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Medicare at a Glance

“Medicare at a Glance” provides a quick overview of the Medicare program, which is a federal health insurance program primarily for people aged 65 and older, but also for some younger individuals with disabilities or specific conditions like End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

Here’s a brief breakdown:

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

  • Part B (Medical Insurance): Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

  • Part C (Medicare Advantage): An alternative to Original Medicare that offers all Part A and Part B benefits through private insurance companies, often including additional benefits like dental, vision, and hearing.

  • Part D (Prescription Drug Coverage): Helps cover the cost of prescription drugs.

This summary helps beneficiaries understand the basic structure and options within Medicare, making it easier to navigate their healthcare choices.

Obama Care

The Affordable Care Act (ACA), commonly known as Obamacare, is a comprehensive health care reform law enacted in March 201012. Its primary goals are to:

  • Expand access to health insurance: The ACA provides subsidies to help lower-income individuals and families afford health insurance. It also allows states to expand Medicaid coverage.

  • Protect consumers: Insurers cannot deny coverage or charge higher premiums based on pre-existing conditions. The law also prohibits lifetime monetary caps on essential health benefits.

  • Improve healthcare quality and reduce costs: The ACA includes provisions to promote preventive care, reduce healthcare fraud, and improve care coordination.

Obamacare aims to make healthcare more accessible and affordable for millions of Americans.

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What can you expect during the Annual Enrollment Season?

During the Annual Enrollment Period (AEP) for Medicare, which runs from October 15 to December 7, you can expect a few key activities and opportunities:

  1. Plan Review and Comparison: This is the time to review your current Medicare plan and compare it with other available options. You can look at different Medicare Advantage (Part C) and Prescription Drug Plans (Part D) to see if there’s a better fit for your needs and budget.

  2. Enrollment Changes: You can make several changes during AEP, such as:

    • Switching from Original Medicare to a Medicare Advantage plan.

    • Switching from a Medicare Advantage plan back to Original Medicare.

    • Changing from one Medicare Advantage plan to another.

    • Enrolling in, changing, or dropping a Medicare Prescription Drug Plan.

  3. Plan Information: Insurance companies will send out Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents. These will detail any changes in your current plan’s coverage, costs, or service area for the upcoming year.

  4. Marketing and Outreach: Expect to receive marketing materials from various insurance providers. This can include mail, phone calls, and emails offering information about different plans.

  5. Assistance and Resources: There are many resources available to help you make informed decisions, including:

    • Medicare.gov: The official Medicare website offers tools to compare plans.

    • State Health Insurance Assistance Programs (SHIPs): Provide free, personalized counseling.

    • Insurance Agents and Brokers: Can offer advice and help you understand your options.

  6. Deadlines: It’s crucial to make any desired changes by December 7, as this is the last day of the AEP. Changes made during this period will take effect on January 1 of the following year.

How to enroll in Medicare Part A & B?

Enrolling in Medicare Part A and Part B is a straightforward process. Here are the steps you can follow:

  1. Online Enrollment:

    • Visit the Social Security website and create a secure account.

    • Follow the instructions to apply for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).

  2. Phone Enrollment:

    • Call the Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778) from Monday to Friday, 8 a.m. to 7 p.m. in most U.S. time zones.

  3. In-Person Enrollment:

    • Visit your local Social Security office. You can find the nearest office using the Social Security Office Locator.

  4. Mail Enrollment:

Special Situations

After you enroll, you will receive a welcome package with your Medicare card and other important information.

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Health Insurance Terms Wordsearch

A Health Insurance Terms Wordsearch is a fun and educational tool designed to help you learn and familiarize yourself with common health insurance terminology. These word searches typically include a variety of terms related to health insurance policies, coverage, and benefits. Here are some examples of terms you might find in such a word search:

  • Premium: The amount you pay for your health insurance every month.

  • Deductible: The amount you pay for covered health care services before your insurance plan starts to pay.

  • Copayment (Copay): A fixed amount you pay for a covered health care service after you’ve paid your deductible.

  • Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service.

  • Network: The facilities, providers, and suppliers your health insurer has contracted with to provide health care services.

  • Out-of-Pocket Maximum: The most you have to pay for covered services in a plan year.

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Medicare Terms Wordsearch

A Medicare Terms Wordsearch is a fun and educational activity designed to help you become familiar with common Medicare-related terminology. These word searches typically include a variety of terms related to Medicare coverage, benefits, and processes. Here are some examples of terms you might find in such a word search:

  • Premium: The amount you pay for your Medicare plan each month.

  • Deductible: The amount you pay out-of-pocket for covered services before Medicare starts to pay.

  • Copayment (Copay): A fixed amount you pay for a covered health care service after you’ve paid your deductible.

  • Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service.

  • Medicare Advantage (Part C): An alternative to Original Medicare that offers all Part A and Part B benefits through private insurance companies, often including additional benefits.

  • Part D: Medicare’s prescription drug coverage.

  • Medigap: Supplemental insurance that helps cover some of the costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.

How to Update My MarketPlace Health Application?

Updating your Marketplace health application is important to ensure your information is current and accurate. Here’s how you can do it:

Online

  1. Log in to your HealthCare.gov account.

  2. Select your current application under “Your existing applications.”

  3. Click “Report a life change” on the left-hand menu.

  4. Follow the prompts to update your information, such as changes in income, household members, or address.

  5. Submit your updated application to get new eligibility results.

By Phone

  • Call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325). A representative can help you update your application over the phone.

In-Person

  • Find local help: You can get assistance from a Navigator or other trained personnel in your community. Use the Find Local Help tool on HealthCare.gov to locate assistance near you.

Important Notes

Updating your application promptly helps you avoid issues with your coverage and ensures you receive the correct amount of financial assistance.

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