Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).
For more information about Medicare, go to www.medicare.gov.
Medicare Health Care Coverage
Part A: Hospital Insurance
Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
Part B: Medical Insurance
Helps cover services from doctors and other health care providers, includes home health care, durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment), and many preventive services (like screenings, shots, or vaccines, and yearly “Wellness” visits)
Part C: Medicare Advantage
Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
PART D: Drug coverage
Helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.
MEDICARE SUPPLEMENTAL INSURANCE (MEDIGAP)
Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare.
To learn more about Medicare and your options, visit: www.medicare.gov.
Open Enrollment Period
You have an option to change your coverage once a year during a timeframe referred to as the Annual Open Enrollment Period. This occurs from October 15 through December 7.
During this time, you are encouraged to review your current health plan and drug coverage, which can change from year to year. A great resource to verify continued coverage is to use the Plan Finder on www.medicare.gov.
You can also create a personal account on www.medicare.gov. to retain your personal information and manage your activity.
Medicare Marketing Violations and Enrollment Fraud
Unlike Original Medicare, Medicare Part C and Part D are administered, marketed, and sold by private insurance companies. The Centers for Medicare & Medicaid Services (CMS) has guidelines for marketing Medicare Part C and Part D insurance that protect beneficiaries from manipulative and deceptive sales and enrollment tactics.
Plan sponsors and their representatives, including agents and brokers, must follow strict guidelines when they wish to market to beneficiaries. A fundamental principle is that marketing cannot be conducted under the guise of education.
Report potential Medicare marketing violations and/or enrollment fraud, errors, or abuse if:
- Prior to October 1st, an agent discusses, or sends marketing information, on what is new in the upcoming 2023 plans.
- You receive an unsolicited phone call from a company you have no prior relationship with.
- A company represents itself as coming from or sent by Medicare, Social Security, or Medicaid.
- You receive information such as leaflets, flyers, door hangers, etc., on your car or at your residence from a company you did not have an appointment with.
- An agent initiates a discussion about other insurance products, such as life insurance or annuities, during a visit or meeting about a Part C or Part D Medicare product.
- An agent returns uninvited to your residence after missing an appointment with them earlier.
- You signed up for a plan after being told by a company that certain prescriptions or services were covered, but after reviewing your EOB, you found they were not covered by the plan, and you received a bill instead.
To learn how to read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB), click here.
Report Suspected Medicare Fraud
Making Health Care Decisions
Trying to decide on which coverage is right for you? Or considering changing your plan?
The world of Medicare presents us with a collection of terms, facts, and options that can seem extensive and perplexing. Whether you are new to Medicare, or you have been on it for years, it can be difficult to understand, and navigating the options can be complicated.
The Senior Medicare Patrol program recognizes the extensive amount of material that needs to be considered when making choices and wants to help Medicare beneficiaries sort through the information. Deciding on which Medicare coverage is right for you is a process. We have created two worksheets to help you with the process, to assist in making informed decisions.
Comparing Medicare Coverage Options
Use the Comparing Medicare Coverage Options to assist with the decision-making process. It is a tool to help you compare different plans and it provides some questions to ask of any coverage you are considering. This is only one tool to assist you in the process. Please consult with an Elder Benefit Specialist as you are comparing options. To locate your local Benefit Specialist, click here, Elder Benefit Specialists | Wisconsin Department of Health Services or refer to www.medicare.gov for more information.
Working With Insurance Agents about a Medicare Plan
ASK THE RIGHT QUESTIONS
Use this worksheet while working with an insurance agent. This tool draws attention to key questions that are fundamental to picking a plan that meets your needs. You can then refer to this form when deciding later about which insurance to choose. If you have questions or need help, contact a Benefit Specialist. To find a local Benefit Specialist, go to: Elder Benefit Specialists | Wisconsin Department of Health Services.
To Navigate the Medicare Maze, Know Your Resources!
It is important to be aware of the resources that are available to you. Click below for a list of reliable resources that can provide you with assistance and guidance on Medicare questions along with offering unbiased information about health insurance plans/benefits and counseling. Connect with these resources to ensure that you get your questions answered and clarification on your options so that you obtain the coverage that is appropriate for your circumstances.