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Changing Medicare Advantage Plans

AEP or SEP

Can you change Medicare Advantage Plans?

The short answer is yes, you can change a Medicare Advantage Plan or a Medicare Part C Plan. However, the timing of when you are able to change your Medicare Advantage Plan will depend on having a qualified enrollment window to make the change. Are you changing during the Annual Enrollment Period (AEP)? Do you have a valid Special Election Period (SEP)? Are you eligible for Medi-Cal California’s version of Medicaid Medi/Medi? Regardless of the reason for changing Medicare Part C Plans, we are experts with helping our clients change or transition plans when the time is right. Contact us if you’re looking to change your Medicare Advantage Plan. 

Change during AEP or the Annual Enrollment Period?

During the Annual Enrollment Period (AEP) you’ll have the opportunity to enroll/change to any of the available Medicare Advantage Plan(s) in your county. You will not be subject to medical underwriting as Medicare Advantage/ Part C Plans do not require Medical underwriting to enroll (no qualifying medical questions). During the AEP (October 15th – December 7th), if you choose to make changes to your coverage, the new Medicare Advantage Plan will become effective January 1 of the following calendar year. Enrolling in a new Medicare Advantage Plan will automatically cause you to be dis-enrolled from your current plan on December 31st of the that year. This means there is no need to cancel the current plan before the start of the new year. Medicare only allows you to be enrolled in one plan at a time, therefore, the old plan will cancel on the 1st of the new year. If you enroll in more than one MAPD plan during the AEP, the last enrollment will be effective on January 1st. 

The AEP is often referred to as the “Open Enrollment Period” as well. I prefer to use more accurate term of Annual Enrollment Period (AEP), as “Open” is somewhat misleading clients. Being that the window of time is not open to move from a Medicare Advantage Plan to a Medicare Supplement Plan guaranteed-issue (no health questions asked) after the first year within a Part C Plan, I do not feel it accurately reflects the window as “open” for clients to move freely among all plans. As for moving from Part C to Part C plans or moving from Part D to Part D plans, it is open to moving among these plans without medical underwriting. 

Annual Enrollment Period (AEP)

October 15th – December 7th each Fall. New plan starts January 1st of the new year.

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Do you have a valid SEP?

If you have a valid SEP from your current Part C Plan or Medicare itself informed you of your ability to move/change your Medicare Advantage Plans, you can use this SEP to move/change plans. The scope of the SEP and the timeline or window may vary depending upon the specific reason for the SEP. Many SEPs are standardized for particular scenarios, but many do have varying timelines based upon the reason for the Special Election Period. The most common SEP for a Medicare Advantage Plan is the plan’s network cancelling their MA plan effective on DEC 31st of the year. In this case, you would have an opportunity to use the AEP to re-enroll in a new MA plan or use SEP status to enroll in any Medicare Supplement of your choice without medical underwriting (no health questions asked). 

To illustrate, your current Medicare Advantage Plan may not meet the standards set by Medicare, or may be cancelled/ no longer available in your area. Under these circumstances, you would have window of time to move your Medicare Advantage Plan outside the standard enrollment window (Annual Enrollment Period each Fall, plus a few months is typical). This SEP may also provide you with guaranteed-issue rights into a Medicare Supplement Plan (no health questions asked) as well as a SEP into a Medicare Prescription Drug Plan. In this particular example, this SEP would give you the ability to transition plan types during the SEP window without penalties, and/or medical underwriting. In addition, it would likely extend the enrollment window 1-2 months past the AEP to give you additional time to make an enrollment decision if for some reason you had missed the cancellation notice in the fall. 

Are you eligible for Medi-Cal's SEP?

If you are eligible for Medi-Cal or commonly referred to as dual eligible Medi/Medi, you’ll have access to a monthly SEP that allows you to move/change to another Medicare Part C plan, also known as a MAPD plan. If you choose to use this SEP, your new plan selection will begin on the 1st of the following month and the current Medicare Advantage Plan will end on the last day of the month you made the move/change. If you’re not qualified for Medi/Medi and struggle with prescription costs, you should see if you qualify for Extra Help with medication costs as this may allow you a SEP for stand-alone Prescription Drug Plans as well as subsidized pricing for generic and brand name drugs. Contact your local Social Security office for more information on Extra Help with Prescription Drug Costs program. 

Why would someone be looking to change their Medicare Part C Plan?

– You’re not satisfied with the access the MAPD provides– seeking a new network of physicians.

– Changing plans because the current MAPD plan is not covering your prescriptions as well another plan. 

– Moved from the plan’s service area and need a new MAPD plan in the new county/state.

– Changing plans to reduce your Out-of-Pocket Max and/or network for your current plan.

– Changing from a Medicare Advantage Plan to a Medicare Supplement Plan & Medicare Prescription Plan.

Need help changing your Medicare Advantage Plan?

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Welcome to MedicareSupplementMentor.com!

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Our Compensation

How are we compenated as Independent brokers?

Our agency works independently of each insurance company we represent to provide objective, unbiased options from a variety of insurance companies.  We do not receive a salary or any other form of payment other than what we make from the plans our clients choose to enroll in through our insurance agency. We are compensated for new clients who choose to work with us as well as current clients who maintain a plan through us. The commission we receive is paid directly by the insurance company for your enrollment. You do not pay us, ever. 

Premiums are exactly the same as going direct.

Medicare insurance products have different payment structures (ie. Medicare Supplement Plans, Medicare Advantage Plans, and Medicare Prescription Drug Plans). Our clients never pay us for any of the services or advice we offer. Medicare insurance plans are priced 100% the same as going direct. It’s a win-win for us and our clients. Monthly plan premiums are exactly the same as going direct to an insurance company’s call center. When you work with us, you get to work directly with the broker as opposed to an employee of the insurance company in a call center. 

Medicare Supplement Plan (Medigap) Compensation

When a client chooses us to help facilitate their enrollment into a Medicare Supplement Plan, we receive a monthly commission based upon a percentage of the monthly premium. You are not charged more than the companies premium for our service. The insurance company pays us a commission for the product you choose. Our clients never pay us for any of the services we offer. We are paid on a monthly or annual period depending on the insurance companies payout structure. 

When it comes to Medicare Supplements, our goal is to keep you in a product with competitive rates. Medicare Supplement Plans are standardized plans, therefore, there’s no reason to pay more for the same exact thing, right? We want you to be confident with any recommendation we make. Transparency is the key to our success. We know every insurance company is seeking your business during this transition to Medicare. When your rates increase, we are not paid on the new “increased amount”. We are paid on the initial premium. Therefore, it is in both our best interest to review your rates each year or every other year to find a new plan that provides you with better rates. We want our clients to be satisfied with the products we offer and the service we provide for our compensation.

Medicare Advantage Plan (Part C) Compensation

Just like Medicare Supplement Plans, we are paid directly from the insurance company for facilitating your enrollment with a Medicare Advantage Plan. Our clients never pay a cent more than going direct to the company’s call center. We are paid is fixed by the Medicare Advantage product and state it is issued through (CA). To be clear, we are paid the fixed amount regardless of the premium you pay for the Medicare Advantage Plan. We receive the same commission on the $0 premium plan as the $100+ plans. We will help you breakdown each plan option to find the best value for all plans available to you. You can simply choose the plan that works best for you. We are then compensated by the insurer of the plan you choose once your enrollment is complete.

The amount we are paid for helping you enroll in the plan of your choice is the same amount whether it is a new plan or a plan we recommend you consider moving to. I like to clarify this so our clients know that if we make a recommendation for a new MAPD plan, it has nothing to do with how we are compensated. We are compensated for helping you maintain your plan and answer questions about your coverage. We are able to offer independent advice because we can provide you will multiple plans from multiple companies. If you ever have a question about a new plan available in your area, or something you’ve seen on television,  please contact us.  We will help you review the plan to see if it’s something that would benefit changing to during the AEP for the following year. 

Medicare Prescription Drug Plan (Part D) Compensation

Similar to the Medicare Advantage Plans, we are paid a fixed amount from the insurance company. This commission we receive is not based on the premium you pay for the Medicare Prescription Drug Plan. We are compensated exactly the same for a $10 a month plan as a $100+ a month prescription drug plan. Monthly premiums our clients pay are exactly the same as premiums for those who enroll directly through a call center. Yes, 100% the same. We receive a commission for helping you initially enroll in the plan. We are also compensated each year you choose to stay in the plan.

When we recommend to move your plan during AEP (each Fall), it is likely because the plan you’re in has changed or it is not going to cover your prescription list as well for the following year. Medicare Prescription Drug Plans are the plan type that change most often year to year. You’ll likely be making updates to your drug coverage every year or every couple years to keep up with annual changes. We help our clients review Part D plans every fall. If you have more questions about how Medicare Prescription Drug Plans work or how we are compensated for providing them to you, please contact us. We would are more than happy to review your current plan and answer any questions you may have.

Transparency is Key.

5 Step Enrollment Guide Introduction

An Educational Approach to Medicare

Can I get a spousal benefit through Social Security and my spouse's quarters to qualify for Medicare?

Yes, to qualify for Medicare, you need to have paid into Social Security for 10 years or 40 quarters, or you can qualify under your spouse’s record of quarters paid to Social Security. Many times, in this scenario the spouse is/will be taking Social Security as well as Medicare through the other spouse. 

The important difference between taking Social Security and taking Medicare through a spouse, is that you must be 65 to qualify for the Medicare portion of benefits through your spouse. I only note this because taking Social Security through a spouse can take place before turning 65. In this situation, the timing of the Medicare benefit for the younger spouse can be mistaken as active when one spouse is over 65 and the other is under 65, yet taking Social Security benefits through the older Medicare eligible spouse. This isn’t a common mistake, but just a reminder. 

Typically, the younger spouse may start taking a portion of the older spouse’s Social Security benefit (allowing their benefit to grow to a certain point) At a later time, they may choose to elect to start their own Social Security benefit separately from their spouse. Timing the Social Security benefit and Medicare are separate enrollments, but many times this can overlap and seem complicated when enrolling in Medicare and changing Social Security benefits at the same time. 

If you have been taking benefits through a spouse (delaying your own benefit) and decide to elect to start your own Social Security benefit at a later date (ie. your SS benefit has been building on the side for you as you have been delaying it), remember to update Medicare and your Medicare insurance plans because it’s likely your Medicare ID# will be updated under your own benefit (you’ll get a new Medicare card). Medicare coverage should not be affected. Rather, just a new Medicare ID# to run your own medical billing through the same product you’re currently covered under. 

For more Social Security planning guidance, please refer to the Social Security 101 tab at the top of the home page or contact my office for one on one advice with John to talk through when its best for you to take your Social Security benefit. 

Are you working past 65, delaying your Social Security benefit, and enrolling in Medicare at a later date?

This is the most complicated election for timing your Medicare start dates, yet it is very common. I’ll walk you through each step to thoroughly cover exactly what you need to do to get Medicare started on time, without penalties, and without any hassles. I’ll assume a few things as we go through this step by step so you can put yourself in this scenario even if your situation is slightly different. 

This Medicare enrollment scenario assumes you are working past the age of 65, delaying your Social Security benefit, and covered through your employer sponsored plan with more than 20 employees or you are older than 65 and covered through your spouse’s employer sponsored plan with more that 20 employees. 

Note: Im very specific with the employer plan being more than 20 employees because if you or your spouse’s employer plan is more than 20 employees, then the employer group plan is primary to Medicare the month you turn 65 and after the age of 65 while you are working. This means that even though you are over the age of 65, you were able to skip enrollment into Part B (and technically Part A) of Medicare since it is not primary coverage (employer plan remains primary). Therefore, enrollment into Part B can be delayed in this scenario without penalty until transitioning to full Medicare A & B the 1st of the month following retirement/leaving the employer group plan. Part A may have been activated at 65 if you enrolled online for “Part A Only” and delayed Part B. Technically whether you enrolled in “Part A Only” or not with more than 20 employees in your group plan, “Part A Only” is just “sitting on the sidelines” until you elect to start Part B (they then both become primary once activated via your SEP).  

If your employer group plans is less than 20 employees, Medicare will be primary and the employer group plan would then act as the supplemental coverage to Medicare. If under 20 employees, you’ll be best off not delaying your Part B of Medicare. You’ll need to proactively enroll in Part B 3 months before turning 65 using IEP even though you are working. I recommend you try to negotiate with your employer to pay your Part B premium as well as the group plan coverage acting as your supplemental in this scenario. Many times the company may offer to pay for the Part B premium, the Medicare Supplement and your Part D plan while working. It is much cheaper for the employer if you to go off their group plan, so many times, they are happy to reimburse the Medicare Part B premium and Medicare insurance products for you each month.  

If you have more questions, call my office so I can go through this with you. It’s tricky, but I’m very familiar with timing these scenarios for my clients.  

Back to the scenario…. you are over 65, working, delaying Social Security, and wishing to enroll at some future date for Medicare to begin the day you leave your or your spouse’s employer group plan that is larger than 20 employees. Let’s assume, you’re 68 years old and wishing to retire in the month of September for a seamless transition to Medicare for October, 1 2022. In this scenario, your birthday is irrelevant when it comes to enrolling in Medicare with Social Security. Since you are outside the Initial Enrollment Period (IEP) (the 7 months surrounding your 65th birthday), you’ll need a different election tool to activate your Medicare properly. You’ll be using whats called, a Special Election Period or SEP. Since you have been covered on an employer group plan prior to the month leading to your 65th birthday, you’ve had what is called “credible coverage”. This credible coverage is going to allow you to enroll into Medicare on any retirement date in the future if you remain covered under that employer group plan while employed with the company. For this example, we are using 10/01/2022 as the preferred Medicare start date after retiring in September so I can be specific with dates for this illustration. 

In this specific scenario you would need to print forms on SSA.gov or print from the Resources Tab under Helpful Medicare Forms and Documents on this site. These forms are SSA form L564 and form 40B. 

40B is a form that you’ll use to “say” that you want to elect to start your Medicare Part B on “X” date. In this example, we are targeting 10/01/2022 for the start date. Print and fill out form 40B indicating your intended Part B start date of 10/01/2022. 

Now, to SSA form L564. This form is what activates the use of form 40B. L564 is a form that your employer administrator will fill out showing you’ve had credible coverage under their group plan from date “X” to date “Y” — signed by the benefits administrator in your company. You can get this form signed up to 8 months prior to your intended Medicare start date- 10/01/2022. 3-4 months prior to your start date is sufficient in my opinion. 

To continue the example, let’s say you filled out the 40B in June/July and had your employer sign off on your credible coverage on the L564 and returned the form to you. You can submit both forms to the Social Security office in person for your 10/01/2022 start date. If you’re working with me on this, I’ll be happy to guide you and fax the documents to the local Social Security office with your permission to get a hard copy receipt of SEP enrollment for 10/01/2022.  

Let’s assume for ease of the this example that you are still delaying your Social Security benefit. You’re Medicare is set for 10/01/2022. You’ll now receive a quarterly Part B billing statement for the Part B premium. Remember, Part A is “premium free” since you paid into the system for more than 10 years. If Part A was activated as “Part A Only” at 65 online it is still “sitting on the sidelines”. Once L564 and 40B go through both Part A and Part B will be activated to be primary on 10/01/2022, once the group employer ends the last day of September. No penalties!

Medicare is now primary and you can work with John to get quotes, pricing, and enroll yourself in the plan of your choice. You will have exactly the same guarantee issue rights as someone who went through the process when turning 65 (no health questions asked). You are not subject to late enrollment penalties for Part B or Part D because of the credible coverage you had through the employer group plan or your spouse’s employer plan. L564 took care of the proof for the Part B penalty, but you may need to show proof of “credible coverage” to the FIRST enrollment into a Part D plan you enroll into whether it be a standalone Part D or Part D included in a Medicare Advantage plan. After this initial Part D enrollment, you should not need to resubmit proof.

If you enroll in Medicare insurance products with my office, we will help you get this organized and submit it with your application before they even ask- avoiding any confusion as to whether you had credible coverage or not. Best to give them the proof ahead of time than deal with it at a later time. 

Once you elect to start your Social Security benefit at a later time (ie. 68-70 in this example), the Part B premium will then be withdrawn automatically each month prior to the monthly draft (your monthly Social Security benefit amount minus the Part B premium = monthly Social Security benefit draft into your account). The standard Part B premium for 2022 is again, $170.10 (more if subject to IRMAA).  

This is one example- please call if you want me to review your specific enrollment scenario so we can pin point the exact months you needs to complete each step to get it all coordinated correctly without penalties. 

Mentor One Insight

Mike is 68 (outside his IEP at 65), he is still working and delaying his Social Security. He is covered through a large employer plan (over 20 employees) so he can delay his Medicare Part B and use his group plan as his primary coverage while he works past 65. He has credible coverage through his employer plan for Part B and Part D. He can retire any month he wants and can elect to have Medicare begin without penalty on the 1st of the month he chooses. He wants to start July 1 – 07/01/2022. He is retiring June 5th -06/05/2022 and therefore, has coverage through 06/30/2022 with his employer plan (check with your benefits to be sure you’re covered through the end of the month- take advantage of this if you can). 

In March/April (3-4 months prior to his desired start date of July 1 – 07/01/2022), Mike printed off the forms 40B and L564 and reviewed the timing of his Medicare with John over the phone to pin point his exact dates. Since he settled on July 1 for his Medicare start date based on leaving his employer at 68 years old on June 5th. He filled out form 40B that indicated a 07/01/2022 Medicare Part B start date (Part A will become active on 07/01/2022 as well). Mike now contacts his employer benefits division to get a representative to sign off on his credible coverage with form L564 to allow him to activate his form 40B. He submits both forms to Social Security in the month of March or early April (depending on when his employer gets the L564 back to him). Mike gets confirmation of Part B effective 07/01/2022.  Part A may have an earlier date and it will always show the earlier date if elected “Part A Only”, however, Part A will become effective 07/01/2022 because the primary insurer (employer) drops 06/30/2022. Both Part A and Part B are coordinated and effective 07/01/2022.

He is now set for his Medicare start date of 07/01/2022 without penalty for his Medicare coverage at 68 years old. Mike meets with John to review Medicare insurance plans, pricing, and enrolls in the plan of his choice. Additional credible coverage proof is sent to the Part D plan of his choice– the Part D penalty is now not applicable to him. He is now fully covered without a lapse in his coverage. His group plan ends June 30th and his Medicare as well as his Medicare insurance product(s) all start July 1 without a lapse in coverage. 

Are you working until 65, delaying your Social Security, and plan to enroll in Medicare at 65?

This scenario is similar to the one above, but in this situation, you are currently working and covered under your employer group plan until the last day of the month you leave your group plan (or spouse’s) and retire. You are planning to retire the month prior to your 65th birthday and looking to time your Medicare start date the day after your employer health plan benefits end (last day of the month). Maybe you chose to work up to this date because you know the cost of insurance plans in your early 60’s are extremely expensive as an individual and you are timing your retirement to coincide with Medicare your 65th birthday IEP Medicare start date. 

In this scenario, you are delaying your Social Security benefit. Therefore, you will need to proactively enroll into Medicare (Part A & B) for coverage to start the 1st of the month you turn 65. It is best to do this 1-3 months before your 65th birthday month (The Part B Initial Enrollment Period starts 3 months before your 65th birthday). Most clients apply in the 1-3 month window prior to their birthday (plan ahead if possible). You can enroll online or in person with the Social Security office (pending appointment availability). We are available to help you through the enrollment process if you have questions at this stage in the process. Once enrolled online or in-person, always print a receipt of your enrollment date, write down and/or print the confirmation number from the Social Security. 

Since you are delaying your Social Security benefit, there is no monthly Social Security benefit check for the Part B premium to be withdrawn from, right? For this reason, you’ll be receiving a quarterly Part B bill. You will need to continue paying this bill to keep you Medicare Part B active until you elect to start your Social Security benefit and it’s automatically withdrawn. You will have the option to pay through a monthly checking account auto draft or monthly credit card. You’ll need to wait until you receive the quarterly bill to set up these other payment options. The standard Part B premium for 2022 is $170.10 (more if subject to IRMAA). Part A is again, “premium free” if you have fulfilled the minimum requirement of 10 years (40 quarters).

Once you elect to start your Social Security benefit at a later time (ie. 66-70), the Part B premium will then be withdrawn automatically each month (your monthly Social Security benefit amount minus the Part B premium = monthly Social Security benefit draft into your checking acct.) 

I chose to show this example because many times the SEP forms for Medicare enrollment for someone leaving an employer group plan AFTER the age of 65 can be mistakenly used in conjunction with IEP or in place of IEP (Initial Enrollment Period) 3 months prior to turning 65. 

IEP will take precedent over the SEP forms in this situation. To be clear, you do not want to use the SEP (leaving an employer group plan) enrollment unless you are outside the IEP period surrounding your 65th birthday. With that being said, for this example, he/she is enrolling prior to turning 65, yet still leaving an employer group plan. So, use the standard IEP enrollment period and proactively enroll directly with Social Security in-person or online for your Medicare (Part A & B) to begin on the 1st of your 65th birthday month. See SEP situation in the next example if you are curious how that works when enrolling in Medicare AFTER turning 65 and leaving an employer group plan outside your IEP. 

Mentor One Insight

Diane is approaching her 65th birthday –August 19th, 2022. Diane has been anticipating her retirement date since last year at 64, but after viewing the cost of medical insurance through the employer COBRA option or going on her own with an individual plan costing her approx. $1000 a month, this wasn’t an option for her. She decided to work another year with her current employer and plans to retire in July- the month before she turns 65. Since she is currently covered under her employer plan, she knows that if she retires the month prior to turning 65 (on the 10th of July and  her 65th bday is August 19th), her Medicare coverage starts 08/01/2022. If she leaves the employer plan on the 10th of July, she will have coverage through the end of the month through the employer plan. She will have no lapse in coverage. 

The day the employer plans ends, is the same day her Medicare activates as her primary coverage (08/01/2022). Diane is delaying her Social Security and plans to take it at a later date (ie.66-70). She is focused on Medicare timing at this time and can elect to start her Social Security at any point she sees fit in the future. Electing to start her Social Security benefit will not have an effect on her Medicare. It will only effect how her Medicare Part B premium is paid to Social Security (quarterly if delaying/monthly withdraw if taking the benefit). 

Three months before Diane’s 65th birthday month of August, Diane should proactively enroll herself into Medicare during her IEP (Initial Enrollment Period). Again, she is proactively enrolling in Medicare in-person or online because she has chosen to delay her Social Security benefit at this time. Once she has met with Social Security or confirmed her effective date/start date by enrolling in Medicare online, she is set to start her Medicare coverage – effective 08/01/2022.  

Now that Diane completed the first enrollment of coordinating her Medicare properly, she can comfortably continue reviewing the second enrollment process of reviewing Medicare plan paths and the insurance products to find the plan that best suits her coverage needs. After reviewing Medicare Basics 101 and the following steps of the process (5 Steps), Diane can now confidently contact John in May, June, or July to confirm her understanding of insurance products on her Medicare plan path as well as ask for quotes, pricing, and enrollment paperwork to start the enrollment process for the insurance products. Diane’s Medicare and Medicare insurance product(s) will all start 08/01/2022. Diane timed her retirement perfectly from leaving an employer group plan and transitioning to Medicare with no lapse in coverage. 

Are you delaying your Social Security benefit and plan to enroll in Medicare when you turn 65?

You will need to proactively enroll into Medicare (Part A & B) for coverage to start the 1st of the month you turn 65. It is best to do this 3 months before your 65th birthday month (The Part B Initial Enrollment Period starts 3 months before your 65th birthday). Most clients apply in this 1-3 month window prior to their birthday (plan ahead if possible).You are able to enroll up to the day prior to your 65th birthday month (ie. March, 31st– for an April 1 start date when 65th birthday is in April). If you apply the month of or just weeks prior to your 65th birthday month, you may not have your card in hand, but you will be covered- effective as of the 1st of your 65th birthday month.  You can enroll online or in person with the Social Security office (pending appointment availability). We are available to help you through the enrollment process if you have questions. Always print a receipt of your enrollment date, write down and/or print the confirmation number from the Social Security website if enrolling online. 

Since you are delaying your Social Security benefit, there is no monthly Social Security benefit for the Part B premium to be drafted from, right? With no Social Security benefit for you to withdraw your Part B, you will be receiving a direct bill in the mail. This bill will likely be quarterly, which you’ll need to continue paying to keep you Medicare active until you elect to start taking your Social Security benefit. The Part B premium will then be automatically withdrawn. 

Referring back to the quarterly Part B bill, you will have the option to pay through a monthly checking account, auto draft, or monthly credit card on the quarterly statements if you choose. You’ll need to wait until you receive the quarterly bill to set up these alternative payment options. The standard Part B premium for 2022 is 170.10 (more if subject to IRMAA). And as with all Medicare beneficiaries that worked for 10 years or 40 quarters and paid into Social Security, Part A is again, “premium free” to you.  

Once you elect to start your Social Security benefit at a later time since you are delaying it at this time, the Part B premium will then be automatically withdrawn each month (your monthly Social Security benefit amount minus the Part B premium = monthly Social Security draft into your account). Once this is set up, you should never have to update it. 

Mentor One Insight

Mark is currently retired. He works part time as a consultant, but continues to be covered through his spouse’s employer group health plan until he turns 65. He turns 65 on April 7th of 2022, so he wants his Medicare to start on the 1st of his 65th birthday month- 04/01/2022. Mark has savings and other forms of income through investments as well as his spouse’s income which is allowing him to delay his Social Security benefit to a later date. He has not decided exactly when he’ll take his benefit (he’s planning on a date between 66 and 70). For now, he is focused on only starting Medicare. Let’s assume it is early January, 2022 in this example. 

Mark will need to proactively enroll in Medicare for his Medicare to activate 04/01/2022. His Initial Enrollment Period for Part B (IEP) begins on January 1 of 2022 (3 months prior to his 65th birthday month). He can call Social Security to schedule an in-person appointment or can go online to SSA.gov to proactively enroll in Medicare prior to his desired April 1 start date. Mark and his wife show less income on their IRMAA than $182,000 so he will be paying the standard $170.10 per month for his Part B premium. He also fulfills the requirement for Part A after working for 45+ years. Therefore, Mark’s Part A is “premium free”. Since he has chosen to delay his Social Security benefit, there is not a monthly Social Security benefit to withdraw the $170.10 Part B premium. He will be mailed a Part B bill for $510.30 (quarterly). He can elect to pay this through his credit card or checking account auto draft as soon as he receives the quarterly statement and coordinates the payment option he prefers. Mark will likely receive this quarterly bill along with his Medicare card 2-4 weeks after coordinating his Medicare with Social Security for his 04/01/2022 start date.

Now that Mark has completed the first enrollment into Medicare (Part A & B) effective 04/01/2022, he can now move to the second enrollment and start reviewing Medicare Basics 101 to begin researching the “Parts” and Medicare plan paths and Medicare insurance products. Mark has a good idea of which “Plan Path” he prefers for his Medicare coverage. Mark scheduled an appointment in late January/early February to review his plan with John and to start the paperwork for completing applications for insurance products to start along with his Medicare on 04/01/2022. 

Are you actively taking your Social Security benefit and plan to enroll in Medicare when you turn 65?

You will be automatically enrolled in Medicare (Part A and B) qualifying by paying into Social Security for 10 years or 40 quarters. Your card will be mailed to you and it will indicate your Medicare coverage to begin on the 1st day of your 65th birthday month (ie. Birthday, March 21st– Medicare starts March 1, 2022). The card will typically be sent 3-4 months prior to your 65th birthday month. Assuming you’ve paid into Social Security for 40 quarters (or you qualify through your spouse), Part A is premium free to you (you were taxed!) Medicare Part B has a separate premium. The standard premium for 2022 is $170.10 (subject to change annually). The Part B premium will be automatically deducted from your Social Security benefit since you’ve already elected to start your Social Security benefit prior to your Medicare start date (you have a benefit amount established to deduct the $170.10 from monthly). 

If you happen to set up your Medicare at the same time you elected to start your Social Security benefit (simultaneously at 65), the Part B premium may be deducted as an automatic monthly draft (if set up in time for Social Security billing), or it may be billed to you as a quarterly statement until the payment deduction is processed. Review your Social Security benefits statement to confirm the Part B premium draft ($170.10 or more if subject to IRMAA).  Call your local Social Security office to confirm payment information or to coordinate the transition of the Part B premium payment. Once you’ve completed this enrollment, you can transition to planning out your second enrollment of choosing your Medicare insurance product(s) for that path.

Mentor One Insight

Roberta has been retired for a couple years and has been covered with an individual health plan until she is Medicare eligible. She is planning to transition to Medicare the month of her 65th birthday (when she is first eligible). She has already elected to start her Social Security benefit early at 62. Her birthday is February, 18 and wants to be sure her Medicare starts on the 1st of February (first possible day for her Medicare to begin). Let’s assume it’s the first week of November, 2021 in this example (3 months before her 65th birthday month).

Roberta will be automatically enrolled in Medicare since she is actively taking her Social Security benefit. She will get her Medicare card approximately 2–3 months prior to February. Since her Social Security benefit is already active, her Part B premium will be automatically deducted from her check each month starting in February of 2022. Her Part B premium will be the standard $170.10 and her Part A is “premium free” since she worked well over the 10 years to qualify. Her Part A and Part B effective dates on her Medicare card will both be 02/01/2022. She does not need to worry about the Part B Initial Enrollment Period (3 months before, the month of 65th bday, and 3 months after) for Medicare enrollment. Remember, Social Security automatically enrolled her using Roberta’s IEP and mailed her card directly to her. Roberta then can move on to the next step of enrollment into a Medicare insurance product of her choice. 

Roberta reviewed Medicare Basics 101 under the navigation bar and continued making her way through the 5 Step Medicare Enrollment Guide to find the Medicare plan path and insurance product that will give her the coverage that suits her healthcare needs. Roberta filled out the Help/Quote Request Form on the website in late November/early December. She now has an appointment scheduled to discuss plans and enroll into Medicare insurance products with John to get everything set up for her 02/01/2022 start date. 

Side-by-side comparison of Medicare Advantage Plans
(Medicare.gov - 95747, Placer, CA)

This screenshot was taken from Medicare.gov for educational purposes. The image above shows 3 of the 18 plans available in Placer County, California (95747) in 2022. These three plans were chosen to illustrate how to use the Medicare.gov plan finder as well as show Medicare beneficiaries how they can search for plans using Medicare.gov for side-by-side comparisons in groups of 3. 

The description of premium, deductibles, and OOP Max is intended to be used as educational examples of how the plans are presented by Medicare.gov. No sales material is provided on this site for Medicare Advantage Plans. Please contact my insurance agency directly, medicare.gov, or the insurance company for more plan details and/or to enroll a Medicare Advantage Plan. 

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Request Help

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Ask a Question.

Questions? We have answers.

Medicare Supplement vs. Medicare Advantage Plans?

At this point, you should have a decent grasp of Medicare Basics 101 and your path to a successful Medicare Enrollment with Social Security. Hopefully, you are planning ahead of your Medicare start date, as its best to give yourself plenty of time to get organized. At this point in the process, you may or may not have confirmation of your Medicare Part A & Part B effective dates. If you do, great. If your Medicare card is on its way, you should have confirmation of dates (online or in-person with SS office), which is just as good. If you’re still in the process of getting the enrollment process started (or planning it out), you’re still on the right track! 

Choosing between these two plan types will be the DECIDING FACTOR which will dictate how your Medicare will function. Try not to think about the insurance carriers yet– once you have a plan type in mind, we can then dig deeper to shop which carriers are offering what plans to find the best value for you. 

Choose your Plan Path:

Medicare (Part A & B) + Medicare Supplement + Part D Prescription Drug Plan

Medicare Advantage Plan w/ Part D Prescription Drug Plan Included (MAPD)

Keep in mind– as long as we get you enrolled in a Medicare Supplement + Part D Rx plan or a Medicare Advantage plan w/ a Part D Rx plan before your Medicare start date, either style of a Medicare insurance plan will be effective the 1st of the month you’re eligible to begin Yes, even if you were to enroll in a plan the day before your start date, although I don’t recommend waiting until the last minute. I only say this so if you’re being told to enroll months ahead by another agent/broker pressuring you, they’re full of it! 

Which Medicare plan type/design do you prefer? If you’ve made your decision, but still want to confirm with me over the phone to make sure you prefer that plan for the right reasons, I can do that for you. If you’ve gone through the plan types and are still unsure, and would like me to guide you through it step by step while you follow on your computer, then let’s do that. Contact my office to schedule a phone appointment and I’ll review anything you have questions about. In fact, talking briefly over the phone typically allows me to clarify questions in matter of minutes rather than both of us writing lengthly emails back and forth. A brief chat will also give you the opportunity to put a voice to your guide. You can then decide if you would like me to help assist you with plan selection as your Medicare insurance broker. I look forward to helping you through the insurance plan selection process.

CMS L564

For printable version-- see Medicare Forms & Documents

CMS- 40B

For printable version-- see Medicare Forms & Documents

CMS- 2022 Medicare Supplement Chart

Are you over 65, delaying your SS benefit, and starting Medicare after you retire?

4th month after turning 65 to any future date while covered under employer group plan.

Using a SEP to activate Medicare Start Date

Covered under an employer group plan after the age of 65. Using Form 40B and L564 to activate Medicare to begin any month you select.

4th month after turning 65 to any future date while covered under employer group plan.

1-8 months prior to desired Medicare start date

Submitting 40B & L564

You’ve signed off on 40B indicating your desired start date (1st of the month). Employer has signed off indicating you’ve had credible employer coverage on form L564. Submit both forms to Social Security to activate your Medicare on the future date-  1st of the month you chose within 8 months of submitting forms.

1-8 months prior to desired Medicare start date

1-3 months before Medicare start date-- after confirmation of Medicare start date with Social Security (SEP)

Enroll in Medicare Insurance Products(s) with Mentor One

Set appointment with John, confirm understanding of your preferred Medicare plans type, review Medicare plan quote, enroll in Medicare insurance product(s) of your choice by phone, in-person, or virtually. 

1-3 months before Medicare start date-- after confirmation of Medicare start date with Social Security (SEP)

Date of choice you indicated Medicare to start and your Medicare insurance product(s) to start.

You’re Covered!

Congratulations! You are covered and may use your Medicare and Medicare insurance product(s) as needed (no penalties applicable with “credible coverage”).

Date of choice you indicated Medicare to start and your Medicare insurance product(s) to start.

Working, delaying your Social Security benefit, and starting Medicare at age 65 (ie. August birthday)

May 1, 2022 - July 31, 2022 (3 months before 65th bday month).

Initial Enrollment Period (IEP) Medicare (Part A & B)

Working, yet retiring prior to 65th bday month. Delaying your Social Security benefit. You’ll be proactively enrolling yourself in-person or online with Social Security to have your Medicare begin on the 1st of your birthday month.

May 1, 2022 - July 31, 2022 (3 months before 65th bday month).

May 1, 2022 - July 31, 2022 (any day before August, 1).

Enroll in Medicare Insurance Product(s) with Mentor One

Set appointment with John, confirm understanding of your preferred Medicare plan type, review Medicare plan quote, enroll in Medicare insurance product(s) of your choice by phone, in-person, or virtually. 

May 1, 2022 - July 31, 2022 (any day before August, 1).

August 1, 2022

Medicare & Medicare Insurance Product(s) Start Date

Medicare (Part A & B) and your Medicare insurance product(s) start on the 1st of your 65th birthday month- 08/01/2022

August 1, 2022

August 1, 2022 - Future

You’re Covered!

Congratulations! You are covered and may use your Medicare card and Medicare insurance product(s) as needed. 

August 1, 2022 - Future

Delaying your SS benefit & starting Medicare at 65
(ie. April Bday)

January 1, 2022 - March 31, 2022 (3 months before 65th bday month).

Intial Enrollment Period (IEP) Medicare (Part A & B)

Since you are delaying your Social Security benefit, you’ll be proactively enrolling yourself in-person or online with Social Security to have your Medicare to begin on the 1st of your 65th birthday month.

January 1, 2022 - March 31, 2022 (3 months before 65th bday month).

January 1, 2022 - March 31, 2022 (any day before April, 1).

Enroll in Medicare Insurance Product(s) with Mentor One

Set appointment with John, confirm understanding of your preferred Medicare plan type, review Medicare plan quote, enroll in Medicare insurance product(s) of your choice by phone, in-person, or virtually. 

January 1, 2022 - March 31, 2022 (any day before April, 1).

April 1, 2022

Medicare & Medicare Insurance Product(s) Start Date

Medicare and your Medicare insurance product(s) start 04/01/2022. 

April 1, 2022

April 1, 2022 - Future

You’re Covered!

Congratulations! You are covered and may use your Medicare card and Medicare insurance cards as needed. 

April 1, 2022 - Future

Medicare Basics 101

Part A, Part B, Part C, Part D– Medicare Supplement plans & Medicare Advantage plans….Who came up with this system!? Well, it’s what we have to work with, so let’s break this down in stages to get a basic understanding of what each “Part” represents.  For starters, NO, you can’t have all 4 parts. As to why they choose to label them (A-D) as if they all fit together still puzzles me as well.  

Start by reviewing each category under Medicare Basics 101. Use this pop up to refer back to as needed:

Medicare Plan Map View how "Parts" interact with each Medicare plan path (two paths)

Original Medicare (Part A & B) The foundation of Medicare. Keep (w/ Medicare Supplement) or Sign Over (w/ Medicare Advantage).

Medicare Supplement Plans (Medigap) View the structure & functionality of the plan. (Keep Original Medicare Add Medicare Supplement).

Medicare Advantage Plans (Part C) View the structure & functionality of the plan. Sign Over to its own "Medicare Plan".

Medicare Prescription Plans (Part D) View the structure and functionality of the plan - Add (w/ Medicare Supplement) or Included (w/ Medicare Advantage).

Medicare Enrollment Planning Overview

First things first! Let’s take you through the enrollment process of activating your Part A & B of Medicare with Social Security. Start here with the Medicare Enrollment Planning section. In this section, you’ll be discovering when you’re able to enroll in Medicare and whether it will be automatic or you’ll need to be proactive with Social Security. You will also be able to view Timeline buttons under each enrollment scenario to reinforce the concepts (ie. IEP -3 months before your 65th birthday month, etc.).

Under this Medicare Enrollment Planning section, I’ve broken down the most likely Medicare Enrollment Scenarios, so you can read through each and find the one that best applies to your situation. The timing will depend on whether you have already started or delayed your Social Security benefit. Are you actively receiving a SS benefit, delaying the benefit, maybe undecided and still working? Every Medicare beneficiary’s goal is to activate their Medicare properly on the day they intend to take benefits, however, each person’s path may differ. Here is an outline of the enrollment scenarios:

- Have you taken your Social Security benefit and plan to enroll in Medicare when you turn 65?

- Are you delaying your Social Security benefit and plan to enroll in Medicare when you turn 65?

- Are you working until 65 or later, and delaying your Social Security benefit and enrolling in Medicare at age 65?

- Are you working past 65, delaying your Social Security benefit and moving to Medicare at later retirement date (leaving a group employer health plan upon retirement)?

- Can I get a spousal benefit through Social Security and my spouse's quarters to qualify for Medicare?

After this initial step of finding your Medicare enrollment path with Social Security, you’ll be ready to confirm your start date with Social Security and/or organize yourself so you’re ready for when the time comes to enroll (depends on how early you’re starting the planning process). After this first step, start the process of reviewing the “Parts” of Medicare and the “Plan Types” being offered to you under Medicare Basics 101.

Medicare Checklist for medicare enrollment.

John V. Crump

Broker | President

Welcome,

I would like to take the opportunity to share with you a little more about myself, John Crump, broker and mentor for MedicareSupplementMentor.com. First and foremost, I believe it’s important that you meet the person delivering the content that may influence your enrollment and/or coverage decision(s). I’ve built this site to help you navigate Medicare and Medicare insurance plans in a pressure free environment.

Us my Medicare Video Library, Map, Checklist, and 5 Step Enrollment Guide to process everything you need to know about “all things Medicare”. Here is a brief outline of what my site will help you with as you weigh your Medicare enrollment options and decide with whom you want to set up your Medicare insurance coverage:

- Coordinating Medicare with Social Security- Medicare Enrollment Planning

- Clearly define and explain to the "Parts" of Medicare- Medicare Basics 101

- Breakdown the Medicare plan paths & Medicare "Plan Types" - Compare Medicare Plans

- Objective Medicare plan quoting & Medicare insurance plan enrollment - Contact John

- Medicare & Medicare insurance product education from a broker's perspective.

As an independent insurance broker, I will be transparent with you. I am in the insurance business of brokering Medicare Supplement Plans for retirees. I make my living off of helping new clients enroll into Medicare insurance plans. My mission is change the high pressure sales environment most retirees are subject to surrounding their transition to Medicare with call centers. MedicareSupplementMentor.com was designed to change the way in which Medicare beneficiaries have access to accurate and trustworthy sources of information. You deserve to have access to information that is clear and direct. The accessible and comprehensive design will allow you to review the Medicare plan material at your own pace without an any agent’s “enroll now” sales pressure. If you found the material on my site useful, I do ask that you give me an opportunity to help you enroll in the Medicare Supplement Plan, Medicare Prescription Drug Plan , or Medicare Advantage Plan of your choice. 

Please take your time reviewing the layout and design of the site’s content. It’s all been constructed with you in mind. Take advantage on the “pop up” informative material, “maps”, and “buttons” which are all accessible throughout the site. Look for my Mentor One Insight, which will provide you with more details on each Medicare topic by applying hypothetical scenarios and examples throughout the site. 

I look forward to guiding you through the maze of Medicare plans when you’re ready.  

Thank you,

John V. Crump

AARP UnitedHealthcare

Aetna

Anthem Blue Cross

Blue Shield of California

Cigna

Authorized to Offer

Continental Life

Combined

Coventry

Health Net

Humana

IAC

Mutual of Omaha

National Guardian Life

Transamerica

Wellcare 

Actively taking Social Security & starting Medicare at 65
(ie. February birthday)

November, 1 2021 - January, 31, 2022 (3 months before 65th bday month)

Initial Enrollment Period (IEP) Medicare Part (A & B)

You’ll have automatic Medicare enrollment since your Social Security benefit is active. Medicare will begin on the first of the month you turn 65.

November, 1 2021 - January, 31, 2022 (3 months before 65th bday month)

November 1, 2021 -January 31, 2022 (any day prior to February, 1).

Enroll in Medicare Insurance Product(s) with Mentor One

Set appointment, confirm understanding of preferred Medicare plan type, review Medicare plan quote, enroll in Medicare insurance product of your choice by phone, in-person, or virtually.  

November 1, 2021 -January 31, 2022 (any day prior to February, 1).

February 1, 2022

Medicare & Medicare Insurance Product(s) Start Date

Medicare and your insurance product(s) start 02/01/2022.

 

February 1, 2022

February 1, 2022 -Future

You’re Covered!

Congratulations! You are covered and are ready to use your Medicare card and Medicare insurance cards as needed.

February 1, 2022 -Future

Medicare Plan Map

Medicare Map - choose your Medicare Plan path.

Medicare Planning Made Simple Booklet

Mailed directly to your mailbox.