Carol K Ayala
NV Lic. No.: 3833562
When it comes to Medicare, you have choices!
Let us help you find the best plan to fit your health care needs.
Simplifying Medicare For Seniors
Whether you are turning 65 and new to Medicare or have been on Medicare for years, we at Simple Senior Benefits will help you understand the world of Medicare.
When you have worked hard to enjoy what you have today, it is important to make sure you have the protection you need and deserve. In this confusing and ever-changing world of insurance benefits for people on Medicare, it’s good to have a specialist on your side.
We, at Simple Senior Benefits, will be your trusted resource for free and unbiased information on Medicare eligibility, coverage choices and plan enrollment. We are also trained to assist with various assistance programs through the State and Social Security, like Extra Help for Prescription Assistance and/or the Medicare Savings Program.
Our goal is to help Seniors get the exact coverage they need and deserve. We are independent advisors that represents many of the top insurance carriers that offer a wide variety of health and life products available to Seniors.
We have extensive experience and knowledge in the products we offer as well as an expertise on how to use those products to provide maximum benefit and protection to the clients we serve. It is our commitment and desire to establish trust and long-lasting relationships with our clients.
Get the Most Out of Your Medicare
There are four basic parts of Medicare: A, B, C and D. Each part helps pay for certain health care services. Each part also has certain costs that you may have to pay. Your Medicare costs will depend on what coverage you choose and on what health care services you use.
Enrolling in Medicare
Timing is everything when you’re enrolling in Medicare, and a lot depends on your specific situation. That’s why we organized this enrollment information based on life circumstances.
When You Turn 65
Turning 65 is a big life event, and thousands of baby boomers are doing it every day.*Here’s what you need to know right off the bat:
- You must be 65 to enroll in Medicare—your spouse’s age doesn’t count.
- You may enroll in Medicare even if you’re not collecting Social Security yet.
- You may enroll in Medicare even if you work past age 65 and have employer coverage, or you are 65 and have coverage through your spouse’s employer.
When to Enroll in Medicare
Your first chance to sign up for Medicare is called your Initial Enrollment Period (IEP). It happens around your 65th birthday and lasts a total of 7 months. It includes your birthday month plus the 3 months before and the 3 months after. It’s best to sign up early to avoid gaps in coverage and late enrollment penalties.
You may be enrolled in Medicare automatically if you currently receive Social Security or Railroad Retirement Board benefits. You’ll receive your Medicare card in the mail a few months before your 65th birthday. You still have an IEP during which you may make Medicare coverage decisions.
Working Past 65
A lot of people reach the age of Medicare eligibility and continue to work. Many have health insurance through their employers. What about Medicare?
Here’s what you need to know:
- You still have a Medicare Initial Enrollment Period (IEP) when you turn 65. You may want to enroll in Part A during this time. It’s premium free, as long as you or your spouse worked and paid Medicare taxes for at least 10 years.
- You have to be proactive and enroll in Medicare yourself. Medicare doesn’t notify you about your IEP unless you currently get Social Security or Railroad Retirement Board benefits.
- You may qualify for a Medicare Special Enrollment Period (SEP) that allows you to delay enrolling in Part B and Part D without incurring late enrollment penalties. You need to get confirmation of creditable coverage from your employer.
Retirement and Medicare Basics
Retiring soon? Know the Medicare basics. Your Medicare health coverage choices can vary based on your age and whether you have retiree coverage through your employer or plan sponsor. Find out what you need to know and the questions to ask to help you retire with peace of mind.
Get Your Medicare Special Enrollment Period Dates
Your SEP, if you qualify for one, begins when you retire or your employer insurance ends—whichever comes first.
How to Use Your Medicare Special Enrollment Period
Talk with your employer health insurance plan administrator before you make any decisions. You need to understand if, and how, your plan may work with Medicare. You may be required to take full Medicare benefits (Parts A and B) at age 65 in some situations, such as if your employer has fewer than 20 employees.
During your SEP, you may:
- Enroll in Part B, and Part A, if you haven’t already. You have 8 months to enroll.
- Enroll in a Medicare Advantage (Part C) or a prescription drug (Part D) plan. You have 2 months to enroll.
You are not eligible for this SEP when COBRA or retiree coverage ends. However, you may be eligible for a different SEP. Talk with your plan administrator or call the Medicare helpline for more information.
If You’re on Disability
You may be eligible for Medicare before age 65 if you have a qualifying disability. Eligibility usually starts after you’ve received disability benefits for 24 months.
Here’s what you need to know:
- You’ll be automatically enrolled in Original Medicare (Parts A and B). Your Medicare card will arrive in the mail a few weeks before your eligibility date.
- Your coverage starts the first day of the month you receive your 25th disability check.
- You still have an Initial Enrollment Period (IEP) when you may make decisions about your Medicare coverage.
Your IEP is 7 months long. It includes your 25th month of disability, the 3 months before and the 3 months after.
How to Use Your Initial Enrollment Period
If you do nothing during your IEP, you will be covered by Original Medicare (Parts A and B). However, Original Medicare doesn’t cover everything.
Your IEP is when you may make other Medicare coverage choices based on your needs, such as adding a prescription drug (Part D) plan and Medicare supplement insurance or choosing a Medicare Advantage (Part C) plan. It’s best to act early to avoid gaps in coverage and possible late enrollment penalties.
Medicare and Disability: Other Coverage
If you have other coverage, such as through an employer, you may choose to delay Part B. Follow the directions on the back of your Medicare card to notify Medicare of your decision.
Note that you could be charged a Part B premium penalty if you decide to enroll in Part B later. Your employer must provide creditable coverage, so you may qualify for a Special Enrollment Period and avoid the penalty.
If You Miss Initial Enrollment
Medicare provides a General Enrollment Period (GEP) every year for people who missed signing up when they were first eligible. It’s like make-up time for Medicare enrollment.
The GEP is January 1 – March 31 every year. Here’s what you need to know:
- You can enroll in Part A, Part B or both during this time.
- Coverage begins on July 1 of the same year.
- You may have to pay a late enrollment penalty.
- You may be eligible enroll in a Medicare Advantage (Part C) or a prescription drug (Part D) plan April 1 – June 30 of the same year.
Changing Plans After Enrolling in Medicare
Once you’re enrolled in Parts A and B, you have a chance to change plans once a year during Medicare Open Enrollment, Oct. 15 – Dec. 7. You may also qualify for a Medicare Special Enrollment Period (SEP). A SEP allows you to change plans outside of Medicare Open Enrollment in certain situations, such as if you move.
Late Enrollment Penalties
Missing your Initial Enrollment Period can be costly. Medicare Part A, Part B and Part D may charge premium penalties if you miss your initial enrollment dates, unless you qualify for a Medicare Special Enrollment Period.
Medicare Part A Premium Penalty
Part A is premium free if you or your spouse worked and paid taxes for at least 10 years. If you have to pay a premium, the penalty for late enrollment is 10%.
The Part A premium penalty is charged for twice the number of years you delay enrollment. If you wait 2 years, for example, you would pay the additional 10% for 4 years (2 x 2 years). The penalty applies no matter how long you delay Part A enrollment.
Medicare Part B Premium Penalty
The penalty for late enrollment in Part B is an additional 10% for each 12-month period that you delay it.
Let’s say your Initial Enrollment Period ended September 30, 2010, for example. Then you enroll in Part B during the General Enrollment Period in March 2013. Your late enrollment penalty would be 20% of the Part B premium, or 2 x 10%. This is because you waited 30 months to sign up, and that time period included 2 full 12-month periods.
In most cases, you have to pay the penalty every month for as long as you have Part B. If you’re under 65 and disabled, any Part B penalty ends once you turn 65 because you’ll have another Initial Enrollment Period based on your age.
Medicare Part D Premium Penalty
The penalty for late enrollment in a Part D plan is 1% of the average Part D premium for each month you delay enrollment. You pay the penalty for as long as you’re enrolled in a Medicare Part D plan.
You may delay enrolling in Medicare Part D without penalty if you qualify for Extra Help or have creditable drug coverage. If it’s been more than 63 days since you’ve had creditable coverage, then the penalty may apply.
How to Enroll in Medicare
Medicare enrollment happens automatically for some people. Others need to enroll themselves when they first become eligible. It all depends on your situation.
After you are enrolled in Medicare, you need to take action if you want additional coverage, such as a Medicare Advantage (Part C) plan, a prescription drug (Part D) plan or a Medicare supplement insurance plan.
How Automatic Enrollment in Medicare Works
You will be enrolled automatically in Original Medicare Parts A and B if:
- You are turning 65 and are getting Social Security or Railroad Retirement Board benefits.
- You are under 65 and have received disability benefits for 24 months.
- You have Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis, or ALS) and start getting disability benefits.
You will get your Medicare card in the mail a few months before your 65th birthday or before your 25th month of getting disability benefits. You’ll get it immediately if you have ALS.
Keeping the card means you accept Original Medicare Part A and Part B coverage. You also agree to pay Part B premiums. (If you live in Puerto Rico, you need to enroll yourself in Part B; it’s not automatic.)
You must notify Medicare if you decide to refuse or delay Part B. You may want to do this if you have other health care coverage, such as through an employer or union. Follow the instructions on the back of your Medicare card.
How to Enroll in Medicare Yourself
You need to take action to sign up for Medicare if:
- You are turning 65 and are not currently getting Social Security or Railroad Retirement Board benefits.
- You qualify for Medicare because you have End-Stage Renal Disease (ESRD).
- You live in Puerto Rico and want Part B coverage.
You can sign up for Medicare online
You can also enroll in Medicare by phone or in person at any Social Security office. Call 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday, 7 a.m. to 7 p.m. local time, to make an appointment.
If you live outside the United States and its territories, contact the nearest U.S. Social Security office, U.S. Embassy or consulate, or the Veterans Affairs Regional Office (VARO) in the Philippines.
How to Enroll in a Private Medicare Plan
You may choose to enroll in a private Medicare plan after you complete your initial enrollment in both Part A and Part B. You can choose a:
- Medicare Advantage plan (Part C) with or without drug coverage
- Stand-alone Medicare prescription drug plan (Part D)
- Medicare supplement insurance plan
You can find out about plans offered where you live at Medicare.gov or directly from the insurance companies that offer them. You can apply online, by phone or through a local insurance agent.
Keep in mind that if you don’t get prescription drug coverage when you’re first eligible, you may be charged a premium penalty if you join a plan later. You could also be charged more for Medicare supplement insurance if you wait to buy a plan. In some cases, you could be denied this coverage entirely based on your health history.
Part A is hospital coverage. It covers care you receive while an inpatient in a hospital or skilled nursing facility.
In general, Part A covers:
- Inpatient care in a hospital
- Skilled nursing facility care
- Inpatient care in a skilled nursing facility (not custodial or long-term care)
- Hospice care
- Home health care
What Does Medicare Part A Cover?
Medicare Part A covers the hospital charges and most of the services you receive when you’re in the hospital. But it doesn’t cover the fees charged by doctors who participate in your care while you’re in the hospital. Medicare Part B helps pay those costs.
What Does Medicare Part A Cost?
You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called “premium-free Part A.”
Most people get premium-free Part A.
You can get premium-free Part A at 65 if:
You already get retirement benefits from Social Security or the Railroad Retirement Board. You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet. You or your spouse had Medicare-covered government employment.
If you’re under 65, you can get premium-free Part A if:
- You got Social Security or Railroad Retirement Board disability benefits for 24 months.
- You have End-Stage Renal Disease (ESRD) and meet certain requirements.
Part A premiums
If you buy Part A, you’ll pay up to $499 each month in 2022. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $499. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $274.
In most cases, if you choose to buy Part A, you must also:
- Have Medicare Part B (Medical Insurance)
- Pay monthly premiums for both Part A and Part B
There are several assistance programs available to help those on a limited fixed income with their medical and/or prescription drug costs through Social Security or your State welfare office. Please take the time and read about the programs below to see if you may qualify for any assistance program or the extra benefits and services often combined with various Medicare Advantage plans.
- Medicare Savings Programs
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualified Individual (QI)
- Extra Help/Low Income Subsidy (LIS)
- Extra Benefits & Services
Medicaid is a state and federal program that provides health coverage if you have a limited fixed income.
Medicaid provides health coverage to people with low-income and asset levels who meet certain eligibility requirements. Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services.
Medicaid pays for “medically necessary” health care such as:
- Physician visits
- X-ray and laboratory tests
- Hospital and nursing-home care
- Home healthcare
- Prosthetic and orthopedic devices
- Hearing aids
- Medical equipment
- Ambulance services
- Certain prescription drugs excluded as a Medicare Part D benefit
Medicaid will only cover these costs and services if you use providers that accept Medicaid. If you have both Medicare and Medicaid, Medicare is the primary payer (meaning Medicare will pay first for Medicare-covered benefits) and Medicaid is the secondary payer. If you qualify for Medicaid, it will also cover your Medicare Part A and B deductibles and co-payments, and pay your monthly Medicare Part B premium.
Medicare Savings Programs are federally funded program administered by each state. These programs are for people with limited income and resources and help pay some or all of the Medicare premiums, deductibles, co-payments and coinsurance.
There are three major Medicare Savings Programs:
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualifying Individual (QI)
Below are general requirements for the MSP:
- Reside in a state or the District of Columbia,
- Are age 65 or older,
- Receive Social Security Disability benefits, or
- People with certain disabilities or permanent kidney failure (even if under age 65)
- Meet standard income and resource requirements.
- Pays Part A Premium, Part B Premium, Part A & B Deductibles, Part A & B Coinsurance
- Income: Up to $1,133/mo Single, $1,526/mo Couple
- Assets: Up to $8,400 Single, $12,600 Couple
- Pays Part B Premium
- Income: Up to $1,359/mo Single, $1,831/mo Couple
- Assets: Up to $8,400 Single, $12,600 Couple
- Pays Part B Premium
- Income: Up to $1,529/mo Single, $2,060/mo Couple
- Assets: Up to $8,400 Single, $12,600 Couple
Extra Help, also known as the Part D Low-Income Subsidy (LIS), is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage for eligible individuals who have a limited income.
Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for:
- Part D monthly premium
- Annual deductible
- Coinsurance and Co-payments.
- Coverage in the gap (donut hole)
- Part D Late Enrollment Penalty (waived)
You may qualify for the Extra Help available under Medicare Part D if:
- Your assets are less than $15,510 (single individual) or $30,950 (married couple living together)
- Your annual income is less than $20,625 (single individual) or $27,705 (married couple living together).
- Your annual income is higher than the eligibility limit, but you support other family members who also live in the same household; or you live in Hawaii or Alaska.
Assets that count toward eligibility include:
- Cash and bank accounts, including checking, savings, and certificates of deposit
- Real estate outside of your primary residence
- Stocks and bonds, including U.S. savings bonds
- Mutual funds and IRAs
There are programs available to help those on Medicare get extra benefits and services, like:
- Over the Counter Health Product
- Basic & Comprehensive Dental Coverage
- Routine Foot Care
- Fitness Membership
- Hearing Exam and Hearing Aid Coverage
- Transportation for Medical Appointments
- Chiropractic & Acupuncture
- Vision Exams and Eyewear
- Find out what assistance programs you qualify for.
- Get a drug plan comparison to see if you can save money on your prescriptions.
- Determine what extra benefits you need.
- Let our Simple Senior Benefits advisors help you through the process to make sure you get all the benefits and services you deserve.
Fill the Gaps
Although Medicare is a great program for covering your standard medical expenses, like hospital, doctor and prescription coverage, there are a lot of gaps that can end up costing you thousand of dollars out of pocket. These are some of the programs available to help you cover some of the expense and risk of what Medicare does not cover:
A hospital stay can be traumatic — to your health, wallet, and family. Even if you have other medical insurance, some costs won’t be covered. That’s when a Hospital Indemnity insurance plan can provide peace of mind by offering customized protection that pays benefits in your time of need.
What Hospital Indemnity insurance is:
Hospitalization is expensive on its own, but it’s easy to overlook the additional costs you can incur while you’re hospitalized. Deductibles and co-pays will start piling up, and you may require follow-up outpatient care or a stay in a nursing facility. That’s where Hospital Indemnity insurance fills in the gaps in a way other insurance plans don’t. You receive your benefit directly, and you may use the payment however you want — from deductibles to travel and lodging expenses.
Why you need Hospital Indemnity insurance
Health insurance and Medicare cover some costs associated with a hospital stay, but not all of them. Hospital insurance acts as a supplemental plan to your existing primary insurance coverage to ensure you’re not dipping into your savings account or retirement income to pay for your hospitalization.
If you were diagnosed with cancer or suffered a heart attack or stroke, the last thing you would want to worry about is your finances. Cancer, Heart Attack and Stroke Insurance helps you receive the financial peace of mind that allows you to focus on what matters most – your recovery.
53% of the costs associated with cancer are non-medical, indirect costs.  Cash benefits from your policy can be used to help supplement lost income for you and your spouse, to pay for car and mortgage expenses and travel to and from medical facilities. It will also allow you to seek treatment that is out of network or not covered without worrying about costs. And, it will give you 24/7 access to Ask Mayo Clinic support services!
Every 40 seconds an American will suffer a stroke.
- American Heart Association, Heart Disease and Stroke Statistics – 2015 Update, 2015. Each year over 735,000 people in the U.S. have a heart attack.
- American Heart Association, Heart Disease and Stroke Statistics – 2015 Update, 2015. 1 in 2 men and 1 in 3 women will develop cancer in their lifetime.
- American Cancer Society, Cancer Facts & Figures, 2015
It’s usually difficult to plan for the unexpected, but Short-Term Care insurance makes it easier to prepare for unforeseen injuries or illnesses. You’ve likely heard about long-term care insurance, but you may be surprised to discover that a Short-Term Care plan could be a better fit for you.
What Short-Term Recovery Care is
When you suffer an illness or injury that requires a short stay of 12 months or less somewhere other than a hospital, Medicare doesn’t cover all the costs. That means, if you need care in a nursing home, assisted living facility, adult daycare, or hospice, you could face considerable out- of-pocket costs. A Short-Term Care plan not only fills in coverage gaps, but it may also give you the flexibility to receive home healthcare, depending on the benefits available in your state.
Why you need Short-Term Recovery Care
If you think a fall or a sudden decline in health can’t happen to you, the U.S. Department of Health and Human Services says seven out of 10 people ages 65 or older will require some kind of skilled care or custodial care in their lifetime. Medicare doesn’t cover custodial care, which is help with basic personal needs, such as getting in and out of bed, bathing, dressing, eating, and getting on and off the toilet. Short-Term Care insurance covers skilled and custodial care, so you don’t have to drain your savings account or retirement income to receive the recovery.
Dental and vision needs can be very costly if you don’t have the right insurance. Since most health insurance plans don’t cover routine checkups for your teeth or eyes, it’s important to find a supplemental insurance plan that fits your needs and budget.
What Dental and/or Vision insurance is
A Dental insurance policy helps you pay for preventive dental care; diagnostic services; procedures, like root canals; and dental apparatuses, such as dentures and bridges. Dental Insurance generally include a mix of dental plans and an optional vision plan that can be added for an additional cost. The Vision insurance provides coverage for routine eye exams, frames & lenses or contacts.
Why you need Dental, Vision, and Hearing coverage
Medicare and most health insurance plans do not cover basic dental and vision exams and services. Medicare only covers these types of procedures if you have a medical emergency or if your doctor orders them for medical treatment.
As you age, your teeth, eyes, and ears need more attention.
- Seniors are more likely to suffer from dental health problems and require dental work, like bridges and crowns. Oral problems should be monitored because they can signal other health conditions, such as diabetes, oral cancer, and heart disease.
- Many eye diseases have no early symptoms, which means they can change your vision permanently before you realize they exist. That’s why the American Optometric Association recommends regular eye exams for everyone over age 60.
Having an insurance policy that covers regular exams and common procedures means you can maintain your health without draining your savings account or retirement income.
It isn’t easy to think about the end of your own life. But, if you consider it as planning for your family’s future when you’re gone, you realize it’s important to ease their financial stress by preparing now. Unfortunately, it’s easy to confuse what the differences are among Final Expense, Pre-need, and Term Life insurance plans.
The answer to that question will vary from person to person. Do you already have term or whole life insurance? If you do, that policy can help your loved ones pay for final expenses. However, if you have term life insurance and you outlive the policy term, it’s a different story. In that case, you may want to consider final expense insurance.
Alternatively, maybe your family will have plenty of assets to work with when you die. In that case, you could use what’s called “self-insurance.” “Self-insurance” is one of those terms that sounds more complicated than it is. To self-insure is just to use your own money rather than use a life insurance payout.
Could your family self-insure for your final expenses? It’s a good idea to assume around $10,000 for funeral expenses. But don’t forget to take into account whether you will want a catered party after the service. Or perhaps a trip abroad to scatter your ashes. Maybe you’ll end up leaving big bills behind. If situations like these sound like your situation, you may want to consider springing for final expense insurance. Additionally, it’s probably best not to count on the lump sum death payment from Social Security to pick up the slack. It’s only $255.