For nearly two decades, banking online has been a popular option for busy people who couldn’t conduct transactions during a workday. Being able to check account balances anytime, without being constrained by “banker’s hours” was a huge draw. In fact, the term “banker’s hours” is often used in a pejorative sense when describing inconvenient business hours.

All the business you used to handle—face-to-face— at a bank branch or credit union can be completed online. Now you can make electronic payments, send cash, schedule transfers, or even apply for a loan from your computer or smartphone. In addition, many employers and most government agencies use direct deposit instead of issuing checks, eliminating the fear of mail theft and the inconvenience of a special trip to the bank. And, on the off chance that you do receive a paper check, you can deposit it easily from home with your bank’s built-in photo app.

Money Management for Seniors

In 2020, banking institutions experienced a sharp rise in the number of customers who switched to online banking exclusively. Baby Boomers who were once reluctant to give up the personal interaction with a teller or loan officer now had to think about more than just protecting their money. With social distancing added to our modern lexicon, many seniors embraced online banking for the very first time.

It wasn’t the technology that made them nervous, but security issues that gave them cause for concern. Many seniors live on a fixed income from pensions, social security, and retirement savings plans. A finite amount of money has to last, and they need to know that it is safe from scammers or hackers. As a result, banks go to extraordinary lengths to protect assets and personal data using frequently updated encryption technology. Encryption technology protects your data by converting it to an encoded format. (In other words, recreating your data with a highly sophisticated secret code that can only be interpreted by your bank’s software.)

Money management for seniors gets much easier when you check account balances, pay bills, transfer funds, or send cash to your favorite grandkids, all from one dashboard. Imagine sitting down in front of your computer to check account balances and pay all your bills with a few clicks, no more filling out addresses or licking stamps. If you know what you owe each month, then you can set up recurring payments that will automatically debit the amount from your account without you having even to log on.

There are other ways to stretch your dollars, too, like exploring refinancing options for mortgage or car payments. You can even start an application while you’re thinking about it. Most of the recognizable bank brands even offer an online look at your real-time credit score. Knowing your current credit score can help you make better and more informed purchasing choices.

Helping Seniors with Finances

There often comes a time when your senior parents can no longer handle their finances on their own. For whatever reason, they have become temporarily or permanently incapacitated by dementia, blindness, or arthritis so severe that they can no longer sign their name on a check. This can be stressful for a loved one when they realize they can no longer perform certain tasks.

It’s hard for them to ask for help, and it can feel like a terrible intrusion if you offer. Be sensitive because giving away even partial control of your finances can feel like a terrible loss of independence. Maybe agree to make the transition over a period of time. Start with making sure that your loved one is capable of safeguarding their online security. Can they keep up with their bills? If not, offer to sit down with them once a month to pay bills together, so they don’t feel shut out of the process.

If you don’t live close by, make sure your parent knows how to set up or at least join a Zoom meeting. That way, you can share screens to look at the bank statements and make decisions together. And don’t worry if your mom, dad, or grandparents have never used Zoom before. They can log on to My for free live events teaching the ins and outs of using Zoom for more than boring business meetings. In addition, Tech Hours are available when your senior relative can get answers to any of their technology questions.

Best Banks for Older Adults

Several banks offer special accounts for seniors that contain enhanced perks and benefits, like high-interest yields. Check out the requirements and features of some of these accounts that cater to senior customers:

  • US Bank: waives monthly maintenance fees and minimum balance requirements for customers over 65. Offers debit cards, online bill pay, and free mobile check deposit

  • Ally: A relatively new Internet-only bank that requires no minimum opening deposit or minimum monthly balance. Also, they don’t charge monthly fees, ATM usage fees, or fees for overdrafts.

  • BB&T: Monthly maintenance fees waiver and several online perks for senior account holders. In addition to some more traditional offerings, BB&T is also 100% online. They allow you one penalty-free early CD withdrawal for a documented medical emergency.

The bottom line is that the best banks for older adults are the ones that they are familiar with. If you’re happy with your current financial institution, then, by all means, stay with them. Just take advantage of all the online services that they offer. And if you’re still a little leery about the technology of online banking, there’s help. Most banks offer online tutorials to help you learn how to use their platforms.

And you can always check out the events calendar at to participate in the Tech Hours hosted every month. The free events are live so that you can ask any questions about technology in general or get specific instructions regarding how to get the most out of online banking.

Paying Bills for Older Adults

The day may come when your elderly relative or friend can no longer handle paying bills on their own. This can be a very emotional time for you both, so if you can plan ahead, do it. Setting up a trust where one trusted agent makes the payments for all necessary living arrangements can help take the pressure off of both of you. Joint accounts are okay, but remember your assets are on the line here too.

Taking care of your health is a top priority. This means regular trips to see medical professionals for ongoing, non-emergency care. Whether it’s doctor visits, trips to the pharmacy, physical therapy, or other healthcare facilities, you need a reliable way to get there. 

While some seniors can drive themselves or have a spouse or child who can pitch in, others are reliant on friends and neighbors. And as you well know, things can and often do come up. 

Whether it’s your physician who has an emergency and must move the appointment a few hours or days, or a grandchild who unexpectedly needs to be picked up from school. Suddenly your best-laid plans have changed and there’s no one to drive you. Your appointment has to be postponed or canceled, and your good health is put on hold. Thankfully, there are resources, like Medicare Advantage, that can help.

Before we dive deeper, it’s important to note that these services are for non-emergency health matters. If someone’s life is at risk, it’s essential that you dial 911 to get immediate care.

Medicare Appointment Transportation: Special Circumstances

While Medicare (Part A and B) can cover certain non-emergency medical transportation needs, these are primarily reserved for those whose health conditions require specialized care. For example, non-emergency ambulatory services for seniors who can’t risk exposure to other forms of transportation. Such circumstances must be specified by your physician in writing, confirming that your medical condition necessitates it.

Some seniors will qualify for PACE (Program of All-Inclusive Care for the Elderly) or Medicaid. These programs have their own transportation guidelines and services for those enrolled. 

To qualify for PACE, you must:

  • Be age 55 years or older
  • Live within a PACE organization’s service area
  • Be certified by the state where you live as requiring a nursing home level of care
  • Be able to safely live in your community with PACE’s assistance

To learn more, visit 

For those enrolled in Medicaid, non-emergency medical transportation assistance may be provided if you meet the eligibility requirements of your state. These might include not having a driver’s license, not owning a working vehicle, having a disability (mental or physical), or being incapable of taking transportation alone. Visit to learn more.

Non Emergency Medical Transportation for Seniors

What if you’re a senior who doesn’t fall into any of the groups mentioned above? You still need help getting access to the ongoing health services you require. As of 2020, many Medicare Advantage plans have begun offering new benefits to assist with this urgent need. And, depending upon the specifics of your plan, you may be able to take trips to not only physician visits, but also pharmacies, physical therapy appointments, and more.

As with any provider, it’s important to know what options are available so you can choose the one that will best suit your circumstances. Here are a few of the key features to examine, which vary according to each plan:

  • Is this transportation service included free, as a part of the Medicare Advantage plan, or is there an added fee?
    Some plans will include this ride benefit at no additional charge. 
  • Which types of non-emergency medical services are approved for Medicare transportation?
    These may include physician appointments, lab tests, pharmacies, physical therapy appointments, visits to health club facilities, etc. Each plan will have a specified list of approved provider types.
  • How many one-way trips are covered?
    Is there a maximum number allowed within a specified timeframe? Some offer unlimited trips, while others have a cap. Take into consideration whether you will have physical therapy or other ongoing treatment needs. Perhaps you have made arrangements to be regularly dropped off by someone but will need transportation back home. In this case, it would count as one trip, rather than two.
    • What is the maximum number of miles allowed per trip? 
      Will this plan enable you to regularly visit the facilities you wish to access? While some plans place no limits on mileage, others set a maximum mileage per trip. For example, a maximum of 25 miles or even 60 miles each way. The good news is that with all Medicare Advantage providers, if your destination falls outside the transportation mileage limit, some special exceptions can be made.
    • Which transportation services are authorized to serve in your area?
      Some partner with ride-sharing services while others work with taxi or van services.
  • What hours/days will the service be available?
    Ensure that it will enable you to reach your destination(s) and return home as needed.

Non-Medicare Transportation Options

If you would like to learn about potential non-Medicare resources in your area that can assist with locating medical transportation for seniors, you may wish to contact your local Area Agency on Aging. You can search for contacts in your region using the Eldercare Locator

Make Your Plan Today

Regardless of which program you choose, be sure you have a transportation plan in place. Ensuring you have the health care you need has never been more important. And transportation should not stand in the way of receiving it. 

If you’re driving yourself or relying on one or two close relatives or friends to assist you, keep in mind that circumstances can change over time. When it’s time to hang up your keys for good, or your driver moves away, you won’t want to be left wanting. Give yourself the peace of mind of knowing you have your bases covered. You’ll be so glad you did!

By Debbie D.

Medicare was signed into law by President Lyndon Johnson in 1965 and covers health insurance for people age 65 or older. Certain younger people can qualify for Medicare too, including those with disabilities, like end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s Disease). You must be either a United States citizen or have been a legal, permanent resident for at least five continuous years.

What is Medicare Part A?

Medicare Part A primarily covers inpatient care, including care received while in a hospital, skilled nursing facility, inpatient rehabilitation facility, and, in limited circumstances, at home. As a patient using Medicare Part A, you will receive coverage for hospital expenses that are critical to your inpatient care, such as a semi-private room, meals, nursing services, medications, services, and supplies required for your inpatient treatment. 

Medicare Part A is free if you or your spouse have worked and paid Medicare taxes for at least ten years (40 quarters.) If you do not have enough working quarters, you will have to pay a premium. 

Medicare Part A: Home Health Care Benefits

Home health care services deemed medically necessary are completely covered and must be provided by a Medicare-certified home healthcare agency. These services may include:

  • Part-time skilled nursing care
  • Physical therapy
  • Speech-language pathology services
  • Occupational therapy
  • Medical social services
  • Limited home health aide services

To qualify for home health care services, a physician must certify that you are homebound. According to Medicare, you are homebound if you can’t leave home without the aid of another person, specialized transportation, or equipment.

Medicare Part A: Skilled Nursing Facility Coverage

Skilled nursing facility (SNF) stays are covered under Medicare Part A after qualifying hospital inpatient stays related to an illness or injury and must be for a minimum of three days. Follow-up visits as an outpatient do not count towards a qualifying stay. SNF care must be provided by a Medicare-certified facility and may include:

  • Semi-private room
  • Meals
  • Skilled nursing services
  • Rehabilitation services 
  • Medical social services
  • Medications 
  • Medical supplies and equipment 
  • Ambulance transportation to a nearby provider for services not provided at the SNF
  • Dietary counseling

Medicare Part A: Hospice Coverage

You may be eligible for hospice care if your doctor has certified that you have a terminal illness with an estimated six months or less to live. Hospice caregivers focus on providing pain control and comfort at the end of a patient’s life. To qualify for Medicare-covered hospice care, you must meet all of the following conditions:

  • You must be enrolled in Medicare Part A.
  • Your healthcare provider must certify that you are terminally ill.
  • You must agree to give up curative treatments for your terminal illness
  • Though hospice care is usually received at home, the care must be provided by a Medicare-approved hospice facility.

Medicare Part A hospice care may include:

  • Physician services
  • Nursing care
  • Pain relief medications
  • Social services
  • Durable medical equipment
  • Medical supplies
  • Hospice aide services
  • Homemaker services such as cleaning or preparing meals
  • Physical and occupational therapy
  • Dietary counseling
  • Short-term inpatient care (to manage pain or ongoing symptoms)
  • Short-term respite care 
  • Spiritual and grief counseling

You have the right to discontinue Medicare hospice care coverage at any time if you want to resume curative treatments. Of course, this is a decision you should discuss with your physician.

Medicare Part A: Eligibility

Most Medicare Part A beneficiaries do not pay a premium for coverage if they have worked at least 10 years and have paid Medicare taxes during that time. Individuals who aren’t eligible for premium-free coverage can still enroll in Medicare Part A and pay a premium. You are eligible for Medicare Part A if:

  • You are age 65 or older. 
  • You are a U.S. citizen or permanent legal resident for at least five consecutive years.
  • You are already receiving retirement benefits.
  • You are disabled and receiving Social Security disability benefits.
  • You have end-stage renal disease (ESRD).
  • You have amyotrophic lateral sclerosis (ALS).

Most people don’t pay a Part A premium if they paid Medicare taxes for 10 years or more. If you don’t qualify for premium-free Part A, you may pay up to $471 each month.

Medicare Part A: Initial Enrollment Period (IEP) 

The seven-month Initial Enrollment Period (IEP) for Medicare benefits begins three months before your 65th birthday includes your birthday month, and ends three months later. If you don’t enroll during your IEP, you will have to wait until the next general enrollment period, January 1 to March 31.

Part A benefits begin the first day of the month you turn 65. If your birthday is on the first day of the month, your benefits will begin the month before you turn 65. Your Medicare card will arrive about three months before your 65th birthday.

If you are disabled, enrollment in Medicare Part A will begin after you have been receiving Social Security disability benefits for 24 months. Your coverage will begin in the 25th month. You will receive your Medicare card about three months before your coverage begins.

If you have ALS, your Medicare Part A hospital insurance (and Medicare Part B medical insurance) will automatically begin the same month that your Social Security disability benefits begin. Your Medicare card will arrive about one month after you sign up for Social Security disability benefits.

If you have ESRD and require dialysis, your Medicare effective date is usually the first day of the fourth month of your dialysis treatments. However, you need to apply for Medicare benefits if you’re younger than 65.

Medicare Part A: General Enrollment Period

If you delayed enrolling for Medicare or need to make changes to your coverage, you may enroll during the next available General Enrollment Period (GEP), unless you are eligible for a Special Enrollment Period (SEP). The GEP occurs each year from January 1 to March 31. If you sign up during general enrollment, your coverage will begin July 1 of that year. Your Medicare card will arrive about three months before your coverage begins.

Medicare Part A: Special Enrollment Period

Everyone experiences unexpected events in their life so you can make changes to your Medicare Part A plan during what is referred to as a Special Enrollment Period (SEP.) For example, you have 8 months to sign up for Part A if you lose your employer-provided health insurance, or if you’re a volunteer, serving in another country.

What is a Medicare Advantage Plan?

Medicare Advantage Plans offer a bundled alternative to Original Medicare. They are offered by private companies approved by Medicare and most often include a combination of Medicare Part A, Medicare Part B and, Medicare Part D (prescription drug coverage.)

When Can You Make Changes to Your Medicare Advantage Plan?

You can make changes to your Medicare Advantage plan at any time during open enrollment, October 15 through December 7. The changes you make will take effect on January 1 of the following year.

By Debbie D.

Before turning 65, you have a few decisions to make regarding what kind of health coverage works best for you. Social Security automatically enrolls you in Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance). Original Medicare helps with the cost of healthcare but does not cover all medical expenses or costs related to long-term care. Many recipients choose to purchase supplemental insurance plans to expand their coverage.

Anyone eligible for premium-free Medicare Part A is eligible for Medicare Part B by enrolling and paying a monthly premium. If you are not eligible for premium-free Medicare Part A, you can qualify for Medicare Part B by meeting the following requirements:

  • You must be 65 years or older.

  • You must be a U.S. citizen, or a permanent legal resident living in the U.S for at least five continuous years.

  • You may also qualify for automatic Medicare Part B enrollment if you are under 65 and receiving Social Security or Railroad Retirement Board (RRB) disability benefits.

  • You will automatically be enrolled in Medicare Part A and Part B after 24 months of disability benefits.

  • You may also be eligible for Medicare Part B enrollment before 65 if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (also known as ALS, or Lou Gehrig’s disease).

What is Medicare Part B?

Medicare Part B (medical insurance) is part of the Original Medicare plan and covers medically necessary services and supplies to treat your health condition. This can include outpatient care, preventive services, ambulance services, and durable medical equipment (wheelchairs, oxygen, etc.). If prescribed by your doctor, Part B also covers part-time home health and rehabilitative services, such as physical therapy.

Medicare Part B services include a one-time, comprehensive “Welcome to Medicare” visit, that includes flu and hepatitis B shots, cardiovascular screenings, cancer screenings, diabetes screenings, and more.

What Does Medicare Part B Cover?

  • Services, tests, or supplies that are needed to diagnose or treat a medical condition

  • Ambulance services

  • Durable medical equipment (wheelchairs, walkers, oxygen, etc.)

  • Mental health (inpatient and outpatient)

  • Clinical Research

  • Approved outpatient prescription drugs

  • Chemotherapy

  • Emergency room visits

  • Kidney dialysis

  • Laboratory testing

  • Occupational therapy

  • Imaging tests and echocardiograms

  • Physical therapy

  • Organ transplants

Medicare Part B also covers certain preventative services like:

  • Bone density measurements

  • Cancer screenings

  • Cardiovascular disease screenings

  • Diabetes screenings

  • Screenings for HIV, hepatitis B, and hepatitis C.

  • Screenings for sexually transmitted infections (STI)

  • Vaccinations for flu, hepatitis B, and pneumonia

  • Wellness checks

What Home Health Care Services are Covered by Medicare Plan B?

Home health care approved as medically necessary is completely covered and must be provided by a Medicare-certified home healthcare agency. These services may include:

  • Part-time skilled nursing care

  • Physical therapy

  • Speech-language pathology services

  • Occupational therapy

  • Medical social services

  • Limited home health aide services

To be eligible for home health care services, a physician must certify that you are homebound. According to Medicare, you are homebound if you can’t leave home without the aid of another person, specialized transportation, or equipment.

Medicare Part B does not cover 24-hour home care, meals, or housekeeping services that are unrelated to your treatment. It also does not cover personal care services, such as help with bathing and dressing, if this is the only care that you need.

Medicare Part B: Eligibility

You automatically qualify for Medicare Part B once you turn 65 years old although you’ll need to enroll during your seven-month Initial Enrollment Period (IEP) which begins three months before your 65th birthday, includes the month you turn 65, and ends three months later.

If you have a disability and are receiving Social Security payments, you’re eligible to enroll in Medicare Part B, regardless of your age.

According to the Social Security Administration, other covered disabilities may include:

  • Sensory disorders

  • Cardiovascular and blood disorders

  • Digestive system disorders

  • Neurological disorders

  • Mental disorders

  • End-stage renal disease (ESRF) that requires dialysis

  • Amyotrophic lateral sclerosis (ALS)

Most people pay the standard Part B premium amount of $148.50.

Medicare Part B: Initial Enrollment Period (IEP)

The seven-month Initial Enrollment Period (IEP) for Medicare benefits begins three months before your 65th birthday includes the month you turn 65, and ends three months later. If you do not enroll during your seven-month IEP, you will be required to wait until the next general enrollment period, January 1st to March 31st.

Part B benefits begin the first day of the month you turn 65. If your birthday is on the first day of the month, your benefits will begin the month before you turn 65. Your Medicare card will arrive about three months before your 65th birthday.

If you are disabled, enrollment in Medicare Part B will begin after you have been receiving Social Security disability benefits for 24 months. Your coverage will begin in the 25th month. You will receive your Medicare card about three months before your coverage begins.

If you have amyotrophic lateral sclerosis (ALS), your Medicare Part B medical insurance will automatically begin the same month that your Social Security disability benefits begin. Your Medicare card will arrive about one month after you sign up for Social Security disability benefits.

If you have end-stage renal disease (ESRD) and require dialysis, your Medicare effective date is usually the first day of the fourth month of your dialysis treatments. However, you need to apply for Medicare benefits; you’re not automatically enrolled if you’re younger than 65.

Medicare Part B: General Enrollment Period

If you were late enrolling for Medicare or need to make changes to your coverage, you may enroll during the next available General Enrollment Period (GEP). The GEP occurs each year from January 1 to March 31 and If you sign up during general enrollment, your coverage will begin July 1 of that year. Your Medicare card will arrive about three months before your coverage begins.

Medicare Part B: Special Enrollment Period

You may be eligible for a Special Enrollment Period (SEP) if you have moved or lost your group health insurance. You have 8 months to sign up for Part A and/or Part B beginning one month after you lose group health plan insurance. You may also qualify for a Special Enrollment Period if you’re a volunteer, serving in a foreign country.

What is a Medicare Advantage Plan?

If you are in a Medicare Advantage plan, you would get both your Medicare Part A and Part B coverage through a private health insurance company contracted with Medicare. By law, Medicare Advantage plans must offer at least the same level of coverage as Original Medicare, and some plans include additional coverage not covered by Original Medicare, like routine dental, vision, hearing, and even prescription drug coverage.

When Can You Make Changes to Your Medicare Advantage Plan?

You can make changes to your Medicare Advantage plan at any time during the annual election period, known as open enrollment. This lasts from October 15 through December 7 each year. The changes you make will take effect on January 1 of the following year.

By Dana Barrett

Seniors enrolled in Medicare can add, drop, or change their Medicare Advantage coverage when certain unexpected life events occur. These changes are made during a Special Election Period or SEP. There are a variety of circumstances that create eligibility for a Special Election Period. Let’s take a look at some of the most common ones.

Medicare Advantage SEP 65

If you initially enroll in a Medicare Advantage Plan at age 65, the first 12 months of enrollment are considered a trial period. During this time, you can switch to a different Medicare Advantage Plan or you can disenroll from Medicare Advantage and enroll in Original Medicare. If you choose to enroll in Original Medicare, you also qualify for a “guaranteed issue right” to purchase a Medigap supplemental plan at the same time. The beneficiary can exercise the issue right for 63 days after leaving their Medicare Advantage Plan.

Special Enrollment Period for the Working Senior

If you are over 65 and retiring from a job where you had private health insurance, you have 8 months from either your last day of work or the last day your private insurance coverage ends to enroll in Medicare Parts A and B. You must be enrolled in Medicare Part B and be paying your Part B premiums to enroll in a Medicare Advantage Plan. 

There is a 2 month “Special Enrollment Period” from the month that your private health coverage ends during which you can enroll in a Medicare Advantage Plan. You are also eligible to enroll during the fall Open Enrollment Period, from October 15 to December 7 each year.


There are several circumstances involving relocation that trigger a SEP. 

  • Moving to a new state or county
  • Moving into or out of a skilled nursing facility or hospital
  • Moving back to the U.S. after living abroad 
  • If you were recently released from jail

Medicare Advantage plans are managed by private insurance providers regionally. So, if you move out of your current Advantage Plan region, you’ll need to find a plan in the area where you currently live. Similarly, if you move back to the U.S. from another country, or you’ve been released from a nursing home or rehabilitation facility you can change Medicare plans to a local Advantage Plan that suits your needs.

Special Election Period for Relocation:

Notifying your plan before your move, will give you 1 month prior to moving and up to 2 months after you’ve moved. If you notify your plan after you move, then you will have 2 months from the date of notification.

If you move into a skilled nursing facility, psychiatric hospital, or rehabilitation facility, the SEP begins the month you are admitted and continues for up to 2 months after you’ve been discharged.

Medicare Advantage SEP – Dual Enrollment

Dual enrollment refers to beneficiaries who are enrolled in both Medicare and Medicaid, or full Medicaid with a Medicare savings plan. If you are dually qualified, you can enroll, disenroll, or switch to another Medicare Advantage plan during the Dual Enrollment SEP. This Special Election Period is one time per quarter during the first 3 quarters of the calendar year. The enrollment change will be effective on the first day of the following month after you make the change.

Medicare Advantage Extra Help or Low-Income Subsidy SEP

This SEP also applies to dually enrolled beneficiaries but is specific to individuals who are approved by the Social Security Administration for the Medicare Part D low-income subsidy (LIS) also called Extra Help. The LIS Special Enrollment Period starts the month you are approved for Extra Help and ends 2 months after you lose Extra Help status. Changes are active on the first day of the month following enrollment.

5-Star Special Enrollment Period

Medicare evaluates the overall performance of Medicare Advantage Plans using customer satisfaction surveys. Each plan is given a rating of 1 to 5 stars. Plan ratings are updated and published every fall for the coming year. The 5-star Special Enrollment Period allows you to switch to a 5-star plan in your region only one time between December 8 and November 30. 

Default Enrollment/Seamless Conversion SEP

There is a Medicare enrollment process called “default enrollment” (previously called “seamless conversion”). This process allows pre-approved Medicare Plan sponsors to automatically transfer the enrollment of a beneficiary into a Medicare Advantage Plan under certain circumstances. 

If you are a senior in a Medicaid Managed Care plan, the plan manager or Centers for Medicare and Medicaid Services (CMS) can transfer your enrollment to a Dual Eligible Special Needs Plan (D-SNP) or a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) when you initially become eligible for Medicare.  

If you are a Medicare recipient that has been transferred into a Medicare Plan but would prefer different coverage, you have a 3-month SEP to disenroll from your assigned plan and enroll in a different plan. The SEP starts from the month your request the change and continues for 2 months after.

Federal Employee Enrollment Errors

Occasionally your Medicare enrollment choices are incorrectly processed by a federal employee. If this happens, there is an SEP during which you can join, switch to, or drop a Medicare Advantage Plan. You can also switch back to Original Medicare or drop your Medicare prescription drug coverage. The Special Enrollment Period allows you to change coverage for 2 full months after you are notified of the error by Medicare.

State Pharmaceutical Assistance Program (SPAP) SEP

As of 2020, 16 states offer State Pharmaceutical Assistance Programs (SPAP) to help people pay for their medication. Eligibility for this service is usually tied to having a specific medical condition. If you are a SPAP participant, you have the option to join or switch to a different Medicare Part D Prescription Drug Plan one time during the calendar year. You can also join a Medicare Advantage Prescription Drug Plan during this SEP.

As you can see, Medicare Special Election Periods provide enrollment flexibility to accommodate various situations for Medicare members. If you need to change your Medicare coverage because of special circumstances, be sure to review the guidelines for Medicare SEPs to determine when you’re eligible to make those changes.

By Dana Barrett

If you are ready to apply for Medicare, you may have questions about your Initial Enrollment Period (IEP) and which Medicare Plans you can enroll in at that time. The following information should help you with questions about the Medicare sign-up age, Medicare’s Initial Enrollment Period, and the Medicare application process. 

When Can I Sign Up for Medicare?

The age to sign-up for Medicare is 65. The Initial Enrollment Period is a 7-month window. It starts 3 months before your 65th birthday, includes your birthday month, then ends 3 months after. The IEP always starts on the first day of the month and always ends on the last day of the month. For example, if your birthday is on May 15th, your Initial Enrollment Period would be from February 1st to August 31st. To calculate your IEP, remember:

Medicare Initial Enrollment Period (7 Full Months)

  • Starts 3 months before your 65th birthday month (on the first day of the month)
  • Includes your birthday month (this is month 4)
  • Ends 3 months after your birthday month (on the last day)

If you apply for Medicare in the 3-month period before your 65th birthday, then your benefits will start on the first day of your birthday month. If you wait to enroll until after your birthday, your benefits start date will be delayed by 1 to 3 months. 

Will I be Automatically Enrolled, or Should I Apply for Medicare?

Some seniors are enrolled in Medicare Parts A and B automatically when they turn 65. This includes people who are receiving Social Security or Railroad Retirement Board benefits. If you are enrolled automatically, expect to receive your Medicare benefits card in the mail a few weeks before your 65th birthday. 

If you’re not enrolled automatically, you will have to apply for Medicare during your Initial Enrollment Period. You won’t be notified by Medicare or Social Security regarding when your enrollment period begins so it’s best to mark your enrollment date on a calendar.

When you apply during your Initial Enrollment Period, you can:

  • Enroll in Original Medicare Parts A and B,
  • Enroll in a Medicare (Part C) Advantage Plans
  • Enroll in a Medicare Part D Prescription Drug Plan
  • Apply for a Medigap Policy 

If you miss the IEP Original Medicare deadline, you can sign up for Medicare during the General Enrollment Period (GEP) which runs from January 1st to March 31st of each calendar year. If you enroll during the General Enrollment Period, you may end up paying higher premiums for Part B coverage as a penalty. Unfortunately, the penalty applies for the entire time you have Medicare Part B. 

Medicare IEP If You are Receiving Disability Payments

If you are under 65 and have a qualifying medical condition or disability, you’ll be enrolled in Original Medicare Parts A and B automatically after you’ve received Disability for 24 months. Your Original Medicare coverage will start on the first of the month in which you receive your 25th Disability payment. However, if you’ve been enrolled through Disability, you still have a 7-month Initial Election Period to change your coverage. 

The 7-month window starts 3 months prior to receiving your 25th Disability payment, includes your payment month, and ends 3 months after. As an example, if you receive your 25th month of disability on August 1st, then your Initial Enrollment Period will be from May 1st until November 30th as the timeframe to make changes. To calculate the IEP for Disability recipients:

Medicare Initial Enrollment Period (7 Full Months)

  • Starts 3 months before your 25th Disability payment month (on the first day of the month)
  • Includes the month you receive your 25th payment (this is month 4)
  • Ends 3 months after you receive your 25th payment (on the last day)

The types of changes you can make during this window include enrolling in a Medicare Advantage Plan (Medicare Part C) or adding Part D Prescription drug coverage. You can also enroll in a Medigap policy during this IEP, to help reduce additional out-of-pocket expenses.

Medicare Enrollment if you Have Employer-Sponsored Insurance

Many people choose to work past the age of 65. If you or your spouse have employer-sponsored health insurance, you may wonder when you should sign-up for Medicare. If the employer providing the insurance has fewer than 20 employees, you can sign up for Medicare during your 7-month Initial Enrollment Period in the year you turn 65.

If the employer has 20 employees or more, you are still able to enroll in Original Medicare Part A during your IEP. You can also choose to drop your private insurance altogether and enroll in Medicare during your 7-month Initial Enrollment Period if Medicare coverage is a better fit for your medical needs. 

If you decide not to sign-up for Medicare during your Initial Enrollment Period because you have an employer-sponsored health plan, you qualify for a Special Election Period (SEP) to enroll in Medicare. This SEP allows you to postpone enrollment until the month that you or your spouse retire, or the date your group health plan coverage ends. 

This 8-month Special Election Period starts the first day of the month following your last day of work or after your group health plan ends. During this 8-month SEP, you can enroll in Original Medicare Parts A and B without incurring a penalty.

It’s important to note that there is a separate 2-month Special Election Period for enrolling in Medicare Advantage (Part C) and Medicare Part D. This 2-month election period also starts the first day of the month after your last day of work or the first month after your group plan ends. So, if your last day of work is June 4th, you’ll have from July 1st to August 31st to enroll in either of these plans.

If you have retiree coverage or are currently covered under a COBRA plan, you are not eligible for either of these Special Election Periods.

How to Sign up for Medicare

You can sign up for Medicare in person at your local Social Security Office, or by calling 1-800-772-1213 Monday thru Friday from 7 am to 7 pm to make an appointment. You can also fill out an Original Medicare application online at You can contact one of our agents for assistance with enrolling in a Medicare Advantage Plan.

By Dana Barrett

What is the Extra Help Medicare Program?

Some low-income folks on Medicare qualify for the Limited Income Subsidy (LIS) more commonly referred to as the “Extra Help Plan”. This subsidy helps to pay prescription drug expenses not covered directly by Medicare Part D. The subsidy level is determined by the recipient’s income when compared to the Federal Poverty Level including resource limits defined by the Social Security Act.

What are the Benefits of the Extra Help Medicare Plan?

If you qualify for this low-income subsidy you’ll have financial assistance to help with fees such as the Medicare Part D monthly premium, as well as any copayments or coinsurance. The subsidy also helps to offset your plan’s annual deductible and eliminates the late penalty if you missed the initial enrollment period for applying for Medicare Part D.

If you are eligible to use Extra Help, make sure that all your current prescriptions are included on your Part D plan’s list of covered medications and brands.  It’s important to note that you are also required to use pharmacies in your plan’s network. If you have a change in health conditions resulting in the need for new medication that isn’t covered by your current Part D plan, you’ll be eligible for a “Special Election Period” to make those changes. 

As a quick review, it’s worth highlighting that most people who qualify for Extra Help receive the following benefits:

  • No premiums,
  • No deductibles (unless receiving the partial subsidy), and
  • No more than $9.20 in 2021 for each drug their plan covers.

Who Qualifies for the Extra Help Medicare Prescription Drug Plan?

Medicare participants who are also enrolled in Medicaid (dual eligibility) automatically qualify for the Extra Help Plan. As do individuals who qualify for a Medicare Savings Program, and also Medicare recipients who are receiving Supplemental Security Income. If you fall into any of these categories, you should receive a notice from the Centers for Medicare & Medicaid Services (CMS) to let you know that you aren’t required to apply for the plan.

If you are enrolled in Medicare or a Medicare Advantage Plan but don’t meet any of these qualifications, then you’re required to apply to Social Security for the Extra Help Plan. Remember that the Extra Help Plan (LIS) is not a substitute for Medicare Part D. You must be enrolled in Part D to qualify for the low-income subsidy.

How is the Eligibility for the Limited-Income Subsidy Determined?

The Centers for Medicare and Medicaid Services release guidelines that outline the income and asset thresholds for qualifying for either full or partial LIS help. Assets that count toward your resources include any real estate in your name that isn’t your primary residence and also funds held in banks or investment accounts. Account assets that affect eligibility include:

  • Checking accounts
  • Savings accounts
  • Mutual funds
  • IRA’s
  • Stocks and bonds
  • CD’s  

It’s important to note that your home, car, and any insurance policies you own are not included in the calculation for eligibility. Income and asset limits to determine if you qualify are updated every year, so you may be eligible one year but not the next. For 2021 the requirements are listed below:

Full Subsidy

  • Single Person – resource limits no greater than $7,970
  • Married couple – resource limits no greater than $11,960

Partial Subsidy

  • Single Person – resource limits no greater than $13,290
  • Married couple – resource limits no greater than $26,520

Are Burial Assets Included in Eligibility Calculations?

As outlined by the CMS, if any resource assets include burial costs then the resource limits increase slightly. This includes costs associated with the purchase or maintenance of a burial plot for either an individual or spouse or even a family plot. Any prepaid fees to a funeral home for burial services also qualify. The recipient is required to notify Social Security of these expenses to have their resource qualification adjusted.

Full Subsidy (with burial expense notification)

  • Single Person – resource limits no greater than $9,470
  • Married couple – resource limits no greater than $14,960

Partial Subsidy (with burial expense notification)

  • Single Person – resource limits no greater than $14,790
  • Married couple – resource limits no greater than $29,520

You may also qualify if your income is above these limits, but you are financially responsible for other members of your family living in the same house.

If you are currently enrolled in the (LIS) Extra Help Plan and you are concerned about potential changes to your coverage due to a mailing that you received from CMS or Social Security, you can find more information here regarding notices about changes to copayment levels, or if Medicare is switching you to a different plan. There is also help for automatic enrollees whose eligibility has ended, and those recipients who chose their own Medicare Part D plan.

Is the Annual Election Period the Same for LIS and Medicare?

When you qualify for the Extra Help Plan, you’ll have access to a Special Enrollment Period (SEP) once per calendar quarter from January 1st until September 31st to either change to another prescription Part D plan or newly enroll for coverage. You are not allowed to use the Extra Help Special Enrollment Period from October through December because you can use the regular Fall Open Enrollment period if you need to make changes to your prescription drug plan. 

The Take-Away

Medicare recipients may be eligible for the Extra Help Plan often referred to as the Part D Low-Income Subsidy, which is provided jointly by the CMS and the Social Security Administration. This plan was designed to protect low-income and fixed-income seniors from the somewhat costly and unpredictable out-of-pocket expenses for their essential prescription drugs. 

If you are already a Medicare or Medicare Advantage recipient, it’s easy to apply for the plan to find out if you qualify for low-income assistance. You can apply online at, or call the Social Security Administration at 800-772-1213. 

By Dana Barrett

Some Medicare Advantage plans provide recipients with an Over-the-Counter (OTC) quarterly or monthly benefit allowing a participant to purchase many healthcare items that don’t require a prescription and are not covered by the standard Medicare Part D program.

What are Over-the-Counter Medications?

Over-the-Counter (OTC) medications include any medication you need that doesn’t require a prescription. This can include cold-medicines like Mucinex, pain relievers such as Advil and Tylenol, and digestive aids like Tums or Pepto-Bismol. Also, multi-vitamins, suppositories, cough drops, and even Neosporin frequently fall under the OTC umbrella.

Eligible OTC Plan Purchases

As mentioned, Medicare Advantage OTC benefits are used to purchase health-related items and medications approved by your Medicare Advantage Plan. In addition to medicine, these plans frequently cover additional health care items such as:

  • Bandages
  • First-aid kits
  • Dental floss
  • Thermometers
  • Blood pressure kits
  • Contact lens solution
  • Sleep aids
  • Probiotics
  • Products for acne care
  • Orthopedic support devices
  • Denture cleaning products
  • Ear care items

Of course, every OTC plan is unique so it is important to check with your insurance carrier or Medicare Advantage provider to find out which items are covered with your plan.

How an Over-the-Counter Benefit Plan Works

If you are enrolled in a Medicare Advantage Plan that includes OTC coverage you will have a quarterly or monthly benefit amount to spend on over-the-counter items. The plan benefit can be anywhere from $10 to $150 per period and it’s essential to ensure that the things you buy are only those items that are included in the your specific Medicare Advantage Plan. When you make a purchase, the cost is deducted from the quarterly or monthly total. Once you have reached the maximum benefit for the plan in each period, the plan benefit cannot be used again until it’s reloaded for the next period.

Medicare Advantage Flex Card Program

Is an OTC Plan the same as a Medicare Advantage Flex Card? The answer is not exactly. There are Medicare Advantage Plans that distribute OTC benefits via a prepaid point-of-sale card referred to as an OTCNetwork card. This card only covers the participant’s OTC benefit and nothing more.

The Flex Card, however, is a Visa debit card that is offered by some Medicare Advantage Plans primarily to help pay out-of-pocket expenses for dental care, vision, and hearing care that exceeds your Advantage plan benefits. There are some insurance carriers who use the Flex card for both dental, vision, and hearing benefits as well as managing a participant’s OTC purchases.

Here’s an example of how a Flex Card is used:  Let’s say your Medicare Advantage Plan coverage limit for eyeglass replacement is $200, but the actual cost of the glasses (with prescription lenses) is $325. You can use your Flex card to pay the difference. 

A Flex Card is delivered to you pre-loaded with the specific dollar amount included with your Medicare Advantage Plan. The plan amount could be anywhere from $200 – $2,000 and that amount is intended to cover the whole year. One of the main benefits of a Flex card is that you have the “flexibility” to choose which eligible services you would like to pay for with the card balance.

How to Use your OTC Medicare Advantage Benefits

The insurance carrier who provides your Medicare Advantage Plan will send you a catalog each calendar year that includes all the items that are eligible OTC purchases. You can order your items directly from the catalog by filling out an order form or you can call to order them over the phone. Some Advantage plans even have a website for online orders. If you have an OTCNetwork card, you can pick up available items at participating retailers. Here is a list of some of those retailers:

  • CVS
  • Target
  • Walgreens
  • Rite Aid 
  • Duane Reade
  • Walmart
  • Dollar General

Medicare Advantage cards may work at other retail stores based on your plan’s coverage. You can check with your plan provider, insurance carrier or just go on to the for a complete list of stores.

Is SPAP Similar to a Flex or OTC Program?

SPAP stands for State Pharmaceutical Assistance Program. These medication assistance programs are offered at the state level to help low-income seniors pay for prescription drugs. SPAP is a different plan from the OTC benefits program in that SPAP only covers medications that are prescribed and SPAP is not offered as part of a Medicare Advantage Plan.

SPAP’s have eligibility requirements that differ based on the rules of the state providing the program. Some state SPAP plans require that you be enrolled in Medicare Part D to qualify for assistance. If you are enrolled in an SPAP that requires Medicare Part D and are taking a prescription drug covered by both your SPAP and your Part D plan, then the amount you pay out-of-pocket combined with the portion that SPAP pays, both count toward your out-of-pocket maximum for the year.

There are also SPAP plans that limit eligibility to only those with chronic conditions or individuals who are HIV+. SPAP’s are not available in every state, only 17 states currently offer these prescription drug assistance programs. If you are not currently receiving Medicare prescription help but would like financial assistance with drug expenses, you can check to see if your state currently offers an SPAP program and review the benefits and eligibility requirements.

The TakeAway

Medicare and Medicare Advantage offer different options for assisting low-income or fixed-income seniors with their medical needs. Medicare Part D is a standard prescription drug plan that doesn’t cover 100% of your health-related needs. 

Medicare Advantage Plans can include OTC and Flex Card benefits to help pay for over-the-counter medical items, as well as extra expenses associated with eye care, hearing, and dental care. SPAP plans offered by some states are an additional payment assistance option that can offset the cost of prescription medications for those who qualify.

By Dana Barrett

Does Medicare Cover Dental Services?

As we age, so does the condition of our teeth, eyesight, and hearing. Dental care can be expensive, especially crowns and bridges, which run in the thousands of dollars. Hearing aids and eyeglasses are also costly, so why are these vital services not covered by Original Medicare?

The Importance of Routine Dental Care

More and more evidence suggests tooth decay and gum disease can lead to a whole host of other health concerns such as cardiovascular disease and memory issues. Also, denture wearers with no natural teeth can struggle with nutritional deficiencies. A mouth full of cavities and gum disease can aggravate health conditions, including heart disease and diabetes. 

Undoubtedly, a lack of regular dental care can delay the diagnosis of more severe health conditions, leading to expensive emergency department visits. Original Medicare only covers dental procedures if they fall within a strictly defined set of circumstances.

Medicare Vision and Hearing Care

Original Medicare doesn’t cover preventative services such as routine eye exams or the expense associated with purchasing eyeglasses or contact lenses. Medicare Part A covers specific eye procedures but only when there’s hospitalization for a condition with eye trauma.

Medicare Part B includes glaucoma screenings and cataract surgery, as these conditions are covered under the umbrella of “general health.” Part B Medicare also includes screenings and tests necessary for the treatment of macular degeneration and diabetes.

Older adults are prone to hearing loss; however, hearing exams and hearing aids are not included in Original Medicare. The only time a hearing evaluation is covered is if it’s a “hearing and balance exam” to diagnose another health condition such as vertigo or a balance disorder. 

Legislative Changes to Medicare

The Social Security Act excludes routine dental, vision, and hearing services from Original Medicare unless they fall under a very narrowly defined set of circumstances.

The federal government has begun to acknowledge the importance of these screening procedures in health maintenance for Medicare recipients, and in 2019 Congress drafted and approved House Resolution 3 (H.R. 3).

H.R. 3 is intended to make changes to Medicare dental insurance and includes improvements in routine eye care and hearing coverage for Original Medicare (Part B) recipients. 

Dental services, routine exams, x-rays and screenings would be covered under Part B benefits starting in 2025. Tooth extractions, fillings, and restorations would also be covered. Original Medicare recipients would still be required to pay the standard 20% as an out-of-pocket expense.

Dental procedures like root canals or dentures are also included but at a much lower rate. Under H.R. 3, the recipient would be responsible for 90% of the out-of-pocket cost but would drop down to 50% over several years. 

Annual vision exams and hearing exams would become standard through Part B Original Medicare. A hearing aid purchase would also be covered under part B, with a 20% copayment. Additionally, there would be an $85 allowance towards the purchase of eyeglasses or contact lenses. Be aware H.R.3 isn’t approved yet. It is still waiting to be voted on in the Senate.

So how can I get these benefits from Medicare now?

The good news is that you can switch from Original Medicare to a Medicare Advantage plan (Medicare Part C) which offers extra coverage for these services. About 75% of Medicare recipients currently have Medicare dental insurance through a Medicare Advantage Plan. Many of these dental plans offer routine care, which can include:

  • Annual exams
  • Cleanings and X-rays
  • The filling of cavities 
  • Root canal treatments
  • Extractions
  • Periodontics
  • Crowns and Bridges
  • Dentures and Implants

Some plans only offer preventative services, while others include more comprehensive dental care. Coverage will be subject to annual limits. 

Dental Discount Cards

Dental discount cards are another option to help offset the cost of dental services. These discount plans are available in most areas, and many major insurance carriers offer their own dental discount memberships for consumers instead of dental insurance. The goal of these programs is to provide immediate discounts for dental services at the time of your visit. Still, they can only be used within a network of participating providers.

It’s important to note that a dental discount card is not part of Medicare. The way the discount card plan works is a network of dentists who agree to charge fixed discounted rates for specific dental procedures covered by the program. Discounts average anywhere from 10% to as deep as 60% for most covered services.

 To join a discount card plan you’ll pay an annual fee; however, these plans don’t require a deductible or copay and there is no annual out-of-pocket cap. The recipient must pay for dental services at the network rates and only with participating providers. You can check with your dentist to see if they are part of a discount plan network, or you can research dental discount cards online.

Medicare Advantage for Eye Care and Hearing

Most Medicare Advantage plan recipients enroll in vision care plans to help reduce the cost of purchasing glasses and contact lenses and have coverage for annual eye exams and fittings. The rates at which these services are covered differ between plans, so be sure to check the plan details when you enroll.

Around 75% of Medicare Advantage customers have hearing coverage. Suppose you’ve been referred to a specialist for a hearing problem. In that case, it makes sense to check with that provider to see which Medicare Advantage plan they accept before making changes to your Medicare Advantage coverage.

Hearing aids are also covered by Medicare Advantage and are available for different price ranges. Basic models typically run from $1,500 – $2,000, but more specialized devices can cost much more. Medicare Advantage plans that offer hearing coverage will cover some or all of that cost. 

 If you need assistance locating Medicare Advantage plans with the added services of dental, vision, and eye care in your area, press the link below and one of our representatives can help you.

By Dana Barrett

As each year begins, the new year ushers in the open enrollment period for making changes to your Medicare. You may be considering whether it’s time to switch from original Medicare to a Medicare Advantage plan, which is often referred to as Medicare Part C. To better understand how that choice could impact your care, we’ve outlined some pros and cons of Medicare Advantage and how it compares to original Medicare.

Signed into law, the Balanced Budget Act of 1997 included the creation of Medicare Choice programs. This private insurance alternative to the federal government’s original Medicare plan was renamed Medicare Advantage as part of the Medicare Modernization Act of 2003. The main goal in creating Medicare Advantage was to improve choices for Medicare recipients, as well as enhance benefits to include additional services such as vision and dental care, while also reducing out-of-pocket costs. 

What is Original Medicare?

Original Medicare is a federal medical insurance plan for citizens over the age of 65, as well as certain people under the age of 65 with physical disabilities, including folks on dialysis due to permanent kidney failure. Original Medicare is divided into 4 separate parts. 

At no charge, Part A covers hospitalizations, hospice care, and long-term care in skilled nursing homes. It also includes some types of in-home health care. Medicare Part covers certain physicians and outpatient care, some preventative care services, approved EKGs, X-rays, lab tests, as well as durable medical equipment. Be aware that Medicare Part B premium does not come free.

When you’re enrolled in the original Medicare plan you have the freedom to choose your doctors, the fees for their services are paid as they’re incurred. You’ll pay a deductible at the beginning of each year, and you usually end up paying about 20% of the cost of the Medicare-approved service out-of-pocket. If you need prescription drug coverage, you can enroll in Medicare Part D. Under Part D, prescription drug coverage includes generic as well as brand-name medications.

Medicare Advantage Plans

As previously mentioned, Medicare Advantage is covered under Medicare Part C. With Medicare Advantage, you choose from a variety of plans that bundle services including Part A and Part B Medicare, as well as expanded care that can also cover prescriptions drugs, dental care, hearing and vision. The private insurance companies that provide Medicare Advantage plans have yearly contracts with Medicare and are legally required to abide by Medicare’s coverage rules. 

If you sign up for a Medicare Advantage plan, you’re still required to pay the original Medicare Part B premium. However, instead of paying the standard 20% coinsurance amount not covered by original Medicare, you’ll only be responsible for the Advantage plan’s copayment amount, if there is any. Medicare Advantage Plans have copays and provider networks that vary based on each specific plan and what services are “bundled” including which of the extra services are included. 

Original Medicare vs. Medicare Advantage Plans

An attractive feature of Medicare Advantage plans is most provide you with more comprehensive coverage by including additional services like vision care and dental, which aren’t included with original Medicare. Some plans even cover gym memberships 

There is a variety of Medicare Advantage plans to choose from. The most common are HMO’s and PPO’s. HMOs are designed to keep costs down. HMO plans will have a broad network of providers available for you to choose from.Medicare Advantage networks are typically defined by geographic region or state and you must reside in that area for a minimum of 6 months to qualify for the plan.

PPO Advantage plans also include networks that provide the most cost-effective medical care. However, with a PPO you can also choose a physician who accepts original Medicare but may be out-of-network. If you go this route, a smaller portion of your costs will be covered by the plan.

Alternately, with original Medicare, you’re open to choose any doctor who accepts original Medicare, and the cost will be exactly the same for covered services (approximately 20%) no matter whom you choose. Keep in mind some doctors limit how many original Medicare patients they’ll accept in their practice so it’s important to check with the provider first. 

Another benefit of Medicare Advantage is in reducing out-of-pocket expenses. If you’ve been enrolled in original Medicare, then you’re aware that having Medicare doesn’t necessarily cover 100% of all your medical bills and the plan does not limit out-of-pocket expenses. Alternately, Medicare Advantage Plans have caps for out-of-pocket costs every year. Once you reach that threshold, you pay nothing for the rest of the year. If you find yourself with a serious long-term illness, the additional costs incurred with original Medicare could be financially devastating.   

Medigap vs. Medicare Advantage

If you have original Medicare, there are supplemental policies you can purchase to offset out-of-pocket medical expenses instead of choosing a Medicare Advantage plan. These plans are referred to as Medicare Medigap policies, or more commonly “Medicare Supplemental Insurance”. 

Private insurance companies offer both Medicare Advantage plans and Medigap policies. However, Medigap is only available to people enrolled in original Medicare. Medigap plans fill the “gap” to cover the extra expenses incurred by original Medicare recipients after Medicare pays. This includes coverage for fees such as copayments, coinsurance and deductibles. 

An important point regarding enrolling in a Medigap plan is that these plans no longer cover prescription drugs. That coverage was phased out of Medicare Supplemental Insurance at the end of 2005. Additionally, unlike Medicare Advantage, Medigap policies don’t offer coverage for dental services, hearing, or vision care. However, some Medigap plans provide foreign travel health care coverage if you find yourself with a medical emergency while traveling outside the United States. 

Clearly there are many variables to consider when making decisions about Medicare. It makes sense to start with a list of your medical needs and review any budget limitations. If you want to simplify your medical coverage with a health care plan that bundles a wide variety of medical care including dental and vision, then a Medicare Advantage plan may be the most cost effective. Speaking with a licensed agent can help with your research and finding an option that’s the best fit for you and your health.