Medicare Insurance Plans
Whether you are 65 years old or disabled, People Need Choices
Medicare Plans Indiana & Ohio
My Commitment
I believe that people need choices. In order to offer those choices a broker needs to offer a wide variety of Insurance Carriers and Plans. What this means for you, is the ability to shop for the benefits and costs that meets your needs. There are plans in each zip code through Indiana & Ohio. There are different choices in costs and benefits. Most people have different medical needs and specific prescription medicines. Some people are very healthy and take no medicines. I will help you obtain the plan that fits your needs.
Supplement "Medigap" Plans are by state. Advantage Plans including PDP Plans are by Zip Code in each County in both Indiana & Ohio.
A SOA Scope of Appointment is required 48 hours in advance of any Medicare appointment (Unless you the consumer initiates the request for contact). Before the appointment starts, you are required to initial what you want to discuss regarding Medicare, then sign and date the SOA Form
WHAT YOU NEED FOR A MEDICARE Plan
You Need your Medicare Card with Part A & Part B dates 1st!
You need to have your Medicare Card 1st! For Supplements, or Advantage Plans:
You need to be Eligible for Part A and Enrolled into Part B. Aging into or Qualifying for Medicare Rules at age 65: You have a 7-month window for your Initial Enrollment: 3 months prior to your birth month, (I recommend 3 months before your birth month when aging in or qualifying for Medicare), Your Birth Month, and up to 3-months after your birth month.
Everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage.
You may choose to work past the age of 65, which you can but you need to have what Medicare considers to be "Credible Coverage".
PDP: You need to have your Medicare Card, be Eligible for Part A and/or Enrolled into Part B. You may have to pay a penalty for not signing up for Part D when it was 1st available to you if you did not have what Medicare considers to be qualifying prescription insurance, "Credible Insurance".
Individuals receiving LIS usually do not have to pay a penalty while on LIS
If you are 65 & did not receive your Medicare Card, you need to contact Social Security to enroll or obtain a coy. Call them at 800-772-1213 or enroll on-line at www.socialsecurity.gov .
You can still work after you turn 65. Many employers offer credible coverage to their employees. Unless you have creditable coverage, you may have to pay a penalty for not taking Part B when it was 1st offered to you. There are time limits when your credible coverage ends. You need to sign up for Part B before the time limit to avoid a penalty.
Medicare & Medicaid? you need your State Medicaid Card Also
There are specific Medicare Plans for those receiving Medicare & Medicaid both.
If you are on Medicare & Medicaid you need your State Medicaid Card also
The Medicare Plans for those receiving Medicare & Medicaid both, offer a wide range of benefits.
July 1st, 2024: The Indiana Family and Social Services Administration launched a new program in July 2024 for Hoosiers aged 60 and over who receive Medicaid (or Medicaid and Medicare) benefits. This program is called Indiana Pathways. What is Indiana PathWays for Aging? Research shows that most older adults - 75% or more - want to age at home and in their communities.
The State believes 75 percent of Hoosiers who join the program will be able to get long-term care at home. With PathWays, older Hoosiers can pick a health plan. And that plan will help them to get the services and support they need to live as independently as possible. The program will not change or expand Medicaid benefits. But each qualifying Hoosier will have a care and services coordinator. These coordinators will help them get all the benefits for which they qualify. Hoosiers in the program may qualify for support like transportation to their doctor’s office. Or they may qualify for help in making meals. Or they may qualify for home-health visits or going to an adult day center. There are many other services and support available. It all depends on what the senior is qualified to receive. About 120,000 Hoosiers qualify for this program in Indiana.
Learn more about the history of the Pathways program
Starting in April 2023: Medicaid Members to be Impacted by Medicaid Re- determination
Starting in April 2023, states will have the ability to resume the Medicaid Re-determination process after three years of being paused due to the COVID pandemic. States can begin to initiate the re- determination process as early as February 1, 2023, and dis-enrollment's can be effective as early as April 1, if adequate notice is given to the Enrollee. Each state will set the date for when re-determination will start.
Approximately 15 million individuals nationally, will be at risk of losing Medicaid coverage. Anyone who is no longer eligible for Medicaid will be dis-enrolled.
Make sure you check your mail carefully for any mailings from your state Medicaid.
I helped many individuals throughout 2023, even if they were not my clients. Too many Medicare recipients found out they no longer had Medicaid when their Social Security check deducted the Part B Premium or when their visit to a doctor informed them they no longer had Medicaid. Many did not receive any notification documents from their state Medicaid that their benefits would cease or that re-determination was due. Some recipients provided the requested re-determination documents to their local Medicaid offices only to find out the documents they provided (sometimes multiple times), were not sent to the proper destinations. It has been a challenging year for those that need Medicaid help the most, for doctors, hospitals, tests, and medicines. Some are making decisions between eating, heat, medicine, doctors, or treatment.
AS INDIVIDUALIZED AS YOU ARE
Medicare Alone Overview
Medicare Part B typically covers 80% of the Medicare approved amount after the Part B deductible is met. This can be reviewed at: https://www.medicare.gov/basics/costs/medicare-costs
(Part A & Part B) most people pay for part B premium - Low income individuals may qualify for help paying their part B premium (Some individuals that did not qualify for part A through working approximately 10 years, or being married to their spouse that worked approximately for 10 years, pay for part A).
Individuals receiving LIS usually do not have to pay a penalty while on LIS.
Supplement Letter Plan Overview
A Medicare Supplement policy (LETTER PLAN ), covers many out-of-pocket medical expenses Original Medicare does not cover. You can go to any facility that accepts Medicare in the U. S. With a Supplement: Most citizens that work for 10 years qualify for Part A, (or your marriage of 10 years or more to the same spouse by their working 10+ years). You Pay for your Part B, Your Supplement Premium and Part D Premium if you also want Prescription Drug Coverage.
Yes, that is 3 payments, Every Month. The Supplement "Medi Gap" is only Guaranteed Issue when you are first eligible for Medicare.
You need to have your Medicare Card. If you want a Drug Plan, “Part D” there is a separate monthly premium. This is in addition to your Part B premium, and your Supplement premium.
That is 3 payments monthly, if you want a Supplement "MediGap" plan and a PDP Prescription Plan.
You may have to pay a penalty for not signing up for Part D when it was 1st available to you if you did not have qualifying prescription insurance, "Credible Insurance".
Medicare beneficiaries may incur a late enrollment penalty (LEP) if there is a continuous period of 63 days or more at any time after the end of the individual's Part D initial enrollment period during which the individual was eligible to enroll, but was not enrolled in a Medicare Part D plan and was not covered under any creditable prescription drug coverage.
Individuals receiving LIS usually do not have to pay a penalty while on LIS.
The highest percentage of the populace that I meet with could not afford the Medications they need without a Drug Plan.
Unless you have creditable coverage, you may have to pay a penalty for not taking Part B when it was 1st available to you. You may choose to continue to work. Many employers have credible coverage for Part B Medical and Part D Prescription Drug Coverage.
PDP Plans overview
If you want a Drug Plan, “Part D” there is a separate monthly premium. This is in addition to your Part B premium.
You need to be Eligible for Part A and/or enrolled into Part B.
You can use Original Medicare Part B that typically covers 80% of the Medicare approved amount after the Part B deductible is met. see https://www.medicare.gov/basics/costs/medicare-costs
You may have to pay a penalty for not signing up for Part D when it was 1st available to you if you did not have qualifying prescription insurance, "Credible Insurance", usually through an employer.
Individuals receiving LIS usually do not have to pay a penalty while on LIS
The highest percentage of the populace that I meet with could not afford the Medications they need without a Prescription Drug Plan.
Advantage Plans, Part D Plans, and Special Needs Plans Overview
Many Advantage Plans combine Medical and Prescription Drug Costs. Some refer to these plans as "C" Plans. Some Advantage Plans are Medical only. Some Advantage Plans also offer extra benefits depending on the plan, state, zip code, and the county you live in.
You need to be Eligible for Part A and Enrolled into Part B.
Advantage Plans have been Guaranteed Issue.
Advantage Plans vary from county to county within each state and in some instances by specific zip code depending on where you live. Some plans combine Hospital, Doctors, and Prescription Drug Coverage. Some plans are Hospital and Doctors only. Not all doctors choose to participate in every Advantage plan. A doctor could accept 3 plans with the same carrier but not the other plans offered in your county or zip code for that same carrier.
Doctors can leave any plan throughout the calendar year. Each year, plans, prescription drugs and carrier benefits change, as do costs. This is why it is so important to sit down with me to go over your "Prescribed Medicines", doctors, and facilities, because they can and do change every year.
Every year I take Federal Medicare training, test out, then take specific courses, and test out for each carrier that I write advantage plans for. Additionally, I complete 24-Credit Hours of training and tests every two years to comply with Indiana Insurance Training Requirements.
Special Needs Plans - Indiana:
If you are on Medicaid and Medicare both, you may be missing many benefits. There are Special Enrollment periods for Dual Special Needs Plans throughout the year. Your income determines if it meets the criteria for being a Medicaid Beneficiary in your state. Indiana now has 3 types of Medicare/Medicaid Plans: Over 60 Full disability, Under 60 Full disability, and ANY AGE - Partial Disability dependent on income. On March 15th 2024, the Indiana Individual Monthly Maximum limit was raised to $1,255.00. Each state has its own base monetary limit.
Dental
AEP
AEP October 15th Through December 7th
Open Enrollment
Open Enrollment for specific changes to Advantage Plans & Original Medicare: Open Enrollment is from January 1st through March 31st.
What Can You Do During Open Enrollment
You can Make ONE Change during OEP
Switch from a Medicare Advantage to Original Medicare & add a Part D Plan (penalty may apply See Below)
Switch from one Medicare Advantage plan to another Medicare Advantage Plan (with or without drug coverage)
During MA OEP: MA-Only enrollees can also switch to another MA-only plan, a MA-PD plan, or original Medicare, a MA-PD (with or without a PDP)
Enroll into a standalone Medicare Prescription Drug Plan if you return to Original Medicare
If you are outside of “When you are/were 1st eligible": (a late enrollment penalty may apply) The late enrollment penalty (also called the “LEP” or “penalty”) is an amount that may be added to a person’s monthly premium for Medicare drug coverage (Part D). A person enrolled in a Medicare plan may owe a late enrollment penalty if they go without Part D or other creditable prescription drug coverage for any continuous period of 63 days or more after the end of their Initial Enrollment Period for Part D coverage.
You May Be Missing Benefits
You may not be getting all the benefits through your current Medicare plan and may not know what you are eligible for. There are new plans, costs, inclusions, exclusions, and different prescription drugs every year that you should review Every AEP or Special Enrollment Period. You may be missing out on benefits you are eligible to receive through new plans offered. Some "Prescription Drug" costs may be cost-prohibitive through one plan and more affordable on another. Prescription Drug Costs and plan benefits can and do change every year.
One of the 1st things I do, when I sit down with clients every year, is go over their current prescriptions. Every year the Formularies (what drugs are listed on every specific plan) and the costs of those prescriptions can and often change. You will need to check every medicine every year to make sure it is on the plan "Formulary" you choose, what tier it is on, and what the cost is.
Every year you need to make sure your doctors are accepting your plan, meaning they are In-Network, for the plan you choose. You should check for your Family Doctor "PCP", Dentists, Doctors for Eye Care, Doctors for Hearing, and your specialists. Any doctor can leave any plan, any time during the year.
If you are on Medicaid and Medicare both, you may be missing many benefits. There are Special Enrollment periods for Dual Special Needs Plans throughout the year. Your income determines if it meets the criteria for being a Medicaid Beneficiary in your state. Indiana now has 3 types of Medicare/Medicaid Plans: Over 60 Full disability, Under 60 Full disability, and ANY AGE - Partial Disability dependent on Income. On March 15th 2024, the Indiana Individual Monthly Maximum limit was raised to $1,255.00. Each state has its own base monetary limit.
The Annual Enrollment Period (AEP) is from October 15th through December 7th. These plans have an effective date of January 1st, of the following year.
The Open Enrollment is from January 1st through March 31st.
(Please review the Open Enrollment) section above for details.
My Qualifications
I work tirelessly to stay informed about the latest changes in the healthcare markets. This requires Federal Medicare Training, training with every Carrier through which I write Advantage Plans, PDP Plans, and training through the ACA "Affordable Health Care" nicknamed Obama Care for Family and Individual Plans. I can provide you with the information that is current for each Annual Enrollment Period, and for those Special Enrollment Periods.
Robo Calls Telemarketers and 3rd Party Telemarketers for a Carrier or Sales Agent
Marketing Compliance Guidelines Permission To Contact You
A SOA Scope of Appointment is required 48 hours in advance of any Medicare appointment (Unless you the consumer initiates the request for contact). Before the appointment starts, you are required to initial what you want to discuss regarding Medicare, then sign and date the SOA Form.
- Without your written permission or now Recorded Permission, Robo or telemarketers are not allowed to contact you by Phone, Text, or Knock on Your Door for Medicare Sales or Added Benefits that are used as a bait and switch to get your information and connect you to a thief or agent that has used non-Medicare compliant means to get in contact with you.
- Only with your written permission or Recorded Call permission is it compliant for anyone to call you, send a text, or knock on your door for Medicare Sales. It is best not to answer calls from any number you do not recognize. Do not ever say "Yes" to an incoming call from someone you do not know.
- Interrupt Marketing calls for Medicare Sales or "Benefits" you may be missing are NOT Compliant with Medicare Contact Guidelines. Unless you give them Written or Recorded Permission to contact you they are NOT Compliant. Do not say yes to any question, hang up immediately. Better yet, do not answer any calls from a number you do not recognize. THESE ARE BAIT & SWITCH calls.
- Most non-compliant callers use local phone numbers that are not in service or disconnected as a rouse to get you to answer. Many of these calls originate from outside the United States. Using local numbers that are unassigned or disconnected, makes it difficult to trace, and helps them avoid prosecution and fines. It requires a legal arrangement process to trace numbers. There are ways and places to report people and numbers calling you.
Every year I hear horrible instances from people that have been taken advantage of by Telemarketers.
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