Your Trusted Medicare Licensed Insurance Agent in Wisconsin

Generally, individuals can enroll in Medicare within a seven-month window around the time they turn age 65. There are several parts to Medicare, with varying premiums

- Part A - Hospital, SNF, Home Health & Hospice

- Part B - Outpatient Care, Doctors, Tests, Procedures, DME

- Part C - AKA Advantage/Parts A, B and C in one plan

- Part D covers prescription drugs

NO! All individuals must enroll except individuals under 65 and taking social security due to a disability, which are automatically enrolled in A & B.

Otherwise, enrollment into Medicare Parts A and B is handled by the Social Security Administration, enrollment to Parts C and D requires an independent agent.

To get started visit www.ssa.gov, call 1-800-772-1213, or visit your local Social Security office.

Original Medicare includes Medicare Part A and B. Medicare Part A helps cover hospital stays and inpatient care and Medicare Part B helps cover doctor visits and outpatient care.

After enrolling in Original Medicare there are options for additional coverage:

Medicare Supplement Plans are offered by private insurance companies and specifically designed to help cover some or all of the out-of-pocket costs that Original Medicare doesn’t cover. Consumers must be enrolled in Original Medicare (Parts A and B) to buy a Medicare Supplement plan. Additionally, consumers who enroll in a Medicare Supplement plan can also enroll in a Medicare Part D plan.

Medicare Advantage Plans (also known as Part C) are also offered by private insurance companies. These plans provide Medicare Part A hospital insurance, Medicare Part B medical insurance and sometimes Medicare Part D prescription drug coverage. Out-of-pocket costs and cost-sharing for the consumer differs from Original Medicare, differs by plan, and may depend on whether the consumer receives in or out-of-network services.

Medicare Part D Plans: Offered by Medicare-approved private insurance companies, these plans provide prescription drug coverage for medications prescribed by a doctor or other health care professional.

If employees are age 65 or older, they should understand whether their employer's coverage is primary or secondary to Medicare:

- If they work for an employer with fewer than 20 employees, they will need to enroll in Medicare to have primary insurance, because health care coverage from employers with fewer than 20 employees pays secondary to Medicare. Failing to enroll will trigger higher-premium penalties.

- If they work for an employer with 20 or more employees, then their employer sponsored health care coverage pays primary to Medicare. They may choose not to enroll in Medicare while they're still employed.

At firms with 20 or more employees, the employer's plan will generally remain primary as long as the employee is actively employed. That means employees—and their providers—should continue to submit claims first to the employer's plan and then to Medicare, as appropriate. Remind employees to alert their providers to this secondary coverage.

An individual may be eligible for Medicare based on any one of the following:

- Age 65 or older

- Younger than 65 with a qualifying disability

- Have a diagnosis of end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, also called Lou Gehrig's disease) at any age

At organizations where Medicare provides primary coverage, employees at age 65 can no longer contribute to an HSA, because once they enroll in Medicare their coverage is no longer HSA compatible.

At larger organizations where the employer's health plan is the primary coverage, employees enrolled in an HSA-compatible, high-deductible health plan may choose to delay enrolling in Medicare and continue contributing funds to their HSA.

Employees at organizations with 20 or more employees, however, should keep in mind that premium-free Medicare Part A provides secondary coverage of hospital expenses that may not be covered by the employer's plan. If they forgo enrolling in Part A, they should weigh the potentially higher preretirement hospital costs against their ability to increase the size of their HSAs before retiring.

If you have a Health Savings Account (HSA), you and your employer should stop contributing to your HSA 6 months before you retire or apply for benefits from Social Security (or the Railroad Retirement Board). This will ensure you avoid a tax penalty.

Employees older than age 65 who deferred Medicare enrollment typically receive an eight-month special enrollment period, starting the month after employment ends or their group health insurance ends, whichever happens first. Employees should beware that if after ending employment they elect to use COBRA for their insurance for more than eight months (and COBRA coverage is generally available for up to 18 months), then the penalties for missing the special enrollment period and enrolling late are significant and, in the form of higher premiums, continuous.

If this option is more cost-effective for you, then absolutely. You’ll want to take into consideration how much you’re paying for your employer group health coverage. If you find yourself spending more on your group insurance than Part B premium and a Medicare Advantage/Supplement plan, you should consider leaving your group insurance and enroll in Part A & B. This is something we can help you figure out.

We often find that it costs less for your spouse to enroll in Medicare vs. staying the employer plan. If spousal insurance is costing you hundreds of dollars a month, you should consider enrolling them in Medicare.

- Dental/Dentures

- Routine Hearing & Hearing Aids

- Routine Vision & Eyeglasses

- Long Term Care

- Cosmetic Surgery

- Acupuncture/Alternative Medicine

- Foreign Travel