Medicare Plans

1. You may be enrolled automatically.
2. If you’re not enrolled automatically, you can apply during certain enrollment periods.
3. To qualify, you must meet certain age, residency, or disability criteria.

In order to qualify for Medicare coverage, you must be at least 65 years old and a citizen (or permanent legal resident) of the United States. You also may qualify if you are under 65 and have a disability.

Most seniors will be enrolled in Original Medicare automatically through Social Security. If not, applicants can apply during certain enrollment periods.  Spearfish Insurance Brokerage cannot enroll you in Medicare.  However, we are more than happy to help navigate you through the Medicare process.  We provide free quotes and consultation to help you find the best Medicare health and prescription drug coverage to fill in Medicare gaps for qualified individuals.

Many people are enrolled in Medicare Parts A & B automatically.  You may be enrolled automatically if one of the following applies to you:

• You’re turning 65 and already get Social Security benefits or benefits through the Railroad Retirement Board (RRB).
• You’re under 65, disabled, and have been getting Social Security or RRB benefits for over 24 months.

If you’re automatically enrolled, you will get a Medicare card in the mail 3 months before your 65th birthday. If you don’t want Part B (which requires you to pay an additional premium), you should follow the instructions on the back of the card to reject it.

If you are not enrolled in Medicare automatically, you need to apply during an enrollment period. Enrollment periods are windows when you can join Medicare. There are 3 enrollment windows for getting Medicare Parts A & B:

• Initial Enrollment Period (IEP)
• Special Enrollment Period (SEP)
• General Enrollment Period (GEP)

The Initial Enrollment Period (IEP) is the first window when you can enroll in Medicare.  Your IEP is 7 months long. It starts 3 months before the month you turn 65. It continues through the month you turn 65 and then for another 3 full months after that. So if you turn 65 on June 5, your IEP starts on March 1st (3 months before June) and ends on September 30 (3 full months after June).

If you know you want Medicare coverage, apply as early as possible. The reason you should apply early is if you apply before the month of your 65th birthday, coverage will start immediately. If you apply during the month of your birthday or later, there will be a delay.

A Special Enrollment Period is when you can sign up if you skipped enrollment when you were first eligible because you were covered by an employment-based group health plan. (Note: COBRA and retiree health plans are not considered employment-based group health plans.)

If this situation applies to you, you can enroll in Parts A & B during the following periods:

• Any time when you’re still covered by the group health plan
• During the 8 months after either employment or group coverage ends. The 8-month period starts after whichever of those two ends first.

The General Enrollment Period is when you can sign up for Part A or Part B if you didn’t during the Initial Enrollment Period and aren’t eligible for a Special Enrollment Period.

The General Enrollment Period lasts from January 1 to March 31 of each year. Those who sign up during this time might pay a higher premium and will not receive coverage until July 1 of that year.

Eligible applicants should apply with the Social Security Administration. Before enrolling in Medicare, you should have the following information ready:

• Date and place of birth
• Medicaid number and start/end dates
• Current health insurance information

After the application is submitted, you will be contacted by a Social Security Administration (SSA) representative if they need any additional information. Accepted applicants should receive a decision letter in the mail. If you manually enroll, your card will arrive within 30 days of enrollment.

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Each part of Medicare provides different health care benefits:

• Part A provides uniform hospital insurance benefits.
• Part B provides uniform medical insurance benefits.
• Part C provides the same benefits as Parts A & B, plus additional benefits depending on which plan you buy.
• Part D covers prescription drugs. Actual benefits vary depending on which plan you buy.

Part A

Part A is hospital insurance and is the first half of Original Medicare. It covers inpatient hospital stays, hospice care, and skilled nursing facility care. Medicare Part A includes:

• Inpatient hospital stays
• Hospice care
• Skilled nursing facility care
• Some home health care

Part B

Part B is medical insurance and is the second half of Original Medicare. It covers outpatient hospital care, preventative care, doctor’s services, and other medical services. Medicare Part B includes:

• Certain doctors services
• Outpatient care
• Medical supplies
• Preventative services

Part C (Medicare Advantage)

Part C is insurance that covers the same things as Original Medicare, but it is provided by private companies and usually includes additional benefits, such as prescription drug coverage, vision, dental, and wellness programs. Medicare Part C includes:

• The same hospital and medical care as Original Medicare
• May include drug coverage, vision, dental, or wellness programs, depending on which plan you choose

Part D

Part D is the Prescription Drug Coverage portion of Medicare. The plans are offered by private insurers and not the federal government. Part D is an optional add-on. Medicare Part D includes:

• Prescription drugs

Meeting with the experienced professionals at Spearfish Insurance Brokerage can help you decide which parts of Medicare are right for you, and help you sign up for additional coverage.  We believe in meeting with our clients face to face so that we can better understand and serve your needs.  We provide free insurance coverage quotes at no additional cost or markup to your premium.