The Loop Newspaper - Tehachapi's Online Community News & Entertainment Guide

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By Sue Wonacott
Medicare certified insurance agent 

Rolling Into Medicare


The Medicare Annual Open Enrollment Period (AEP) is from October 15, 2014 through December 7, 2014. You may start talking about Medicare and your choices with your agent but applications may not be sent in until October 15, 2014 due to CMS (Centers for Medicare and Medicaid Services) rules.

If you would like to make changes to your Medicare selections such as a new Advantage plan, add a PDP plan (stand alone prescription drug plan) or add a Supplemental plan to help cover the 20% that Medicare does not cover, this is the time period in which to do it. Medicare is usually a 20/80% split with Medicare paying 80% and you, the beneficiary, paying 20%, as long as the doctor accepts Medicare assignment.

Otherwise, you will have to wait another year until the next Annual Open Enrollment in October 15, 2015 through December 7, 2015. The exception to this rule is a Special Enrollment Period (SEP) which occurs when a beneficiary moves, loses their plan to the service area being changed or perhaps the carrier drops the plan, or the employer plan ends.

The simplest way to understand Medicare is to break it into parts. Put the parts together and you have solved the puzzle. There are 4 parts to Medicare: A,B,C,D and then, of course, a Medicare Supplement plan if you so chose one.

Part A- covers inpatient hospitalization

Part B- covers professional services such as doctor’s visits

Part C- Advantage plans offered from several carriers. I like to say they are an “advantage” over Original Medicare (A&B) as they offer more services and benefits and often include drug coverage (MAPD)

Part D- prescription drug coverage

The Supplemental plans help cover the 20% that Medicare does not cover and this includes co pays which are a set amount, such as $25 for your doctor’s office visit, deductibles which often have to be met before the plan pays your claim, and coinsurance which is a percentage of the claim. If you have a bill for $20,000 from the hospital, 20% can be a mighty amount of money to come up with.

It’s a good idea to work with a Medicare certified insurance agent to fully understand your Medicare choices as you usually receive a huge amount of literature from each insurance carrier wanting your business ... usually enough to wallpaper a room in your home, which just adds to the confusion.

It is my pleasure to help you unravel the confusion of Medicare. Let me help you put the pieces of the puzzle together. I represent many carriers to help give you the choices you need that will give you confidence and a piece of mind.

I am available at Marty Pay Insurance Agency (Farmer’s Agency) at 121 East F Street, Tehachapi,CA and may be reached by cell phone 661-304-4695 or at the office 661-822-3737 or drop me a note via



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