Helpful materials from SHIINE to guide you through Step 1:
You are approaching your Initial Enrollment Period.
|Birthday: July 26th - Enrollment Period|
|If you join during:|| || || ||3 months before birthday month||Birthday month||3 months after birthday month|| || |
|Medicare starts:|| || || ||July 1||Aug 1||Oct 1||Dec 1||Jan 1|| || |
As you explore your coverage with your Original Medicare (Parts A & B) benefits you will be faced with a decision whether to add additional coverage or not. The two options you have to do this are with a Medicare Supplement (Medigap) plan (Option 1) or a Part C plan (Option 2).
Whether you take prescription drugs or not, another decision you will face at this time is adding prescription drug coverage (Part D plan or coverage with a Part C plan). Be mindful that any delays without creditable coverage for prescription drugs will most likely result in a future life-long penalty.
|Option 1: |
|- Hospital Care||- Clinic and Outpatient Care|
|You may want to add the following insurance to avoid penalties and fill gaps in coverage from Part A and Part B.|
| - Medicare Part A & B Supplement |
You still retain your Medicare coverage and can see providers that accept Medicare, these plans add coverage for services beyond Medicare's coverage.
Private insurance companies offer standardized coverage (plans A-N) for ease in comparing cost.
| - Prescription drug coverage |
(Avoid penalties for late enrollment)
|Option 2: |
Part C (Medicare Advantage or Health Plans)
Alternative to Original Medicare (Part A & B) sold by private insurance companies. Medicare has rules the insurance companies need to follow and pays a fixed amount to the plan each month to provide coverage for your care. If you are enrolled in one of these plans you are no longer covered by Original Medicare. Your plan will provide the sameservices that Medicare covers but you must use the plan's provider network (if applicable) and pay for services at that plan's rates.
You are still subject to your Part B premium.
|Most Part C plans in South Dakota include drug coverage. |
If the plan you choose doesn't have prescription drug coverage, you should consider adding a Part D Plan to avoid penalties.
Other insurance and how it works with Medicare
Helpful materials from SHIINE to guide you through Step 3:
Once you know which option in Step 3 is best for your situation you will still need to shop around for the plan that is right for you. The ultimate goal is to find a plan with sufficient coverage that makes you feel comfortable. Instead of shopping around using the pile of plan solicitations and marketing materials that are inundating your mailbox you can use the information below to look for a plan that meets your needs best. For unbiased assistance contact SHIINE.
SHIINE's Medicare Supplement Consumer Guide explains Medigap plans and lists the companies that were willing to share their pricing information. All prices are based off of a example scenario and are estimates as of the date the guide was printed.
The best time to enroll in a Medicare Supplement (Medigap) plan is during your Open Enrollment (Guaranteed Issue Right). This is usually the first six months in which you are enrolled in Part B.
Each county in South Dakota has a different list of Part C plans available. To find out what plans are available in your area visit Medicare.gov's Plan Finder Tool and enter your zip code or do a Personalized Search. Follow the steps and when you get to Step 4 choose "Medicare Health Plans (with or without drug coverage)" to get a list for your area. Once you discover what is available in your county you will need to determine if any of those options will work well for you.
SHIINE recommends you look into all the plans you are considering before enrolling to determine what is the best fit for your situation. This will require some research and probably a phone call to the plan and your health care providers. Check out the helpful materials listed below for a list of questions to ask your plan and providers or for help comparing several options side-by-side.
Determining if a plan is a good fit for your situation is something that you should do right away when enrolling in a Part D plan for the first time. Even if you do not currently take prescription drugs it is important to understand the cost of waiting until a later date to enroll. Sometimes people find it more affordable to enroll in a low premium plan right away than to accrue a penalty without Part D insurance coverage (or other creditable coverage).
To compare the plans that work best with the prescriptions you take and your pharmacy of choice visit Medicare.gov's Plan Finder Tool and enter your zip code or do a Personalized Search. Follow the steps and the list of results will be listed in order of lowest cost for the details you entered. SHIINE has www.Medicare.gov Plan Finder Instructions available to assist you through the process.
A comparison shouldbe done each year to ensure that you are always enrolled in a plan that covers all of your medications and works with your pharmacy. SHIINE recommends you do a plan comparison every year during Open Enrollment (October 15 - December 7) and can help you determine the plan that meets these very important needs: cost, coverage and convenience.
You might be wondering how often you need to revisit your plan options to continue to ensure you have coverage that meets your needs and the answer varies depending on which part of Medicare you are talking about. Use this chart to determine how to plan for your next review.
|Part of Medicare||When to Review||Important Considerations|
|Original Medicare (Parts A & B)||Typically once you are enrolled you will stay enrolled in Medicare Parts A & B.||If you do not enroll in Medicare when you are eligible or do not have creditable coverage you could be assessed a penalty.|
|Medicare Supplement (Medigap) Plans||Most people enroll in a Medigap policy and stay enrolled for a long time. Sometimes the policy will become too costly and people will shop around for new coverage.||A Medigap plan can deny your application for enrollment. Be cautious when dropping current coverage for new coverage.|
|Part C Plans||Each year review the Annual Notice of Change that is mailed to you by your plan in September and verify your providers of choice will be covered with your plan. Reflect on your health care situation and make sure that the plan adequately covers your current and prospective needs. Note any changes in coverage, cost increases for services or changes in out-of-pocket limits for the upcoming year.||If you are shopping for a new Part C plan make sure you understand the network of facilities and providers that are available and determine if the premium, anticipated co-payments and out-of-pocket maximums are affordable for your situation. SHIINE assists beneficiaries with free, unbiased and confidential counseling on the prescription drug coverage of Part C plans and provides tools and resources to make comparing Part C health plan options easier.|
|Part D Plans||Each year review the Annual Notice of Change that is mailed to you by your plan in September. Compare your plan with the other plans available by using the Plan Finder tool on www.Medicare.gov or by scheduling a counseling session with SHIINE during Open Enrollment (October 15 - December 7).||Consider coverage of all your prescriptions and convenience of your favorite pharmacy as you determine if the plan is most affordable for you. SHIINE assists beneficiaries with free, unbiased and confidential counseling of Part D plans.|