Individuals with a Medicare Advantage or prescription drug plan are generally "locked in,” which means they can switch Medicare plans only during certain times of the year, such as during Medicare’s Annual Enrollment Period (AEP) or the Open Enrollment Period (OEP).
What is the lock in provision?
lock-in clause. A mortgage provision that prohibits prepayment of the loan during a portion or the entire term of a loan. The purpose of such mortgage agreements is to ensure that the lender receives its anticipated yield during the lock-in period.
When Medicare runs out what happens?
For days 21–100, Medicare pays all but a daily coinsurance for covered services. You pay a daily coinsurance. For days beyond 100, Medicare pays nothing. You pay the full cost for covered services.
Does Medicare automatically kick in at 65?
Yes. If you are receiving benefits, the Social Security Administration will automatically sign you up at age 65 for parts A and B of Medicare. (Medicare is operated by the federal Centers for Medicare & Medicaid Services, but Social Security handles enrollment.)
Can you put Medicare on hold?
Generally speaking, if you (or your spouse) have group coverage at a company with 20 or more employees, you can delay signing up for Medicare. Some workers sign up for Part A (hospital coverage) because it typically comes with no premium and then delay Part B (outpatient care) and Part D (prescription drug coverage).
Is Medicare about to collapse?
At its current pace, Medicare will go bankrupt in 2026 (the same as last year's projection) and the Social Security Trust Funds for old-aged benefits and disability benefits will become exhausted by 2034.
What is the 3 day rule for Medicare?
The 3-day rule requires the patient have a medically necessary 3-consecutive-day inpatient hospital stay. The 3-consecutive-day count doesn't include the discharge day or pre-admission time spent in the Emergency Room (ER) or outpatient observation.
Can I get Medicare Part B for free?
While Medicare Part A – which covers hospital care – is free for most enrollees, Part B – which covers doctor visits, diagnostics, and preventive care – charges participants a premium. Those premiums are a burden for many seniors, but here's how you can pay less for them.
Is Medicare Part A free?
Most people don't pay a monthly premium for Part A (sometimes called "premium-free Part A"). If you buy Part A, you'll pay up to $499 each month in 2022. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $499.
How soon before you turn 65 should you apply for Social Security?
You can apply up to four months before you want your retirement benefits to start. For example, if you turn 62 on December 2, you can start your benefits as early as December, and apply in August. Even if you are not ready to retire, you still should sign up for Medicare three months before your 65th birthday.
Can you defer Medicare if you are still working?
As long as you have group health insurance from an employer for which you or your spouse actively works after you turn 65, you can delay enrolling in Medicare until the employment ends or the coverage stops (whichever happens first), without incurring any late penalties if you enroll later.
What happens if you decline Medicare Part B?
Declining Part B Coverage If you don't have other insurance, you'll have to pay an additional 10% on your premium for every full year that you decline Part B coverage. In 2022, the Medicare Part B premium is $170.10 or a bit less per month, depending on your situation. It's higher if your annual income is over $91,000.
Can I keep my Medicare if I go back to work?
Under this law, how long will I get to keep Medicare if I return to work? As long as your disabling condition still meets our rules, you can keep your Medicare coverage for at least 8 ½ years after you return to work. (The 8 ½ years includes your nine month trial work period.)
What is hospital indemnity insurance?
Hospital indemnity insurance is a supplemental insurance plan that will help pay for hospital admission costs that are not covered by other insurance. Some of these plans offer cash payments to help pay for any extra expenses accrued during hospital stays, as well as deductibles, observation stays, surgeries, medications and more. These plans are beneficial for people with Medicare Advantage Plans, which can sometimes leave beneficiaries with large bills from hospital stays.
Does Medicare cover long term care?
Many Medicare beneficiaries are under the impression that long-term care, such as stays in nursing homes or assisted living facilities, is covered by Original Medicare. Unfortunately, this is not the case, so when selling Medicare products, it is important to note to your clients that long-term care is generally not covered. While Medicare does cover certain things that are deemed medically necessary by a doctor, for the most part, it will not cover costs for people who need custodial care (including non-medical needs such as eating and bathing). This is a great opportunity to suggest long-term care insurance, and if they will not qualify for it, suggest a short-term care insurance plan instead.
Does Medicare Supplement offer dental insurance?
Original Medicare and Medicare Supplement Plans do not offer dental, vision or hearing insurance. These plans are the perfect products to cross-sell to your clients because no underwriting is necessary for them, and they are typically inexpensive. You can help your customers find a plan that offers them the extra coverage they need at a very attractive price.
What is a SNP plan?
SNPs are specific Medicare Advantage (MA) plans that allow the certain people who qualify for them to enroll in an SNP at that time — even if it’s outside of the Annual Enrollment Period. There are two main types of SNPs that agents can sell: Chronic Condition Special Needs Plans (C-SNPs) and Dual Eligible Special Needs Plans (D-SNPs). You already sell Medicare products. Why not start offering these similar types of plans and keep selling Medicare year-round?
Does Medicare cover long term care?
Did you know that long-term care (LTC) costs are one of the greatest financial risks for someone in retirement? Many people, probably quite a few of your clients, incorrectly believe that Medicare will cover the costs associated with a nursing home or assisted living facility stay if they need one when they’re older. However, Medicare won’t cover LTC costs for people in need of “custodial” care — they’ll only help pay for costs if the care is deemed “medically necessary.”
Does Medicare cover dental and vision?
You may be surprised to learn (or maybe not if you’re the knowledgeable agent we think you are) that Original Medicare and Medicare Supplements don’t cover basic dental, vision, and hearing (DVH) exams and services. And while MA plans often offer DVH benefits, their coverage of DVH exams and services isn’t extremely comprehensive. That’s why DVH plans make for another great product type to cross-sell to your Medicare clients! Many people are used to having this type of coverage through a previous employer and already understand it. Plus, no underwriting is required, making this coverage even easier to cross-sell!
What is an SNP?
Special Needs Plans (SNPs) function like a Medicare Advantage HMO or PPO plan, but are specialized even more to their members’ needs. For this reason, enrollment is limited to people with certain diseases or characteristics.
How do they work?
Special Needs Plans are private plans that, by law, must cover all medically necessary and preventative services that would be covered under Original Medicare. It must also provide prescription drug coverage that would normally be covered under Part D.
Who is eligible?
There are three different types of SNPs to serve different needs: Chronic Condition Special Needs Plans (C-SNPs), Dual-Eligible Special Needs Plans (D-SNPs), and Institutional Special Needs Plans (I-SNPs). The eligibility requirements are in line with the care that beneficiaries require:
C-SNPs
C-SNPs cover those with chronic conditions on Medicare, and the coverage is tailored to their specific illness.
D-SNPs
Dual-Eligible SNPs are your most common lock-in sales. To enroll in a D-SNP, a client must qualify for both Medicaid and Medicare. If they do, most of their medical costs will be covered by the plan.
I-SNPs
Last in our alphabet soup are Institutional SNPs, which cover people who are living in an institution or require home nursing care.
Most importantly, when can they join?
Normal enrollment for a C-SNP occurs during an Initial Election Period (IEP) or the Annual Enrollment Period (AEP), but a client can get an SEP if they have a doctor’s documentation of a newly-acquired chronic condition.
Medicare Supplement Plans
- Medicare Supplement Plans are great because you can sell them all year round. Thousands of people turn 65 every day, and each of them has the opportunity to look into Medicare Supplement Plans after enrolling in Medicare. But that is not the only time they can sign up for a Medicare Supplement Plan: technically a senior can apply for a plan anytime, even during the lock-in period, as long as they are enrolled in Medicare Parts A and B. S…
Dental, Vision & Hearing Plans
- Original Medicare and Medicare Supplement Plans do not offer dental, vision or hearinginsurance. These plans are the perfect products to cross-sell to your clients because no underwriting is necessary for them, and they are typically inexpensive. You can help your customers find a plan that offers them the extra coverage they need at a very attractive price.
Long-Term Care Insurance
- Many Medicare beneficiariesare under the impression that long-term care, such as stays in nursing homes or assisted living facilities, is covered by Original Medicare. Unfortunately, this is not the case, so when selling Medicare products, it is important to note to your clients that long-term care is generally not covered. While Medicare does cover certain things that are deemed medically necessary by a doctor, for the most part, it will no…
Hospital Indemnity Insurance
- Hospital indemnity insurance is a supplemental insurance plan that will help pay for hospital admission costs that are not covered by other insurance. Some of these plans offer cash payments to help pay for any extra expenses accrued during hospital stays, as well as deductibles, observation stays, surgeries, medications and more. These plans are b...