With Medicare Part A & Part B (also known as Original Medicare) you are covered for about 80% or less of your medical services1.  The purchase of a Medicare Supplement or Medigap policy will help fill these gaps as well as the Part A & B deductibles which are not covered by Medicare.  Many people think that all their bases are covered at that point, but that is often not the case.  The following are 4 important expenses that are not covered by Original Medicare.

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Turning 65? Review your Medicare options

Before you turn 65 you need to review your Medicare Health Insurance choices. Everyone, whether working or not, needs to examine their choices for health insurance. We all would love the definitive “Yes” or “No” answers; however, with Medicare, those answers generally don’t exist.  Usually, you have to dig through Medicare.gov and countless amounts of rules and regulations to insure you are taking the correct action within the allotted timeline. The best advice I can give you is to call our office as we are able to discuss your specific situation with you. We can give you your options as they pertain to your specific situation and make sure you side-step any potential problems.  Let’s discuss a few of the common enrollment scenarios:

Medicare beneficiaries that have group health insurance through their employer or their spouse’s employer GENERALLY do not have to sign up for Medicare Part B when they turn 65. Enrollment in Medicare Part A will be automatic and premium free for those beneficiaries (or their spouses) who have paid into Social Security for 40 quarters or 10 years. Even though the beneficiary is enrolled in Part A automatically, typically they can keep their insurance through their (or their spouses) employer as long as the employee is actively working. When the employee retires, they will then have an eight month window in which to sign up for Medicare without facing any penalties for late enrollment.

Sounds pretty clear-cut? But, what If you are 65 or older and your employer has fewer than 20 employees?  In this case, IF the beneficiary’s employer has 20 or fewer employees Medicare GENERALLY would pay first; therefore, they would need to start their Medicare Part B upon reaching age 65. The group coverage would then pay after Medicare pays. Failure to enroll in Medicare would result in a penalty and/or a delay in enrollment.  If you have any question that this may apply to you contact your group health administrator as they should be able to provide you with the information used to determine if your group plan pays AFTER Medicare pays.

Here is the links to the information I have discussed:


Should I enroll in Part B?

Who pays first?

Making these determinations can be tricky and making a mistake can be costly, but using an insurance agent will save you time and money. Both of the two situations above are not clear-cut and can have different outcomes. Talk with a licensed insurance agent to make sure that you are making the correct enrollment decision. Now that you have examined your enrollment options you should then examine which path is THE MOST COST EFFECTIVE. Call us at 1-847-697-0104 and let us help you make that determination.

Drew Cosentino


ADH Insurance Agency, Inc.