To be eligible for Medicare coverage, individuals must typically be at least 65 years old. Certain individuals under 65 may qualify if they have a disability or specific medical conditions such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). Additionally, individuals of any age with ESRD or ALS can also qualify for Medicare coverage

If you have access to group coverage, there are several factors you'll want to consider.

• Company size- if the company has more than 20 employees on the health plan, then you can wait (if you choose) to sign up for Medicare till you retire or leave that job. The plan will typically provide notice that the coverage meets Medicare's requirements and no penalties will be accessed, but you'll want to verify that with your employer.

• Benefit Quality and Monthly Expense: If your plan at work is exceptionally good , your contribution is very small, and you plan on continuing to work, you may be better off to keep your benefits at work. However, if your benefits through work are not so nice or your expense is high, going onto Medicare coverage may be a better option.

• Dependents Covered at Work: Medicare coverage is only for each individual eligible person and doesn't insure families or spouses, so you may want consider all your options for your family and your Medicare options as a whole to know which way is the best.

• Network and Coverage: You may be able to get better network access to doctors and providers on a Medicare Supplement or Advantage plan than available through your current employer coverage.

We can walk through each consideration with you to help you make the best decision based on your needs and desires.

You can change your Medicare Advantage Plan or Prescription Drug Plan each year during the Annual Election Period from October 15th to December 7th and the new plan you select will be effective on January 1st of the new year.

If you miss your initial enrollment period for Medicare, you can sign up during the general enrollment period from January 1 to March 31 each year. However, you may have to pay a late enrollment penalty in the form of higher premiums, which can last as long as you have Medicare coverage.

It is important to enroll in Medicare when you are first eligible or verify that you have other qualifying coverage through an employer to avoid these potential penalties.

When it comes to Medicare, penalties can occur if individuals do not enroll during their initial eligibility period and do not have creditable coverage elsewhere. There are penalties for late enrollment in Medicare Part A, Part B, Part C (Medicare Advantage), and Part D (prescription drug coverage). These penalties are in place to encourage timely enrollment and help cover the costs for those who do enroll on time. The penalty amounts can vary depending on how long the individual went without coverage and the specific part of Medicare.

• Part B Late Enrollment Penalty: This is accessed if you do not sign up on time (usually around your 65th birthday) and did not have creditable coverage from an employer that has at least 20 employees on their plan. You're accessed a 10% penalty per year you don't have creditable coverage of the Part B premium.

• Part D Drug Penalty: This penalty is put into place if you don't have creditable drug coverage after you're eligible for Medicare. You pay one percent of the national average drug plan cost (published each year) for each month that you don't have creditable coverage.

Both Penalties are access on you for the rest of your life while enrolled in Medicare, but with proper planning these penalties can easily be avoided.

This is a document that is required to be completed before meeting with an agent to discuss Medicare generally 48 hours prior to speaking with us.

There is no commitment in this form, it strictly tells us what you want to talk about in the meeting. You check the boxes and we can discuss it. The options are Medicare Supplements, Medicare Advantage Plans, Prescription Drug Plans, and Dental/Vision/ Hospital plans.

It is worth noting that before you can have a Supplement or Advantage plan, you must be signed up for Original Medicare parts A & B provided by the government.

Here's a description of both plans:

Medicare Supplement

• Definition: It may sound silly, but a supplement is a plan that supplements original Medicare, meaning that Original Medicare pays first and if there is something left over, that's where the supplement will help pay the bills. Generally you will still have some money to pay for services such as the part B Deductible which in 2024 is $240. There may be other expenses such as copays depending on which supplement you purchase.

• Network Providers: You can seek care from any provider or facility in the United States that accepts Medicare and are not limited to your state.

• Drug Plan: You must generally purchase a separate Part D Drug Plan to cover your drugs with your Medicare Supplement.

• Cost and Benefits: Typically, you will spend more premium each month on a Supplement and drug plan than you would on a Medicare Advantage plan, but the benefits (depending on which plan you have) will be drastically better than on an Advantage Plan. We like to think of the Supplement (especially a plan G or N) as a "pay more up front, worry less" plan because your out of pocket expense for actual medical costs is considerably lower than an advantage plan.

Medicare Advantage Plans:

• Definition: Advantage plans came into being in 2006 when Medicare started to pay insurance companies to manage the healthcare of those eligible for Medicare, if they chose to sign up with a particular insurance company. So instead of paying after Medicare pays like a supplement (in most cases) the insurance company manages payments for all services and creates plan designs and benefits to attract members to sign up for one of their plans. Generally there are copayments and occasionally deductibles, but these plans have a Max-Out-of-Pocket (the most you can pay for medical services) that caps your liability for the remainder of the year.

  In our experience, most plans in Idaho take a very very substantial amount of services to meet the Max Out of Pocket.

• Network Providers: Since the insurance company is managing care of those on their plan, the members are limited to using providers on the plan network. This helps the them control costs and strive to offer excellent benefits and extras. Many plans have networks more limited to the surrounding areas of the county, but will often make exceptions (if needed) to seek special care in other areas.

• Drug Coverage: Many Advantage plans will have drug coverage included in them, but not all. Some are specific to those that don't need drug coverage because of other qualifying coverage such as Veterans Benefits or employer drug coverage.

• Cost and Benefits: We discussed the benefits above, but we think of these plans as the "pay as you go plan with a low monthly cost." If you don't use the services, odds are you saved money that year, but if you had a terrible year you could come out worse off, but probably not much worse of than the supplement.

  These are the plans that you see so heavily advertised on TV with all the "extra" perks of dental, vision, hearing, and other benefits.

Conclusion: With these distinctions made, we help each person come to a decision on which choice they'd like to make. Some clients chose based on their budget and current health with an advantage plan. Others choose based on peace of mind and flexibility to travel everywhere with a supplement or know they'll need significant and constant health services. They won't need to worry as much with a supplement because it's pretty clean and clear what they'll pay.

Premiums change a bit every year on both programs and we evaluate with every client annually as a part of the Annual Election Period. Each has a decision to make, but we'll be there to assist and inform you.