HEALTH INSURANCE FOR INDIVIDUAL AND FAMILY-TX-MO-KS

1. Initial Enrollment Period: 3 months before your 65th birthday, your birthday month, and 3 months after your birthday. You can apply for Medicare Parts A, B, C, and D during this time. Your coverage will start no sooner than your birthday month.

- Part B and D start date will depend on which month you enrolled in Part B and D during the Initial Enrollment Period. 

*** Part D coverage cannot start before Part A and/or B begins.

*** Late penalty up to 10% may apply for individuals who don't buy Part A and/or B when they are first eligible.

2. Period Jan. 1 to Mar. 31:

2a. General Enrollment Period: Can sign up for Medicare Parts A & B between Jan. 1 to Mar. 31 each year. Medicare coverage would begin on July 1 of the same year.

2b. Medicare Advantage Open Enrollment Period: Provides additional opportunities to change your Medicare Advantage plan. Annual MA OEP runs from Jan. 1 to Mar. 31.

3. Special Enrollment Period: While you have coverage from an employer:

A/ Special Enrollment for Parts A and/or B:

i/ Any time you are still covered. 

ii/ During the 8-month period after coverage ends.

B/ Special Enrollment for Parts C and D:

i/ Within 63 days after coverage ends.

ii/ Switch Part D plans in certain events. 

4. Open Enrollment Period/Annual Election Period: From Oct. 15 to Dec. 7 every year and coverage begins Jan. 1 for Medicare Advantage and Part D.

5. Medigap Open Enrollment: During 6 months of the Medigap Open Enrollment Period, you can buy any Medigap policy sold in your state, even if you have health problems. The enrollment period starts on the 65th birthday month and is enrolled in Medicare Part B.

In short, Part A is free for qualified individual and cover inpatient care in Hospitals only. 

1. For an individual who does not have enough 40 quarters working, the monthly Part A premium in 2021 is:

- $471 for individuals or their spouses who paid Medicare taxes for less than 30 quarters.

- $259 for individuals or their spouses who paid Medicare taxes for 30-39 quarters.

 *** Late penalty up to 10% may apply for individuals who don't buy Part A and/or B when they are first eligible. 

2.  In 2021 one time deductible of $1484 for the first 60 days of each benefit period. After 60 days, there is coinsurance per day for up to 90 days. After 90 days, you have the option to use 60 lifetime reserve days with higher coinsurance. After these cover days, there is Unlimited out-of-pocket. 

3. Each benefit period you only have 90 days use for inpatient hospital and skilled nursing facility services. The new benefit period starts after 60 days you remain out of the hospital in a row.

4. 60 Lifetime reserve days can be used only once with coinsurance for each day is $742 in 2021.

5. Part A covers: Blood, hospice care, home health care, skilled nurse, inpatient psychiatric care with a limited number of days and you have to pay coinsurance.

6. Part A doesn't cover long-term care.

Extra benefits payout of your pocket with other Carriers.

Individuals who are entitled to benefits under Part A and enrolled under Part B are eligible to enroll in a Medicare Advantage plan.

Medicare Advantage has the option to cover Part D or not.

Most Medicare and Medicaid individual can have Medicare Advantage Health plan for free which also cover Dental care, Eyecare, Footcare, and some other services.