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Medicare is health insurance for people 65 or older, under 65 with certain disabilities and people with End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant.


The ABC’s of Medicare.  One of the first things we learn in elementary school is our ABC’s.  Now that you’re approaching or eligible for Medicare, one of the first things you must learn again are your ABC’s of Medicare.

What Are the Different Parts of Medicare?

Medicare Part A (Hospital Insurance) helps cover:

Hospital Inpatient Care

Skilled Nursing Facility Care (100-Day Limit)

Hospice Care

Medicare Part B (Medical Insurance) helps cover:

Medical Services from Doctors and other Health Care Providers (Inpatient and Outpatient)

Surgical Services 

Home Health Care (not Custodial Care)

Laboratory and Diagnostic Services

Durable Medical Equipment

Medicare Part C (Medicare Advantage Plans – Commonly Referred to as Medicare Managed Health Care):

Many require no premium.

Many include prescription drug coverage.

Additional benefits may include vision or dental within their network.

Medicare Part D (Medicare Prescription Drug Coverage):

Helps pay for the cost of your prescription drugs.

Run by Centers for Medicare and Medicaid Services with approved insurance companies that must follow (CMS) rules.  Drug plans change from year-to-year and should be reviewed annually.


There are different Medicare options available to you.  I help my clients with traditional Medicare, Medicare Supplements and Part D Prescription Drug coverage.

Should you desire a Medicare Advantage plan, Kaiser or any type of managed health care plan, you still have to apply to Medicare for Parts A and B.  You would then assign your Medicare benefits to the appropriate organization or insurance company and they will manage your health care.  Many times these plans are advertised as free, but this coverage has its share of limitations.  I do not write Medicare Advantage plans and would refer you to an associate of mine, marketing organization or the appropriate insurance company.

Normally you pay for Part B (Medical) only not Part A (Hospital) services.  You won’t pay for Medicare Part A if you paid Medicare taxes for 10+ years (40 quarters) while working.  Note there is always a 2-year look back an IRS verification of your income to determine what you will pay for Medicare Part B premiums and it is adjusted each year.  2022 looks back to 2020 and 2023 looks back to 2021, etc.

When enrolling, you can first sign up for Part A and / or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

If you sign up for Part A and / or Part B during the first 3 months of your Initial Enrollment Period, your coverage starts the first day of the month preceding your 65th birthday.  However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month.

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I normally recommend you apply early and within the first 3 months of your eligibility.  It makes everything much easier for you.  All Medicare, Medicare Supplement and Prescription Drug coverage falls into place with the same coordinated effective dates, and by applying in a timely manner you’re eliminating any potential and permanent Medicare Part B or Part D (Prescription Drug) premium penalties in some situations when you apply late.

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We can set up a meeting at my office to apply online at the www.medicare.gov website.  You can apply online at the same website and I can walk you through the enrollment process, you can call Social Security (800) 772-1213 enroll over the phone or schedule an appointment at the local Social Security office of your choice.  Remember you’re only going to apply for Medicare benefits, not Social Security retirement benefits unless you have a reason to accept Social Security income at this time.

If we didn’t apply together for your Medicare benefits, let me know when you have scheduled or completed your appointment for enrollment into Medicare so we can schedule a follow-up meeting to apply for your Medicare Supplement and Prescription Drug Coverage in the appropriate timeframe.

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Some Questions You Might Have…

Click the “+” to reveal the answer!

If you are collecting social security benefits, you will automatically be enrolled in Medicare within 90 days of your 65th birthday.

You need to apply for Medicare Part A and Part B and can arrange payments for these amounts until you start receiving Social Security income.  Once you start collecting Social Security income you can pay your Part B and Part D (prescription drug premiums) from your monthly payment.

It normally takes around 20 to 30 days to enroll in Medicare and receive your Medicare ID card. We will then connect again and apply for the appropriate Medicare Supplement plan and Part D prescription drug plan coordinating all effective dates with your Medicare coverage.

No. This is why you must purchase a Medicare supplement plan which pays for the costs Medicare does not cover. I emphasis applying in a timely manner because it provides guaranteed issue (no medical questions) for the appropriate Medicare supplement plan. IMPORTANT! You never want to answer any medical questions to get a Medicare supplement plan.

Very limited nursing home benefits for 100 days if Medicare guidelines are followed carefully. No benefits after 100 days. No benefits for home care (custodial services), adult day-care or assisted living.

No, all Medicare supplement plans provide standardized benefits regardless of the company and I can represent them all.  Medicare supplement plans tend to be premium driven.

Yes, and why you should review them each year during the AEP (Annual Enrollment Period) October 15 – December 7 to determine based on your prescription drugs whether you have the lowest cost drug plan for the upcoming year starting on January 1.  If you don’t review your prescription drug plan, you’re locked into the same plan for another year.

Yes. Traditional Medicare allows you to use any doctor or hospital in the United States that accepts Medicare. There are no more networks.

Let’s consider the size of the group health plan and why? The why answer determines who is the primary and secondary payor for your health claims and when you need to sign up for your Medicare A & B benefits.

If your group is under 20 lives (employees), Medicare pays first, and your employer’s group plan will pay second. I recommend you enroll in both Parts A (premium-free) and B (requires a premium) as soon as you’re eligible. What can happen? Your employer’s group plan can refuse to pay your claims. Your insurance might cover these costs if you don’t have Parts A and B, but they can change that at any time, with no warning, leaving you responsible for your medical expenses. If the group is over 20 lives (employees), you should apply for Medicare Part A (premium-free), but can delay Medicare Part B. However, you must purchase Part B when you terminate from the group plan in a timely manner under a (SEP) Special Enrollment Period. Note COBRA and retiree health plans aren’t considered (creditable) coverage after 8 months under a Special Enrollment Period when your group coverage ends. Permanent late enrollment penalties will be incurred 8 months after your first eligible under a (SEP) Special Enrollment Period.

What are the penalties for not signing up at the right time? Your monthly premium for Part B can go up 10% of the standard premium for each full 12-month period you could have had Part B, but didn't sign up for it, and you'll have to pay this penalty for as long as you have Part B. Keep in mind there may be advantages to staying on the group plan over 20 lives because of lower premiums, benefits, prescription drug coverage, or for dependent eligibility reasons. What’s important is to add up premiums and all of the benefits of remaining on your group coverage then compare them to what Medicare will cost with Part B / Part D, a Medicare Supplement Plan, and Part D RX coverage as well as what it will cost your dependents, if applicable, to have an individual or other health insurance policy for them.

Yes! Medicare and your Supplement plan provide very limited coverage when traveling outside the United States. These travel medical insurance plans are very inexpensive. You can get a quote for the period of time you’re traveling, apply online, print ID cards and even the policy. Click here for more information: http://www.geobluetravelinsurance.com/products/single-trip/voyager-5-overview.cfm?link_id=104626

Social Security and Medicare are separate programs, but both are designed to help Americans and noncitizens working here deal with the challenges of their senior years. Social Security provides monthly benefits to retirees, people with disabilities and people who have lost their spouses and breadwinners. Medicare, which is run by the Centers for Medicare and Medicaid Services (CMS), is the nation's health insurance program for people 65 and older and the disabled.

Here’s the important tie-in: Social Security works closely with Medicare to inform people about the health insurance program, sign them up in a timely way, process their applications and collect premiums.

Inevitably, there are cases where IRS information goes astray or where income circumstances have changed. When that happens, you'll need to contact Social Security (800) 772-1213 to settle the dispute or clarify the IRS numbers.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) makes changes to Medicare Supplement policies that cover the Part B deductible for “newly eligible” Medicare Beneficiaries turning 65 after January 1, 2020.

Anyone who turns 65 on or after January 1, 2020 will only be able to purchase a Medicare Supplement Plan G. It covers everything that Plan F does except the Part B calendar year deductible ($198 in 2020) which can increase annually by inflation.

Plan F is not going away for anyone who currently has a Medicare Supplement Plan F prior to January 1, 2020. It is grandfathered. Plan F is still available for anyone who turned 65 before 2020 but delayed going onto Medicare as they were still working and remained on employer provided insurance. Once they leave this insurance and change to Medicare. They can enroll in a Medicare Supplement Plan F.

CA has a very unique and consumer-friendly (no medical questions guaranteed issue) rule that allows an individual depending on the company to move to a lesser benefit plan with the same company or other companies same Plan F or lesser benefit Plan G during your birthday month which is why it is referred to as the “Birthday Rule”.

Here are some “Birthday Rule” Key Points:

(1) Has to be done around your birthday each year.

(2) Can only move to a plan of equal or lesser benefit Medicare Supplement Plan F to F, F to G.

(3) The effective date has to be after your birthday, so the new premium will reflect your new age.

(4) The effective date can be 60 days after your birthday.

(5) No medical underwriting or questions are required.

(6) What is the essential difference between an F and a G plan? Other than discounted benefits provided by the company. The G plan requires you to pay the Part B calendar year medical deductible.

(7) The older one gets the greater the Plan F to Plan G premium savings.

(8) Household discounts may also be available.

All supplement plans provide standardized benefits so as far as claims they all pay because they follow Medicare and pay the gaps in coverage e.g., 20% co-insurance, deductibles, and hospital co-pays. Note if Medicare doesn’t pay because the doctor doesn’t accept Medicare, or it is not a covered expense. No Medicare Supplement plan will pay either.

Here Is A Valuable Resource For You!

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Go to the www.medicare.gov website click on the doctor finder and you can search out doctors who accept Medicare.  While on this website click on the forms, help, and resources tab and search for the Medicare & You 2022 publication and download it to your computer.  This is an informative publication along with many others that you will find of value and can save to your computer.

Always verify in advance and prior to receiving medical services from the doctor’s insurance billing person or department confirming that the doctor accepts Medicare and the medical services being provided to you are accepted medical expenses with Medicare.  Otherwise, you’re 100% responsible for all medical bills not covered, and by seeing a doctor who does not accept Medicare your Medicare Supplement plan will not pay any benefits either.

It’s important to call me so I can discuss your personal situation and properly advise you of your Medicare options.

Marc Maretsky Personal Insurance Services based in Beverly Hills, serves all of California and the United States.  I help my clients acquire life, disability, long-term care, and critical illness insured solutions, as well as enroll them into Medicare when eligible.

“No matter how fast technology changes our world and everything around us.  I believe the personal touch and a human voice are more important than ever.”

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