Mark Mabaquiao, Medicare Insurance Broker

Answer: Yes, you have a couple Special Enrollment Periods (SEP) to consider when losing employer (ER) coverage.

The first type of SEP is called the Part B SEP (B SEP). This time period allows you to enroll in Medicare Part B without paying a late enrollment penalty. The B SEP lasts for eight months after you lose the ER coverage.

The second type of SEP allows you to enroll in a Medicare Advantage (MA) plan or a stand-alone prescription drug plan (PDP). This period lasts for 2 full months after the month your ER coverage ends.

Most folks do not want a break in benefits after they have lost their ER coverage. In this case, we can work on making sure your Part B and MA or PDP plan begins the day after your ER coverage ends.

Answer: I’m sorry for your difficulty with trying to reach Medicare and getting straight answers. I have two options for you:

First of all, you should consider calling during off-peak hours, which are probably early morning or late night. It helps that their hotline is available 24hrs 7 days a week, so conceivably, calling them at 1AM is going to be a better experience than 1PM.

Second, explore a local resource. Depending on your specific question, you might find help from your State Health Insurance Assistance Program (SHIP), especially with filling appeals from a denied claim. A great resource is a local Medicare insurance professional who has experience and a solid reputation. Typically, they can answer your Medicare questions from the simple to the complex.

Answer: As it relates to your Medicare benefits, Social Security (SS) will automatically enroll you into Medicare Parts A & B with an effective date of the 1st of the month you turn 65. You should expect to receive your Medicare card from SS approximately three months before the month you turn 65.

Moreover, if you're also enrolling in a Medicare Advantage or Medigap (plus stand-alone drug plan) plan, you want to start researching or working with a trusted expert 2-3 months before the month your turn 65.

Answer: First of all, it's important to understand that Medicare Parts A & B (A&B), by themselves, generally do not cover you outside of the United States (US). There are some rare exceptions, like if you're on a cruise ship that's within 6 hours of a US port, but I would just accept the fact that in probably 99% of cases, A&B will not cover your medical and prescription expenses outside of the US.

If you have a Medicare Advantage (MA) plan, you may have expanded coverage outside the US for emergencies and urgent care only. Also, you might have to pay for your care first, then when you return to the US, submit the paid invoices to your MA carrier, and if approved, be reimbursed.

If you have a Medicare Supplement plan, like Plan C, D, F, G, M, or N, you also have coverage outside the US for emergencies only. After a $250 deductible, your plan would cover the next 80% up to a lifetime maximum of $50,000.

The final option, which I recommend you consider, is getting travel insurance from a quality carrier who gives you access to a network of international doctors and hospitals. With travel insurance, you will have coverage for medical and prescription drugs, and you won't be limited to only being covered for emergencies or urgent care.

Answer: First of all, they are two separate departments of the government. Social Security Disability Insurance (SSDI) provides financial support, whereas, Medicare provides comprehensive health insurance coverage.

Once you've received SSDI benefits for 24 months, your Medicare Parts A & B (A&B) become active on the 25th month. It’s also important to determine if a Medicare Advantage plan or stand-alone drug plan plus a Medicare Supplement is an addition to consider along with your A&B. Work with a local and reputable licensed professional that can assist you with this process at least two months before your 25th month of SSDI.

Answer: Generally no. There are, however, two scenarios where you might be able to switch from a Medicare Advantage (MA) plan to Original Medicare with a Medigap policy mid-year.

The first scenario is if you moved or are about to move. Your new location might have guaranteed issue options for a new Medigap plan when you are coming from an MA plan. You have a two month window to utilize this option.

The second scenario is a concept called "Medicare trial rights (MTR)". According to Medicare.gov this is how MTRs work:

MTR #1 - If you drop a Medigap policy to join an MA plan for the first time, you’ll have a single 12-month period (your trial right period) to get your Medigap policy back if the same insurance company still sells it once you return to Original Medicare. If it isn't available, you can buy a Medigap policy you qualify for that's sold by an insurance company in your state (except for Plans M and N). You may also have an opportunity to enroll in a Medicare drug plan at this time.

MTR #2 - If you joined an MA plan when you were first eligible for Medicare Part A at 65, you can choose from any Medigap policy that's sold by an insurance company in your state if you switch to Original Medicare within the first year of joining the MA plan. You may also have an opportunity to enroll in a Medicare drug plan at this time.

As always, check with a local and reputable licensed Medicare expert. You can also check with Medicare.gov, 1-800-Medicare, and your local SHIP counselor.

Answer: It depends on your situation. If you are about to retire and lose group health coverage, I recommend you start preparing about 2.5 to 3 months before you lose employer coverage. On the other hand, if you already have a Medicare Advantage or stand-alone drug plan, you can start reviewing your options for the following year on October 1. If you have a Medicare Supplement (Medigap) plan, you can actually review your options any time during the year.

Answer: In my experience, one of the most unfortunate and costly decisions individuals make is choosing not to enroll in a Medicare Part D prescription drug plan—often because they weren’t taking any medications at the time. I’ve had a handful of conversations with individuals who reach out mid-year, after being diagnosed with a serious condition, only to realize they now need expensive, life-saving medications. Unfortunately, because they opted out of coverage, they’re left facing two major challenges: the financial burden of paying out-of-pocket for essential prescriptions and the emotional and physical toll of managing their health while waiting for the next Medicare enrollment period.

Answer: Basically, here are the things or questions you need to consider when moving to Medicare when retiring (at 65 years old):

(1) Will you enroll in Medicare Parts A and B online at ssa.gov or will you be automatically enrolled because you are currently receiving Social Security benefits?

(2) How do Medicare Parts A, B, C, D, and E work?

(3) Based on your prescription drugs (if any), medical providers (if any), and medical concerns (if any), which Medicare coverage model gives you better peace of mind - Medicare Advantage or Medigap (plus a drug plan)?

(4) Should you consider adding additional policies like dental / vision / hearing, hospital indemnity, cancer / heart / stroke, short-term care, and long-term care?

(5) Should you consider working with a licensed professional, a SHIP counselor, a Medicare.gov rep, or do all the research on your own.

Answer: The good news is that you won't be paying more than $2000 for all your covered medications for the year (not including the monthly premium). The bad news is that you might have to pay higher copays at the beginning of the year - almost like a reverse donut hole where you're hitting the donut hole immediately rather than towards the middle or latter end of the year. You do have the option to break up your out-of-pocket drug costs into monthly payments, so it lessens the amount you have to pay initially.

Answer: Yes, the 5-star Medicare Advantage special enrollment period (MA SEP) is different from the OEP and AEP. The AEP is the time period between October 15 and December 7 where you can enroll in a different Medicare Advantage or stand-alone drug plan effective January 1 of the following year. The OEP is the time period between January 1 and March 31 where someone with a Medicare Advantage plan can switch to a different Medicare Advantage plan or return to Original Medicare. The 5-star MA SEP is available between December 8 and November 30 (of the following year) and it's a one-time opportunity for a Medicare beneficiary to enroll in a 5-star Medicare Advantage available in their area.