Medicare Season
Before we discuss those time frames it’s probably a good idea to discuss what Medicare is and isn’t. Medicare is a government run program from those 65 and older or those under 65 with a disability who have been disabled for 24 months. When you are disabled and go onto Medicare you have another period where you can change plans and that is when you turn 65.
Medicare is the only insurance in the United States that does not have a maximum out-of-pocket. It is an 80/20 plan meaning you pay 20% of the bill and Medicare pays the 80%. As an example, let’s assume you are hospitalized and the bill is $350,000. Medicare will reduce that based on location and you are responsible for 20% of the reduced bill. When a doctor or facility bills Medicare, they bill their retail price, and Medicare reduces it to what is usual and customary in your location. California or New York typically have much higher pricing then Arkansas or Georgia or the mid-west. The prices are adjusted by location. All other insurance plans have a maximum out of pocket meaning when you reach that maximum, then the plan pays all changes for the remainder of the calendar year.
Let’s also look at the time frames for when you are first eligible for Medicare. That is usually the 6-month period prior to your 65th birthday month unless your birthday falls on the 1st of the month. It is the month before your birthday and 6 months back. Unnecessarily complicated but remember what Ronald Regan said about the government. The nine most feared words in the English language is “Hi, I’m from the government and here to help.”
Medicare Supplements
In Nevada, Medicare supplements are not available to those under 65, but the MAPD plans are available.
So, when can I change my plan is a loaded question because it depends upon which type of plan you are on.
Original Medicare, a supplement and a stand-alone drug plan-You can technically change your supplement whenever you want but if you need guaranteed issue (no medical underwriting) then in Nevada the month of and the month after your birthday you can change with guaranteed issue, or no underwriting. (Some carriers will only allow you to do it in the month of and the month after your birthday, but the majority allow you to write the new plan the month before with an effective date of the month of your birthday.) The drug plan can only be changed during the Annual Election Period (AEP) from October 15th through December 7th with a January effective date.
Almost all the seniors I know and have as clients do not understand the differences between election periods because it is too complicated for most noninsurance people to understand.
Medicare Advantage Plans
These plans are run by private insurance, but the plan benefits and pricing must be approved by CMS (Centers for Medicare, Medicaid Services) annually. What Medicare is doing is allowing insurance companies to offer plans specifically designed for seniors and these plans replace Original Medicare and a standalone drug plan. You have a choice of going with Original Medicare and a standalone drug plan. (Not recommended because there is no maximum out-of-pocket with Original Medicare). The only real benefit is you can see any doctor, go to any hospital; that serves Medicare, anywhere in the country.
Medicare Advantage Plans or MAPD can be changed during the Annual Election Period (October 15th through December 7th) or through the Open Enrollment Period, (January 1st through March 31st). During the AEP you can change plans as many times as you want but the last one becomes effective on January 1st of the following year. The dates don’t make sense, in my opinion, because the annual election period should be from October 15th through December 31st. These plans are county based so Clark and Nye is are one set of plans and they differ in Washoe or Douglas County as an example.
In Southern Nevada, there are 84 different plans to review and decide which will work best to meet their needs. Personally, prior to meeting with a potential client I want to know their medications including dosage and frequency along with their doctors. That way, I can research and figure out which plan or plans would work best for them. The decision is one they need to make based on the facts provided. Providing that information eliminates them from having to do the research themselves. Reviewing 84 plans is time consuming and should be done by a professional who understands thoroughly Medicare with all it’s complexities. We cannot charge for our services, which is also better for the seniors. Since the insurance business is referral based, those that continue to take care and serve their client base will continue to grow their business. These Medicare Advantage plans or MAPD plans also offer many different noninsurance options to entice you to pick their plan versus the completion. Gym membership, extra help in getting non-medical supplies, dental, vison including glasses, chiropractic and podiatry services can be among the many options also included in these plans.
There are also special needs plans dedicated to specific diseases, so those clients receive additional services based on their unique medical needs. Each plan has specific medical conditions they serve, and you need to prove you have that condition to be considered for that plan. There are also special needs plans for those on both Medicare and Medicaid and again proof is required to join one of those plans. If you meet the needs of either the special needs plan or the Medicare-Medicaid plans, you can join those plans at almost any time during the year, and not just AEP or OEP. These particulars should be discussed with a broker familiar with these plans so they can guide you to the best option.
As you can see there are many options for seniors to consider before finalizing your choice. Please consider using an independent broker with knowledge of your marketplace to help you navigate what I call “The Medicare Maze”. It really is in your best interest.
I hope this information is useful, and if anyone has questions, please contact me via phone or email and I will respond quickly.
Also, you may want to take a look at 2026 Medicare Information.
Len Barend, Broker
Cell: 702-250-2200
Email: len@insurance4unevada.com
