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Why Seniors Need Help with Medicare Enrollment

Medicare is very important for seniors because it provides life-saving health insurance during the years of our lives when most of us require the most healthcare. Some really significant decisions get made during the Initial Enrollment Period (IEP) when kupuna (and disabled Americans) first become eligible for Medicare that affect how they will receive their Medicare benefits. Choosing the right plan(s) is a must for controlling costs and assuring access to needed care. With that said, signing up for Medicare can be confusing because of all the options so getting help with Medicare enrollment is really important.

Almost half of seniors (45%) who are enrolled in Original Medicare and 37% of those enrolled in a Medicare Advantage plan chose their plan(s) without help from a Medicare expert, according to research by The Commonwealth Fund. The challenge with choosing a plan without expert advice is that it’s so easy to be pulled in by advertising for low premiums and deductibles without understanding the coverage it comes with. Medicare enrollment choices are best made with the help of a Medicare expert who can compare the best plans available for your needs and budget.

Why Seniors Need Help with Medicare Enrollment

There are many reasons why seniors benefit from help with Medicare enrollment.

Choice between traditional Medicare or Advantage

All seniors get Part A (hospital insurance) and Part B (medical insurance) whether they choose to enroll in traditional Medicare with a Medigap plan or a Medicare Advantage plan. Seniors may not realize it, but it’s only during their Initial Enrollment Period that they can choose a Medigap supplement insurance plan during a guaranteed issue period without having to undergo medical underwriting. (It’s possible to enroll in a supplement plan after the IEP but insurance companies have the right to charge more or decline coverage altogether based on pre-existing conditions).

Medicare Advantage plans have many advantages, including coverage for services and an annual out-of-pocket maximum that don’t come with Original Medicare. They are truly a great option for many kupuna, but Medicare Advantage should be chosen with the understanding that it may not be easy to switch to Original Medicare with supplemental insurance down the road.

Preventing late-enrollment penalties

It is important to know how to avoid additional costs such as late enrollment penalties that add on 10% of the standard Part B premium for each 12 months of delay for the lifetime of coverage. Medicare penalties are assessed for various reasons, but mostly for failing to sign up for coverage within designated enrollment windows. Once seniors are eligible for Medicare (usually at age 65), there is a seven-month Initial Enrollment Period that begins three months before, includes the month of and ends at the end of the three months after the 65th birthday. There is one exception to this rule: people who continue to work past the age of 65 (or have a spouse who is still working) and have group health coverage. A Medicare expert can help seniors avoid late-enrollment penalties.

Annual review

Many seniors breathe a sigh of relief after they have completed their initial enrollment in Medicare but the truth is that Part D prescription drug and Advantage plans can (and often do) change from year to year. Because of this, it’s really important to review your Annual Notice of Change and look at all your options for the upcoming year during the Annual Enrollment Period between October 15 and December 7. A Medicare agent can answer your questions about changes and show you your best options for the following year.

Where to get free, reliable Medicare advice

There are three main options for free, reliable Medicare advice:

1. Each State has a federally funded State Health Insurance Assistance Program (SHIP) that offers free help with Medicare from knowledgeable volunteer counselors. Click here for access to Hawaii’s SHIP.

2. The Medicare Rights Center is a national nonprofit advocacy organization that provides assistance with a range of Medicare problems. Kupuna can call 800-333-4114 to access their services. The organization also publishes Medicare Interactive, which is a website that publishes information on a range of Medicare topics.

3. Local Medicare insurance agents provide free Medicare advice to kupuna who are getting ready to transition to Medicare or who want to make sure they are on the best plan to fit their needs. Medicare brokers who sell health insurance products related to Medicare have to pass a test on their knowledge of Medicare every year, which means they are up to date on the latest plans and rules. They can also help seniors apply for Extra Help and other programs for low income, low resource seniors and check for specific coverage needs in the plans being considered, among other services. Click here to ready about the top 5 reasons seniors benefit from working with a Medicare agent.

Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. We are the only insurance agency in Hawaii contracted with EVERY Medicare Advantage plan, which means we are able to offer unbiased advice; all at no cost to our clients.

At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.


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