plan you choose, it may cover:

• Medicare Part A coinsurance and hospital costs
• Medicare Part B coinsurance or copayments
• The first three pints of blood used in a medical procedure
• Part A hospice care coinsurance or copayments
• Skilled nursing facility care coinsurance
• Part A deductible
• Part B deductible (for some older plans)
• Part B excess charges
• Foreign travel emergency coverage (up to plan limits)

Each Medigap plan is standardized, meaning that the benefits for each plan type are the same no matter which insurance company offers the plan. For example, Medigap Plan G from one insurance company will offer the same benefits as Medigap Plan G from another. However, premiums can vary based on things like your home state, income, and more, so it’s essential to compare offerings or work with a Medicare broker, like our team at Emerald Medicare, to find the best plan for your needs and budget.

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Why Should I Choose a Medigap Plan?

Medigap plans, as opposed to Medicare Advantage (Part C) plans, are particularly beneficial for individuals who:

• Want predictable healthcare costs: If you want to avoid unexpected out-of-pocket expenses, a Medigap plan can provide peace of mind by covering those costs.
• Travel frequently: Some Medigap plans offer coverage for medical care when traveling outside the U.S. (a benefit not offered by Original Medicare).
• Need frequent medical care: If you visit doctors or specialists regularly or require frequent hospital stays, Medigap plans can help reduce the financial burden of these services.
• Prefer flexibility in healthcare providers: Unlike Medicare Advantage plans, Medigap plans don’t have network restrictions. You can see any doctor or specialist nationwide who accepts Medicare.

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Medigap vs. Medicare Advantage: What’s the Difference?

It’s essential to understand that Medigap and Medicare Advantage plans are different, and you cannot have both – only one or the other.

• Medigap works with Original Medicare (Parts A and B) to cover out-of-pocket medical costs, like co-insurance and/or certain deductibles. However, as prescription medications are not covered by Medigap plans, you are also required to enroll in a Part D plan (Prescription Drug Plan) when enrolling in a Supplemental plan. In tandem, A Medigap plan + a Prescription Drug Plan is a highly comprehensive option for a higher monthly premium – with less restrictions than Medicare Advantage. Any doctor’s office in America will accept your Medigap insurance as long as their office accepts Medicare.

• Medicare Advantage (Part C) is an alternative to Medicare Supplement + Part D coverage that combines hospital, medical, and drug coverage into one all-encompassing plan, often including additional benefits like dental or vision. However, Medicare Advantage plans all have their own unique network of ‘preferred’ medical providers that beneficiaries are limited to, meaning the patient will be 100% financially responsible for services received from Out-Of-Network doctors. Furthermore, some Medicare Advantage plans provide less comprehensive drug coverage when compared to dedicated Prescription Drug Plans (Part D) and their formularies.

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How to Enroll in a Medigap Plan

You can enroll in a Medigap plan during your Initial Enrollment Period [IEP] – which begins as you approach age 65 – after enrolling in Original Medicare (Parts A & B). This six-month IEP window is critical because during this time, you have guaranteed issue rights, meaning insurance companies can’t deny you coverage or charge higher premiums based on your health status. After this period, you may still be able to apply for a Medigap plan, but insurers can use medical underwriting to determine your eligibility and rates.

How to Choose the Right Medigap Plan

Choosing the right Medigap plan depends on your specific healthcare needs, budget, and lifestyle. Here are a few tips to help you decide:

1. Assess your current health needs: If you frequently visit doctors or specialists, a Medigap plan that covers Part B copayments and coinsurance can be very beneficial.
2. Consider your travel habits: If you travel frequently, especially outside the U.S., look for a Medigap plan that includes foreign travel emergency coverage.
3. Plan for the long term: While some Medigap plans may have higher premiums, they can save you money in the long run by limiting out-of-pocket expenses.
4. Consult with a Medicare broker: A licensed Medicare broker, like the experts at Emerald Medicare, can help you compare different Medigap options, review costs, and find the plan that best suits your needs.

For advice on choosing a Prescription Drug Plan, read our Blog Post to learn more:  

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Explore Medigap Options with Emerald Medicare

At Emerald Medicare, we’re here to help you make informed decisions about your healthcare. Medigap plans can be a great way to secure financial peace of mind while ensuring that you get the care you need. Our team of licensed Medicare experts will guide you through the process, helping you understand your options and choosing a plan that fits your unique needs.

If you’re interested in learning more about Medigap plans or need help finding the right one for you, we’re here to help. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us directly:

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

Medicare Open Enrollment is one of the most important times of the year for Medicare beneficiaries. It’s your opportunity to review your current healthcare coverage, make changes, or enroll in a new plan to better suit your needs. As your trusted Medicare experts, Emerald Medicare is here to help guide you through the process with objectivity and always with your best interest in mind.

What Can You Do During Medicare Open Enrollment?
During AEP, you have several options for updating your Medicare coverage, including:

1. Switching from Original Medicare to Medicare Advantage
If you’re currently enrolled in Original Medicare (Parts A and B) which is only 80% medical coverage and no Part D coverage and may want to explore additional ancillary benefits and look at the option of a Medicare Advantage (Part C and D) plan. Medicare Advantage plans often offer coverage beyond Original Medicare, such as dental, eye exams, hearing, and prescription drug coverage.

2. Switching from Medicare Advantage back to Original Medicare
If your Medicare Advantage plan no longer meets your needs or you prefer the flexibility of Original Medicare, you may be able to switch back to Original Medicare during AEP based on the state you live in and the pre-existing rules for each state. You may also want to consider enrolling in a Medicare Supplement (Medigap) plan to help cover more of the out-of-pocket costs but with a higher premium cost. These plans are offered without some of the ancillary benefits the Medicare Advantage plans offer.

3. Changing Medicare Advantage plans
If you’re already enrolled in a Medicare Advantage plan but are unsatisfied with your coverage, you can review your doctors and medications to consider a change to a different Medicare Advantage plan during AEP that best suits your health and your needs . This is the best time of year to compare plans and ensure you’re getting the best benefits that you need or want at the cost that fits your budget.

4. Enrolling in or changing your Medicare Part D (Prescription Drug Plan)
If you’re not currently enrolled in a Medicare Part D plan and need prescription drug coverage, you can sign up for one during AEP. Also, you can change to a different Part D plan when you are on Original Medicare if your current plan’s formulary, premiums or co-pay costs has changed.

Key Dates for Medicare Open Enrollment

• October 15: Open Enrollment begins. This is your first chance to review your current coverage and make any changes or enroll in new plans for the upcoming year.
• December 7: Open Enrollment ends. After this date, you won’t be able to make changes to your Medicare coverage unless you qualify for a Special Enrollment Period (SEP). Check with your broker if you have the need to change any of your plan decisions after this date.
• January 1: Any changes made during Open Enrollment will go into effect on this date.

Tips for Making the Most of Medicare Open Enrollment

1. Review Your Current Coverage
• Before making any changes, take the time to review your current plan’s coverage for the new year. A Annual Notie of Change is the document that was sent to you with any changes that your plan is offering for the new year. Ask yourself if your needs or budget have changed over the past year. Have you been prescribed new medications or seeing any new doctors? Do you need additional coverage, such as dental or eye exam coverage?
2. Compare Plans on Medicare.gov
• One of the best tools for comparing Medicare plans is the Medicare Plan Finder on Medicare.gov. This website allows you to compare costs, coverage, and carrier ratings of different Medicare Advantage, Part D, and Medigap plans. The Emerald Medicare team uses this trusted resource to help our Medicare enrollees find the best options for their healthcare needs.
3. Consider Your Medications
• Prescription drug coverage is a critical component of Medicare. If you take medications regularly, it’s important to ensure that your Part D plan’s formulary (the list of covered drugs) still covers your prescriptions at an affordable cost. Make sure to compare different Part D plans to avoid surprises in the new year.
4. Check Your Providers
• If you’re considering a Medicare Advantage plan, it’s important to confirm that your preferred doctors, specialists, and facilities are in-network. Provider networks can change from year to year, so always verify that your healthcare team will be covered by the plan you choose.
5. Look for Changes in Benefits
• Medicare Advantage plans often update their benefits from year to year. During AEP, review the benefits offered by different plans, such as coverage for dental, vision, hearing, and fitness memberships. Be sure to choose a plan that offers the additional benefits you value most. Review your Annual Notice of Change documentation that you received in the mail. Called a ANOC.
6. Get Help from a Medicare Broker
• The Medicare Open Enrollment period can feel overwhelming, but you don’t have to go through it alone. By working with a Medicare broker, you can get expert, personalized advice based on your healthcare needs and budget. At Emerald Medicare, we can walk you through all your options and help you make the best choice for the coming year.

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Stay Prepared for Open Enrollment with Emerald Medicare

The Medicare Annual Enrollment Period is your best chance to review your healthcare coverage and make the changes that will benefit you in the year ahead. By taking the time to compare plans, review your current coverage, and explore new options, you can ensure you have the right plan for your needs.

Need help navigating Medicare Open Enrollment? At Emerald Medicare, we’re here to provide the expert guidance you need to make informed decisions. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us directly at the number or email below.

Contact Us:

• Phone: (888) 683-6372 or (845) 358-1220
• Email: office@emeraldmedicare.com

As your go-to team of Medicare experts, we’re here to help you navigate your options with confidence. We understand how crucial it is to have the right prescription drug coverage. Choosing a Medicare Part D plan can be overwhelming with so many options available, but with the right guidance, you can find the best available drug plan that fits your needs and budget each year. In this post, we’ll provide tips on how to select the best Medicare Part D plan based on your individual needs, ensuring that you have access to the medications you require without unnecessary expenses.

What is Medicare Part D?

Medicare Part D is the prescription drug coverage component of Medicare. It helps cover some of the cost of prescription medications, which are not included under Original Medicare (Parts A and B). Part D plans are offered by private insurance companies, whom have been approved by Medicare. These plans are typically combined with a stand-alone Medigap plan, or in some cases, a Medicare Advantage plan. The specifics of each plan—such as the drugs covered, co-pay costs, and pharmacy networks—can vary significantly depending on the plan year, insurance carrier, and more.

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Tips for Choosing the Right Part D Plan

1. Assess Your Prescription Drug Needs

Evaluate Your Medications: Start by making a list of all the prescription medications you currently take, including the dosage and frequency and your preferred pharmacies. This list will be important when comparing different Part D plans, as each plan has its own formulary (the list of covered drugs and costs).

Consider Future Needs: Think about any potential changes in your medication needs since you last made this Medicare decision. If your doctor has mentioned that you might need new medications in the future, choose a plan that includes those medications.

2. Compare Formularies

Check Drug Coverage: Not all Part D plans cover the same medications. With the assistance of a broker or by your own research, review the formularies of each plan to confirm that your current medications are covered and at what cost. Some plans may cover certain drugs at a lower cost than others, which can significantly affect your out-of-pocket expenses throughout the year.

Understand Tiers: Many Part D plans categorize drugs into tiers, with each tier having different costs. Typically, generic drugs are in lower tiers and are more affordable, while brand-name and specialty drugs are in higher tiers and cost more. Knowing what tier your medications fall into on each plan’s formulary is helpful when looking at yearly costs or discussing options with your doctor.

3. Evaluate Costs Beyond Premiums

Look at the Big Picture: Calculate your expected annual costs based on the medications you take and the coverage each plan offers using medicare.gov. If you notice a very expensive drug, look at discount cards such as GoodRx for lower cost options.

4. Review the Pharmacy Network

Check Preferred Pharmacies: Each Part D plan has a network of pharmacies where you can fill your prescriptions. However, some plans offer lower medication costs at partner, “preferred” pharmacies. It’s essential to compare drug prices from multiple pharmacies.

Mail-Order Options: If you prefer the convenience of having your medications delivered, look for a plan that offers a mail-order pharmacy option. This can in many cases save you money but certainly can save you time.

5. Use Medicare.gov for Research

The best way to compare Part D plans is by using a reliable Medicare broker or by accessing Medicare.gov, the official Medicare website. This is the same tool that your Emerald Medicare team utilizes to research and identify the best coverage options for your specific health needs. The website allows you to enter your medications and compare plans based on costs, coverage, tiers, pharmacies, zip code, and more.

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Block Out the Confusion with Emerald Medicare

Choosing the right Medicare Part D plan is a critical step in managing your healthcare costs and ensuring you have access to the medications you need. By carefully considering your medication needs, costs, and pharmacy preferences, and using trusted resources like Medicare.gov, you can make an informed decision on your Part D coverage each year.

As Medicare’s Open Enrollment Period approaches, the Emerald Medicare team is here to help. This will be an especially challenging year for changes occurring with Medicare Part D plans. We’re committed to delivering personalized assistance and finding the best Part D plan options to meet your needs for the current year. Click below to schedule an appointment with one of our expert Medicare advisors through Calendly, or contact us directly at the number / email below.

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

As your trusted Medicare resource with Licensed Medicare experts, we know that understanding Medicare eligibility and the enrollment process can often overwhelming or confusing. Whether you’re approaching age of 65 or considering retirement, or navigating Medicare eligibility for yourself or a loved one, this guide will help clarify who qualifies for Medicare and how to navigate the enrollment process.

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Who Qualifies for Medicare?

The most common way to qualify for Medicare is by reaching the age of 65. If you or your spouse have worked and paid Medicare taxes for at least 10 years (40 quarters), you’re eligible for premium-free Medicare Part A (hospital insurance). Medicare Part B (medical insurance) is available for a monthly premium based on your adjusted gross income from your tax return income from 2 years prior.

If you’re under 65 but have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, you automatically qualify for Medicare. You’ll receive Medicare Parts A and B, just like someone who qualifies based on age. Based on the health insurance you have access to currently you may or may not accept Part B at that time.

Individuals of any age with End-Stage Renal Disease (ESRD), requiring regular dialysis or a kidney transplant, qualify for Medicare. Coverage usually starts the first month of dialysis if you apply promptly.

If you have ALS, you automatically qualify for Medicare the first month you start receiving SSDI benefits, with no 24-month waiting period.

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How to Apply for Medicare

Already Receiving Social Security: If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. Your Medicare card will arrive in the mail about three months before your 65th birthday. Based on your specific situation if you are working or covered through your spouse you may keep your company coverage or consider Medicare options at this time. If you choose to keep the company coverage you would need to reject your Part B so that the premium for Part B does NOT come out of your social security check. This decision is an important one and our suggestion is to consult with an experienced Medicare advisor to guide you properly to your best course of action at this stage.

If you’re not receiving Social Security benefits, you will need to be proactive in signing up for Medicare on your own when the time is right. You can do this through the Social Security Administration (SSA) website, by phone by scheduling an appointment, or in person at your local SSA office. Consult a medicare expert to ensure you avoid timing and/or penalty issues. 

The Initial Enrollment Period is a seven-month window that includes the three months before your 65th birthday, the month of your birthday, and the three months after. This is your first opportunity to sign up for Medicare Parts A and B. This ONLY applies to individuals who are self-employed, unemployed or working for a company of less than 20 employees. This is often a very often misunderstood aspect of Medicare.

If you’re still employed (for a company greater than 20 employees) and covered by an employer’s health plan, you can delay enrolling in Part B without penalty. Once your employment ends, you’ll have an eight-month Special Enrollment Period to sign up for Part B before you would incur a penalty. Each person’s situation is different based on the cost of Cobra for you and your family and the quality and details of coverage your company provides.

Missed Initial Enrollment: If you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you can enroll in Medicare during the General Enrollment Period, which runs from January 1 to March 31 each year. However, a late enrollment penalty may apply.

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Understanding Medicare Parts A and B

Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Medicare Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical supplies.

Understanding these components is crucial for selecting the right coverage and avoiding potential penalties. To learn more, click below to read our blog post on Medicare Parts A and B. 

Take Charge of Your Medicare Journey with Emerald Medicare

Navigating Medicare eligibility and enrollment can be overwhelming, but you don’t have to do it alone. Our team of Licensed Medicare experts is here to guide you through every step of the process, ensuring you make informed decisions about your healthcare coverage. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us via the provided phone number or email.

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com