What is the difference between Original Medicare and a Medicare Advantage Plan?
Original Medicare is Part A (hospital insurance) and Part B (medical insurance). It is offered by Medicare.

With Original Medicare you have to decide if you want to join a Medicare Prescription Drug (Part D) plan, which is handled by private companies approved by Medicare.

If you want supplemental coverage (Medigap), you can choose a Medigap policy from a private company. 

A Medicare Advantage (MA) plan is sometimes called Part C, and it includes Part A and Part B. Private insurance companies offer MA plans.
If you want prescription drug coverage and if it's offered by your plan, then you have to get it through your plan in most cases.

You cannot use Medigap insurance with an MA plan to pay for costs such as copayments, deductibles and premiums.

In addition to Original Medicare and an MA plan, you may be able to join other types of Medicare health plans. You can also have other coverage, like employer or union, military or veterans' benefits while having Medicare.

How do I know if I’ll be enrolled automatically into Medicare Part A and B?

You will be enrolled automatically if:

  • You’re already getting benefits from Social Security or the Railroad Retirement Board (RRB)
  • You are under 65 and have a disability
  • You have ALS (Amyotrophic Lateral Sclerosis/Lou Gherig’s disease)
  • You live in Puerto Rico and get benefits from Social Security or the RRB

If you are enrolled automatically, your Medicare card will be sent by mail 3 months before you turn 65 or during your 25th month of disability.

You need to sign-up for Part A and Part B if:

  • You aren’t getting SS or RRB benefits (for example, because you are still working)
  • You qualify for Medicare because you have End-Stage Renal Disease (ESRD)
  • You live in Puerto Rico and want to sign up for Part B (since you automatically get Part A) but you must have Part A to apply for Part B

What do Ancillary Products cover?
Ancillary products are additional health insurance products that can be added to a medical insurance plan. Vision and dental are two examples of ancillary products.

No Coverage in 2014?

You'll pay whichever is higher of the following amounts:

  • 1% of your yearly household income or
  • $95 per person for the year ($47.50 per child under 18 years of age)

What does preventative care include?
Preventative care includes routine doctor visits such as checkups, flu shots and cholesterol screenings.

Is Short-Term Health Insurance for me?
     If you have recently become uninsured, Short-Term Health Insurance will cover your unexpected medical expenses and lasts less than a year, depending on your state of residence and your coverage needs. It is meant to provide coverage in between other insurance options and does not meet the minimum qualification requirement under the Affordable Care Act (ACA/ObamaCare).

 Short-Term Health Insurance does not cover pre-existing conditions and is non-renewable. With short-term health plans you can be denied coverage because it is not considered guarantee issue. They might not have the same protections offered by the ACA.

What are qualifying life events?

  • Marriage
  • Divorce
  • Having a baby
  • Adopting a child
  • Placing a child up for adoption
  • Fostering a child
  • Legally separating
  • Experiencing a death

Can you help me enroll in Affordable Care Act (ACA) coverage?
Yes, click here for more information or here to contact an agent directly. Don’t hesitate to call because we are here to help!

Can I change my insurance plan outside of the Open Enrollment period for the Affordable Care Act (ACA)?

Yes, but only if you have experienced a qualifying life event (life changing) that allows you to be a part of the Special Election Period (SEP).


Frequently Asked Questions

What is the difference between a Medicare Supplement and Original Medicare? 
Medicare Supplement Insurance (Medigap) can help cover costs that Original Medicare does not cover such as copayments, coinsurance and deductibles. Some Medigap policies will even cover your medical care while you are outside of the United States.

A Medigap policy is different than a Medicare Advantage (MA) Plan. A MA plan is a way to get Medicare benefits, and a Medigap policy only adds to your Original Medicare plan.

Usually, Medigap policies don't cover long-term care, vision or dental, hearing aids, eyeglasses or private-duty nursing.

Medigap insurance plans are NOT:

  • Medicare Advantage Plans (as in HMO, PPO or Private Fee-for-Service plan)
  • Medicare Prescription Drug Plans (Part D)
  • Medicaid
  • Employer or union plans, including Federal Employees Health Benefits Program (FEHBP)
  • Long-term care insurance policies
  • Indian Health Service, Tribal and Urban Indian Health Plans

What is the difference between Medicare and Medicaid?

Medicare - program tied to Social Security that helps cover healthcare costs for people over 65 years of age or people with certain disabilities. It is available regardless of income.

Medicaid - program that helps low-income individuals and families pay for medical expenses and long-term custodial care. It is available specific to income.

What are the four parts of Medicare?

The four parts include:

Part A: Hospital insurance

  • Usually, this covers hospital care, skilled nursing facility care, nursing home care (as long as it is more than just custodial care), hospice and home health services

Part B: Medical insurance

  • This includes medically necessary services (services or supplies needed to diagnose or treat a medical condition as well as meet accepted standards of medical practice) and preventative services such as health care to prevent illness (like the flu) or detect it at an early stage
  • Usually, Part B includes things like clinical research, ambulance services, durable medical equipment, mental health (inpatient, outpatient, partial hospitalization), getting a second opinion before surgery and limited outpatient prescription drugs

Part C: Medicare Advantage Plan

  • Private supplemental insurance that provides additional services (All Medicare services offered through A and B can be accessed with C)

Part D: Prescription drug coverage

No Coverage for 2015?

You'll pay whichever is higher of the following amounts:

  • 2% of your yearly household income or
  • $325 per person for the year ($162.50 per child under 18 years of age)

What happens if I don't get health insurance under the Affordable Care Act (ACA)?

If you don't have health insurance that qualifies the minimum essential coverage under the Affordable Care Act, you must either pay a penalty fee or apply for an exemption from the fee. You will pay the fee on the federal income tax return you file for the year that you don't have coverage. The penalty fee increases every year.

  • Gaining citizenship
  • Moving outside of your insurance plan's service area
  • Being denied Medicaid or Children's Health Insurance Program (CHIP)
  • Losing your health coverage
  • Entering or leaving incarceration
  • Having a change in income
  • Losing or changing your job (Losing your job-based coverage)
  • Changing to or from part-time employment