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Medicare

COMING 2025

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The Inflation Reduction Act (IRA) includes several changes to Part D, including a $2,000 annual cap on out-of-pocket prescription costs. The coverage gap, also known as the "donut hole", will be eliminated, and Part D coverage will consist of three phases: deductible, initial coverage, and catastrophic. Part D plans and drug manufacturers will also be required to pay a greater share of costs for enrollees in the catastrophic coverage phase.

 

 

On Wednesday, April 5, 2023, the Centers for Medicare and Medicaid Services (CMS) released a final rule governing policy and technical changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-inclusive Care for the Elderly.

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Medicare Advantage (MA) (Part C) program and Medicare Prescription Drug Benefit (Part D) - CMS Final Rule
 

UPDATED Required CMS Disclaimer:  “We do not offer every plan available in your area. Currently we represent five (5) organizations which offer thirty-one (31) products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.”

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Why Our Office Will Record Medicare Calls & Provide a New Disclaimer This Fall 

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Medicare Carrier's AJM Associates, Inc. represents:
 

  1. Blue Cross Blue Shield of Michigan

  2. Blue Care Network

  3. Health Alliance Plan (HAP)

  4. CIGNA

  5. Aetna

 

 

What Is Medicare?

 

Medicare sends you a questionnaire about three months before you’re entitled to coverage. Your answers help Medicare set up your file and make sure your claims are paid correctly.


Medicare is health insurance for people who are age 65 or older, under 65 with certain disabilities, or any age with End-stage Renal Disease (permanent kidney failure).

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Medicare Advantage Open Enrollment Period
 

Medicare open enrollment – also known as Medicare’s annual election period – runs from October 15 through December 7 each year. During this annual window, Medicare plan enrollees can reevaluate their coverage – whether it’s Original Medicare with supplemental drug coverage, or Medicare Advantage – and make changes or purchase new policies if they want to do so.

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Medicare Supplemental (Medigap) Open Enrollment Period

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This is the six-month (6) period that starts on first day of the month that you are both 65 or older and enrolled in Medicare Part B. Throughout this period, you can enroll in any Medigap plan offered in your service area with guaranteed issue. This means that insurance companies aren’t allowed to use your medical history or pre-existing conditions as the basis for charging you more for coverage or denying you altogether. If you have medical issues or disabilities, it’s especially important to take advantage of this period. Once your Medigap Open Enrollment Period passes, you may not be able to enroll in a Medicare Supplement insurance plan as easily if you’re doing so for the first time.

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Types of Medicare
 

There are four types of Medicare.
 

  1. Medicare Part A helps cover inpatient care in hospitals, skilled nursing facilities, and hospice and home health care. Generally there is no monthly premium if you qualify and paid Medicare taxes while working.
     

  2. Medicare Part B helps cover medical services like doctors’ services, outpatient care and other medically necessary services that Part A doesn’t cover. You need to enroll in Medicare Part B and pay a monthly premium determined by your income, along with a deductible.  Medicare Part B standard monthly premium is $185.00 per month for 2025.
     

  3. Many people also purchase a supplemental insurance policy, such as a Medigap plan, to handle any Part A and B coverage gaps. Medicare Advantage Plans, also known as Medicare Part C, are combination plans managed by private insurance companies approved by Medicare. They typically are a combination of Part A, Part B and sometimes Part D coverage.
     

  4. Part D coverage, but must cover medically necessary services. These plans have discretion to assign their own copays, deductibles and coinsurance. Medicare Part D is prescription drug coverage and is available to everyone with Medicare. It is a separate plan provided by private Medicare-approved companies, and you must pay a monthly premium.

 

Getting Started

 

Medicare sends you a questionnaire about three months before you’re entitled to Medicare coverage. Your answers to these questions, including whether you have group health insurance through an employer or family member, help Medicare set up your file and make sure your claims are paid correctly.

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If your health insurance or coverage changes at any time after submitting the questionnaire, call the Medicare Coordination of Benefits Contractor at 800-999-1118 to update your file.

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Once you start Medicare, you should schedule a free preventive visit within the first 12 months to assess your current health status and provide a health roadmap for the future.

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Also, create an account on Medicare.gov to access your information and keep track of claims. If you want your family or friends to be able to call Medicare on your behalf, fill out an Authorization Form to allow them to do so.

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Coordination of Coverage
 

If you have Medicare and another type of insurance, the question of who should pay or who should pay first can be tricky. For example, generally a group health plan would pay before Medicare, but there are several exceptions. Contact AJM Associates, Inc. for specific answers for your situation.

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Helpful Information
 

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Licensed Agent for Medicare Plans

Agent Information:  Karl J. Ruth Jr.  •  National Producer Number: 7267003  

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