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Insurance / Medicare Counseling

Health Insurance / Medicare Counseling ("SHIP")

Central Vermont Council on Aging provides information, counseling, and assistance to all Medicare eligible persons under the auspices of the State Health Insurance & Assistance Program or “SHIP”.

Our staff counsels individuals and provides workshops to the public on Medicare. We can answer your questions about Medicare, private insurance plans, supplemental insurance plans, and Vermont State insurance programs. We offer regularly scheduled “Medicare & You"” workshops to the public in locations convenient to you. Here are the programs we offer:

Health Insurance Counseling is available to answer your questions about Medicare or other insurance plans, including the Vermont State programs. We can also guide you through your online enrollment.

Medicare Prescription Part D Enrollment Information

CVCOA provides helpful information about Part D and how to enroll. We also offer individual assistance by phone, email, and Zoom. For an appointment call 479-0531.

Medicare & You Workshops are offered regularly to help individuals who are new to the Medicare system. During the COVID-19 pandemic, we are pleased to announce CVCOA is offering Medicare & You sessions remotely using Zoom. If you want to participate, pre-register with us by calling (802) 479-0531 or mail to[email protected]. When you call to register, you will receive information on how to join in the workshop session on Zoom. Here are upcoming dates and times:                                                                       

                                         Wednesday, Sept 9, 10am - noon

                                         Monday, Sept 21, 5pm - 7pm

                                         Tuesday, Oct 6, 1-3 pm

                                         Monday, Oct 19, 5-7 pm

                                         Tuesday, Nov 3, 3:30-5:30 pm

                                         Monday, Nov 16, 5-7 pm

For those wishing to explore Medicare on your own, we recommend the following videos from the Centers for Medicare and Medicaid Services:

Medicare & You: Different Parts of Medicare  

Medicare & You: Understanding Your Medicare Choices

Medicare & You: Deciding to Sign Up for Medicare Part B 

Medicare & You: Medicare Open Enrollment (general information)

Medicare & You: Medicare’s Preventive Benefits 

Medicare & You: Traveling Abroad 

 

Frequently Asked Questions

What are the parts of Medicare and what do they cover?

Medicare is a federal health insurance program for people age 65 or older, for certain younger people with disabilities, and for people with end-stage renal disease.

  • Inpatient hospital care
  • Skilled nursing facility care (short term). Only if you were first admitted to the hospital as an inpatient for 3 days
  • Medically necessary home health care. Only if you were first admitted to the hospital as an inpatient for 3 days
  • Hospice care

Part B covers outpatient health care:

  • Medically necessary services, such as doctors’ visits, lab tests, x-rays, ambulance transport, durable medical equipment, diabetic supplies, mental health services
  • Preventive services
  • To find out if a test, item or service is covered go to: https://www.medicare.gov/coverage

Medicare Part B does not cover every possible medical expense. Here’s a partial list of what Part B doesn’t generally cover:

  • Routine dental care
  • Routine vision care
  • Most prescription drugs you take at home. (These are covered under Part D). Medicare Part B may cover certain medications administered to you in an outpatient setting.
  • Hearing aids
  • 24-hour home health care
  • Long-term care, such as you might get in a nursing home. If the only care you need is custodial, meaning help with tasks such as bathing and dressing, Medicare doesn’t generally cover it.

Part C is also known as an Advantage Plan

Part D covers prescription drugs

Original Medicare and Advantage Plans

Original Medicare is the name for Medicare managed by the federal government.

  • Advantage plans (also known as Part C) are an alternative way to get Medicare. They are sold by private health insurance companies who administer Medicare for the federal government.
  • Advantage plans must cover the same services as Original Medicare (Medicare administered by the federal government) BUT they do not have to cover the services at the same rates. (For example, they can cover Part B services at 70% or with a flat rate co-pay, etc.)
  • You will still need to have Medicare Part A and pay a monthly premium for Part B.
  • In Vermont, Advantage plans include a prescription drug plan.
  • Original Medicare is the traditional program offered directly through the federal government, while Medicare Advantage are private plans that contract with the federal government to provide Medicare benefits.
  • Original Medicare includes Part A and Part B. Most doctors in the United States take Original Medicare.
  • Medicare Advantage Plans are commonly either HMO (Health Maintenance organization) or PPO (preferred provider organization) or PFFS (Private Fee-for-Service). Plans must cover the same benefits offered by Original Medicare, but they may apply different rules, costs, and restrictions. They also may offer certain benefits that Original Medicare does not. You will still need to have
  • Medicare Parts A and Parts B.
  • With Original Medicare you can see any provider and use any facility that accepts Medicare; with Medicare Advantage plans you may need to use doctors and hospitals in the plan’s network.
  • Original Medicare does not require referrals for specialists; Medicare Advantage Plans may require a referral to see a specialist.
  • Medicare Advantage Plans may cover additional services, such as vision, hearing and/or dental; Original Medicare does not cover these services.

Yes, but there are limitations

  • 12 month Trial period
    • Only available to those who enroll in an Advantage plan when they are first eligible for Medicare or if they drop a Medigap policy to enroll in an Advantage plan for the first time.
  • Fall Open Enrollment
    • October 15 – December 7 you can drop an Advantage Plan and return to Original Medicare with a Jan 1 change date
  • Medicare Advantage Open Enrollment
    • January 1 – March 31 with the change taking effect the 1st of the following month
  • However, if you don’t qualify for the 12 month Trial Period, you may not find a Medigap plan that will take you as you will be outside of “guaranteed issue” for Medigap plans.

You are not required to buy either a Medigap plan or an Advantage plan. If you have neither, you will be responsible to pay the portion that Medicare does not cover out-of-pocket unless you qualify for financial assistance.

Medicare Costs

Most people do not pay a monthly premium for Part A.

  • If you or your spouse worked and paid Medicare taxes for 10 years, you won’t have to pay a premium for Part A
  • If you didn’t pay Medicare taxes for long enough, you may have to pay a premium for Part A.

Part A has a hospital stay deductible. In 2020 the deductible is $1408 per benefit period. This covers the beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care. A benefit period starts the day you are admitted to the hospital and ends 60 days after discharge.

  • Most people pay a monthly premium for Medicare Part B. In 2020 the standard premium is $144.60/month. You could pay more than that (IRMAA) if your income is higher than a certain amount, (in 2020: $87,000 for an individual and $174,000 for a couple filing jointly) and less if you qualify for state-based help if your income is lower than a certain amount.
  • A Part B deductible applies to some covered services. In 2020 the annual Part B deductible is $198.
  • After you pay your deductible, Medicare Part B generally pays 80% of approved costs of covered services, and you pay the other 20%. Some services, like flu shots, may cost you nothing.

It varies. In 2020 premiums range from $0/month - $139/month.

It varies. In 2020 premiums range from $13.20/month - $128/month.

  • IRMAA stands for Income-Related Monthly Adjustment Amount
  • Individuals with income over $87,000/year and couples with income greater than $174,000/year in 2020 pay an additional amount above the cost of their Part B and Part D premiums. This extra amount is paid directly to Medicare, not the prescription plan.

Social Security will contact you, based on your income. Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago.

You will need to fill out form SSA-44 to request a reduction in your IRMAA

Part D: Prescription Drug plans

Prescription drug coverage through private insurers

Choose a plan based on the prescriptions you take.

Go to the medicare.gov website for plan comparison and enrollment.

Watch our video to learn how to choose the Part D prescription drug plan that works best for you

If you take no prescriptions and do not enroll in a prescription drug plan when first eligible, and you choose to enroll at a later date, you will have a lifetime late enrollment penalty added to your monthly premium. The cost is calculated by multiplying 1% of the national average premium times the number of uncovered months you didn’t have Part D or creditable coverage.

  • If you are turning 65, you have a 7 month time period starting 3 months before the month you turn 65, your birthday month, and continuing 3 months after the month you turn 65.
  • You may also qualify for a Special Enrollment Period, for example if you are losing coverage from your or your spouse’s employer.
  • Go to medicare.gov for plan comparison and enrollment.
  • The Central Vermont Council on Aging can assist with Part D plan comparison and enrollment: 802/479-0531

Every year during Open Enrollment, Oct 15 – Dec 7, you have the opportunity to change prescription drug plans.

It varies. In 2020 premiums range from $13.20/month - $128/month.

If you do not enroll in a Part D plan when first eligible, a penalty of 1% per month for each month of non-enrollment will apply for the rest of your life.

Enrollment

  • You usually have a 7 month Initial Enrollment Period beginning 3 months before the month you turn 65, the month you turn 65, and ending 3 months after the month you turn 65.
  • Most people enroll in Medicare Part A when they turn 65, even if they have health insurance from an employer. This is because most people paid Medicare taxes while they worked and therefore do not pay a monthly premium for Part A.
  • However, if you or your employer contribute to an HSA you may want to delay enrolling in Medicare Part A. Once you have Medicare neither you nor your employer are allowed to contribute to an HSA. However, you may continue to withdraw money from your HSA.
  • Most people enroll in Part B when they turn 65 unless they have insurance from their or their spouse’s current large employer. (20 employees or more)
  • If you are insured through an employer with fewer than 20 employees, you should enroll in Medicare when you turn 65. In this case Medicare will be your primary insurance and your employer insurance will pay second.
  • If you are already collecting Social Security at least 4 months before you turn 65, you will be automatically enrolled and do not need to do anything. You will get a “Welcome to Medicare” package and your Medicare card in the mail about 3 months before your 65th birthday. If you do not receive your Medicare card, contact Social Security.
  • If you are not getting Social Security benefits you will need to submit an application for Medicare to Social Security. You have 2 options:
    • Apply online: ssa.gov
    • Call Social Security: 1-800-772-1213 (7am – 7pm)

Yes, if you are insured by a large employer.

Apply online: ssa.gov

  • Call Social Security: 1-800-772-1213 (7am – 7pm)
  • If you are covered under an employer’s or union-based health insurance plan through your or your spouse’s employment, and the employer has 20 employees or more, you DO NOT have to enroll in Medicare Part A or Part B. You will not pay a penalty when you enroll in Part B as long as you enroll within 8 months of losing your coverage. You will want to plan ahead and enroll in Part B a month before you stop working or your employer coverage ends, so you don’t have a gap in coverage.
  • If you are covered under an employer’s or union-based health insurance plan through your or your spouse’s employment, and the employer has fewer than 20 employees, you DO have to enroll in both Medicare Part A and Part B when you turn 65. In this case
  • Medicare will be your primary insurance and your employer insurance will be secondary.
  • These rules are only for coverage by insurance when you or your spouse are actively working, not for retiree insurance coverage.

YES! Once you enroll in Part A neither you nor your employer will be able to contribute to your HSA. If you would like to continue making contributions to your HSA, you can delay both Parts A and B until you (or your spouse) stop working or lose that employer coverage. You will NOT pay a penalty for delaying Medicare as long as you enroll within 8 months of losing your coverage or stopping work (whichever happens first.)

Note: Once you enroll in Part A, it will start up to 6 months retroactively. You should stop making contributions to your HSA 6 months before you enroll in Part A.

No

You can enroll on the medicare.gov website, or through an insurance agent.

  • You usually have a 7 month Initial Enrollment Period beginning 3 months before the month you turn 65, the month you turn 65, and ending 3 months after the month you turn 65.
  • You may also qualify for a Special Enrollment Period, for example if you are losing coverage from your or your spouse’s employer.
  • Every year during Open Enrollment, Oct 15 – Dec 7, you have the opportunity to join or change Advantage plans, or change from
  • Original Medicare to an Advantage plan or vice versa.
  • If you are turning 65, you have a 7 month time period starting 3 months before the month you turn 65, your birthday month, and continuing 3 months after the month you turn 65.
  • You may also qualify for a Special Enrollment Period, for example if you are losing coverage from your or your spouse’s employer.
  • Go to medicare.gov for plan comparison and enrollment.
  • The Central Vermont Council on Aging can assist with Part D plan comparison and enrollment: 802/479-0531

Under 65 and Disabled

When you have received Social Security Disability Insurance checks for at least 24 months.

You will be automatically enrolled in Medicare Parts A and B at the beginning of the 25th month that you receive an SSDI check.

Yes, you will need to enroll either in a prescription drug plan or an Advantage plan. You may also choose to purchase a supplement. You will not be automatically enrolled in any of these.

  • You may be eligible for financial assistance with your Part B premium and/or your prescription drug plan premium, including Medicaid for the Working Disabled. See the Financial Assistance section.
  • Whether or not you purchase a Medigap plan/Supplement (see Medigap Plans/Supplements section) now, you will be eligible to purchase one or change plans once you turn 65.

Medigap Plans/Supplements

Medigap plans, also known as Medicare supplement plans, help cover some of the costs Medicare Parts A and B do not cover and you must pay.

Medicare Supplement plans, also known as Medigap plans, help cover some of the costs Medicare Parts A and B do not cover and you must pay.

  • Medigap plans are standardized policies identified by letters, A-N. The plans are standardized, meaning Plan A offers the same coverage no matter which state you live in when you purchase it, or which insurance company you purchase it from.
  • Each letter plan offers different coverage and has different out of pocket costs. See https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies for more information.

Current prices are listed on the VT Department of Financial Regulation website: https://dfr.vermont.gov/document/dfr-insurance-medicaresupp-rates-1

If you are enrolled in Part B and you want help paying some of the health care costs that Medicare doesn’t cover.

You are not required to buy a Medigap plan or an Advantage plan. You will be responsible to pay the portion that Medicare does not cover out-of-pocket unless you qualify for financial assistance.

You may not need a Medigap plan if you have other health insurance, such as from an employer, military retiree, employer retiree coverage, or if you also have Medicaid.

  • The best time to buy a plan is when you first enroll in Part B or up to 6 months after. If you enroll in a plan during this period, the insurer cannot refuse to sell you a plan.
  • After 6 months have passed, the insurer can refuse to sell you a Medigap plan.

Once you buy a Medigap plan, the insurance plan must continue to renew it as long as you pay your premiums on time.

Yes, you can change plans. However, your options may be limited depending on whether it has been more than 6 months since you enrolled in Part B. After 6 months no insurer has to sell you a plan.

You need to contact the insurance company directly.

Open Enrollment

Medicare health and drug plans can make changes each year, including costs, coverage, and what providers and pharmacies are in their networks. Medicare Open Enrollment is an annual period of time (October 15 – December 7) when current Medicare users can choose to re-evaluate their Medicare coverage and make changes for the following year.

Every year from October 15 – December 7

  • You can change from your current prescription drug plan to a different one.
  • You can change from your current Advantage plan to a different one.
  • You can change from your current Advantage plan to Original Medicare with a prescription drug plan or vice versa.

Jan 1 of the following year.

People in a Medicare health or prescription drug plan should always review the materials their plans send them, like the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC). If their plans are changing, they should make sure their plans will still meet their needs for the following year. If they’re satisfied that their current plans will meet their needs for next year and it’s still being offered, they don’t need to do anything.

The medicare.gov website

Call the Central Vermont Council on Aging for an appointment: 802-479-0531

Financial Assistance

Yes!

No, however if you qualify for Medicaid it will act as a supplement and you will not need to purchase a Medigap plan.

Where do I start?

If you are turning 65 and not covered by an employer plan:

  • Enroll in Medicare Parts A and B
  • Decide if you would like to get Medicare through Original Medicare or an Advantage plan (see section titled Advantage Plans v Original Medicare)
    • Enroll in a Drug plan or an Advantage plan
    • Enroll in a Medigap policy if you would like supplemental coverage instead of an Advantage plan

If you are turning 65 and covered by a small employer plan:

  • Enroll in Medicare Parts A and B
  • Decide if you would like your employer insurance to act as your supplement and prescription drug plan or if you prefer to purchase them on your own.
    • If you choose to purchase them on your own, decide if you would like to get Medicare through Original Medicare or an Advantage plan (see section titled Original Medicare and Advantage Plans)
    • Enroll in a Drug plan or an Advantage plan
    • Enroll in a Medigap policy if you would like supplemental coverage instead of an Advantage plan

If you are turning 65 and covered by a large employer plan:

  • See questions 6 and 7 under Enrollment.

Where can I get help?

Take one of our “Medicare and You” classes: find the schedule on our website: https://www.cvcoa.org, or call (802) 479-0531, or email [email protected]

Call the Central VT Council on Aging Helpline: 1-800-642-5119

Call the Central VT Council on Aging for an appointment: 802-479-0531

Watch our video to learn how to choose the Part D prescription drug plan that works best for you