FAQ's

a. What is the Medicare Annual Enrollment Period?

Medicare Advantage Plans and Prescription Drug Plans can make changes each year—things like cost, coverage, pharmacy acceptance, and provider network are all important considerations. October 15 to December 7 is when all people with Medicare can change their Medicare Advantage Plan or Prescription Drug Plan for the following year to better meet their needs.

b. When is the Medicare Annual Enrollment Period?

Every year, Medicare’s Annual Enrollment Period is October 15 - December 7.

a. What is the Medicare Open Enrollment Period?
Medicare Beneficiaries who have chosen Medicare Advantage Plans can make one additional change from January 1st to March 31st if they are displeased with their active Advantage Plan. It is important to note that once March 31st has passed, Medicare Beneficiaries must wait until the Annual Enrollment Period to make a change (barring any Special Election Periods). 

b. When is the Medicare Annual Enrollment Period?
Every year, Medicare’s Open Enrollment Period is January 1st to March 31st.

If you're enrolled in a Medicare Advantage Plan or Medicare Prescription Drug Plan, your plan will send you the "Evidence of Coverage" (EOC) and the “Annual Notice of Change” (ANOC) each year in the Fall, no later than September 30th.  

a. Evidence of Coverage (EOC)
The EOC is a complete, detailed book explaining all your current plan’s rules, covered benefits, and procedures for the upcoming year. It’s recommended a recipient review any changes to ensure the plan will continue to meet your needs for the upcoming year.

b. Annual Notice of Change (ANOC)
The Annual Notice of Change is a short summary of what is changing in your plan’s costs, rules, or drug tiers for the next calendar year. Review this notice to see if your plan will continue to meet your health care needs in the coming year.

Medicare is an extremely personalized type of healthcare that we caution is NOT “One Size Fits All”.  While there are many aspects that go into choosing the correct Plan for you, the most important features of your plan should be tailored to your personal healthcare needs, medication requirements and cost, retirement plans, income, location of residence(s), and provider acceptance. 

If you are having issues with Medical or Medication costs, lack of Dental/Vision/Hearing, or finding Doctors that accept your plan, we would encourage you to reach out for a free Medicare Consultation with our Senior Benefits Team.

It is a common misconception that Employer/Group Healthcare is always a better option than making the transition to Medicare. While in some cases this may be true due to certain circumstances such as income or retiree healthcare offerings, we find that in most cases making the move to Medicare is less costly and offers more robust coverage. However, a thorough Cost vs Benefits analysis must be done before that can be determined.

Best practice is to always have a full Medicare Consultation prior to deciding on your Healthcare needs as you approach age 65. Madison Insurance Group Senior Benefits’ Team offers a number of educational opportunities for those approaching this chapter in life including “Turning 65” seminars, one on one Medicare Consultations, Community outreach events, and Employer Partnerships all at no cost!

Medicare and most health insurance plans don't pay for long-term care. Non-skilled personal care, like help with activities of daily living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom. Other items and services Original Medicare DOES NOT cover include:

•    Long-Term Care (also called custodial care)
•    Most dental care
•    Eye exams (for prescription glasses)
•    Dentures
•    Cosmetic surgery  
•    Massage therapy
•    Hearing aids and fitting exams
•    Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)
•    Covered items or services you get from an opt-out doctor or other provider (except in the case of an emergency or urgent need)

a. People who are turning 65 have a 7-month window called the Initial Enrollment Period (IEP) that begins three months prior to your birth month, the month of your birth, and three months after. If you elect not to enroll at this time you will be subject to premium penalties unless you have Creditable Coverage through your Employer’s Group Healthcare Plan.

b. People who have been on Disability for 24 months will receive Medicare Benefits in the 25th month. This will be backdated to the date determined by Social Security as the onset of disability.  

c. Those with ESRD (End Stage Renal Disease)

•    Dialysis Start: Coverage generally begins on the first day of the fourth month of regular dialysis.
•    Home dialysis training: Coverage can start as early as the first month if you join a home dialysis training program.
•    Kidney transplant: Coverage can begin immediately in the month you receive a transplant.
•    Coverage End: Medicare that is solely based on ESRD usually ends 12 months after stopping dialysis or 36 months after a successful transplant.

d.    Those with Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig’s Disease)

•    SSDI approval: Coverage starts immediately in the exact month your Social Security Disability Insurance (SSDI) benefits begin.
•    Waiting period waived: The standard 5-month SSDI waiting period and the 24-month Medicare waiting period do not apply to ALS diagnoses.

Yes, there are penalties for failing to enroll into Original Medicare Part A & Part B, as well as Part D (Prescription Drug Plans). These penalties will stay with you in perpetuity unless you qualify for the Low-Income Subsidy (LIS), a Medicare Savings Plan (MSP), or maintain Creditable Coverage through your Employer’s Group Healthcare Plan (Not COBRA). 

These penalties can be costly and have specific timeframes to which you must adhere. If you feel like you may be vulnerable to a penalty or simply wish to ensure that you don’t accrue one, our Senior Benefits Team is happy to offer you a no cost Consultation to review your personal situation and protect you from getting a penalty or compounding one.