HEALTH INSURANCE FOR INDIVIDUAL AND FAMILY

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 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. 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.

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

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

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

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

1. In 2019 one time deductible $1364 for first 60 days of each benefit period. After 60 days, there is coinsurace per day up to 90 days. You have 60 lifetime reserve days with higher coinsurance. There is Unlimited out-of-pocket beyond lifetime reserve days

2. Each benefit period you only have 90 days use for inpatient hospital and skilled nursing facility services. New benefit period start after 60 days you remain out of the hosital in a row.

3. 60 Lifetime reserve days can be used only once with coinsurance for each day is $682 in 2019.

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

5. Part A doesn't cover long term care.

2019 Standard premium $135.50/month (also depending on income).

After deductible each year ($185 in 2019), pay 20% coinisurance.

Part B covers:

* Medically necessary services

* Preventive services

Part A & B NOT cover: Dental care, Eye care, Foot care and some other services.

Extra benefits, pay out-of your pocket with other Carriers.

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

Individual who has either Part A or Part B or both, is eligible for Part D Prescription drug benefits.

Individual pays monthly premium, annual deductible and per-prescription cost-sharing.

Extra helps, pay out-of your pocket with other Carriers to fill gaps in Original Medicare coverage.

Medigap may pay all or a portion of Part A and B deductible, coinsurance, copayments. Some Medigap plans cover foreign travel.

*** Individual newly eligible for Medicare after Jan. 1, 2020 cannot buy Medigap plan covers the Part B deductible.

Medigap plans are standardized A to N.

Individual with Medigap plan may only enroll through a stand-alone Part D. Since Medigap plans H, I, and J no longer be sold as of Jan. 1, 2006.

Medigap plan cannot be used with a Medicare Advantage Health plan and is NOT a Medicare health plan.