To be eligible to enroll in health coverage through the Marketplace, you must:

• Live in the United States (U.S).
• Be a U.S. citizen or national, or be lawfully present non-citizen in the U.S.
• Not be incarcerated.

• November 1: Open Enrollment starts for health coverage for the next plan year — first day you can enroll in, renew, or change health plans through the Marketplace. Coverage can start as soon as January 1.
• December 15: Last day to enroll in or change plans for coverage to start January 1.
• January 1: Coverage starts for those who enroll in or change plans by December 15 and pay their first premium.
• January 15: Open Enrollment ends — last day to enroll in or change health plans for the year. After this date, you can enroll in or change plans only if you qualify for a Special Enrollment Period.
• February 1: Coverage starts for those who enroll in or change plans December 16 through January 16 and pay their first premium.
• Special Enrollment Period
  • A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or due to a life event or based on your income.

If you don’t have health insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying health coverage, you can find coverage through the Marketplace.

This is one of the most asked questions. The answer depends on your specific situation. Are you retired or currently working? Are you already taking Social Security? Will you continue to work and stay on a group medical plan?

If you currently are receiving Social Security or a Railroad Retirement Board Benefit, you may be automatically enrolled. You’ll receive your Medicare card in the mail before your 65th birthday. You will still have an Initial Enrollment Period (IEP), during which you may make Medicare coverage decisions.

If you are not currently receiving Social Security or Railroad Retirement Board Benefits, when you turn 65, you’ll need to sign up for Medicare yourself. Medicare may not notify you about your eligibility, so be sure to obtain your Initial Enrollment Period (IEP) dates and put them on your calendar.

Around your 65th birthday (or 25th disability check), you’ll have a 7-month window of time when you can sign up for Medicare. It’s called your Initial Enrollment Period — or IEP for short. Your IEP includes your 65th birthday month, the 3 months before and the 3 months after. If, however, your birthday is on the 1st of the month, then your IEP is determined as though you were born the month before.

You will likely pay the Part B premium to Medicare. Beyond that, you may pay other premiums, deductibles, co-pays, and co-insurance. The total amount you pay will depend on the type of Medicare plan(s) you choose, and the health care services you use during the year.

No part of Medicare is mandatory, but if you choose to enroll in any part of Medicare after your Initial Enrollment Period, you could face financial penalties unless you qualify for a Special Enrollment Period with creditable employer coverage.

In general, you are eligible for Medicare after receiving Social Security disability benefits for 24 months. There are exceptions for people with certain medical conditions.

It is illegal to enroll in both a Medicare Supplement plan and a Medicare Advantage plan. If you were to enroll in both plans, neither would become your primary coverage, leading to a denial of services. This could leave you paying out-of-pocket for all your healthcare services, regardless of having both coverages.

Original Medicare does not cover prescription drugs. If you wish to have coverage for prescription Medications, you will need to enroll in Medicare Part D. Medicare Part D helps cover the cost of prescription medications. Additionally, some Medicare Advantage plans provide prescription drug coverage as well.
If you do not enroll in Medicare Part D, you may be subject to the Medicare Part D late enrollment penalty. This penalty is for those who delay Part D benefits without creditable coverage. You will be required to pay the additional cost if you have Medicare Part D.

It is not required for you to enroll in Medicare if you have VA benefits. However, if you ever receive coverage outside of the VA system, you will need medical coverage to cover these costs. Remember, if you have VA coverage and delay Medicare Part B enrollment, you will have to pay the Medicare Part B penalty if you decide to enroll in Medicare coverage later in life. Once you enroll in Medicare, it pays primary, and the VA pays secondary.

Original Medicare benefits do not change each year. However, the premiums, deductibles, and covered services may change each year.

New prices are generally released in October and reflect changes for the upcoming year. Also, if there is a change in covered services, you will receive notice in advance that Medicare will no longer provide coverage. Medicare Advantage plan benefits do change every year. Thus, it is essential to review the changes to your plan each year during the Annual Enrollment Period. During this time, you do have the option to change your plan if you do not like the new changes for the year. Any changes made during this enrollment period will be effective on January 1 of the upcoming year. Medicare Supplement plans do not typically change yearly. However, the deductible and premium costs may differ each year.

If you have a Medicare Advantage plan and wish to switch to a Medicare Supplement (Medigap) plan, you may have to wait until the Annual Enrollment Period. Unlike Medicare Supplement plans, Medicare Advantage plans require you to enroll for one year unless you have a life-changing event that would allow you to leave the plan early. This means you cannot change plans whenever you wish throughout the year. Except for your first year on Medicare, Medicare Advantage plans are a 12-month term lasting from January to December. To change your plan for the upcoming year, you will need to enroll during the Annual Enrollment Period. By doing so, you must answer underwriting health questions to enroll in a Medicare Supplement plan. This means that your application for coverage may be denied depending on your answers to the health questions.

If you enroll in Medicare Part D, you have the opportunity once per year to enroll in a new plan during the Annual Enrollment Period each fall.
Medicare Part D plans do not require you to answer health questions, so you can enroll in any plan you wish during this enrollment period. Keep in mind, any changes made to your Medicare Part D plan during the Annual Enrollment Period go into effect on January 1 of the following year.
Each year, Medicare Part D plan formularies change to reflect the needs of the majority consumer. Your plan may change how it covers your specific drugs, and your copayments and deductibles may change each year.
So, even if you are satisfied with your benefits, it is essential to review the changes for the upcoming year and ensure that your drugs will still be adequately covered.

Original Medicare does not have a typical network of doctors and hospitals. Instead, doctors and hospitals can opt in or opt out of accepting Medicare. In 2024, nearly 93% of doctors and hospitals nationwide will accept Medicare. When you enroll in a Medicare Advantage plan, you will have to follow the network of doctors who accept your plan. This is one of the downsides of enrolling in an Advantage plan. You lose the freedom to choose your care team thoroughly. However, with a Medicare Supplement plan, you will be able to see any doctor nationwide. This is a bonus if you often travel or have dual residency.

• Call us first…
  • Any time you have a Medicare question or concern, call us first.
  • We work with all the major Medicare companies in the country.

We can answer your question or provide you with guidance on how to handle the situation. We are your advisors and are here to serve you at no cost. Every year we will review your plan to make sure it is right for you for the next year.
Even though things may not have changed with you, your plan could have made changes that could cost you.