Unsure when to enroll in Medicare or when to change plans? Let’s simplify! Depending on your age, needs, or life changes, there’s a right time for you. Check out the guide below to find your fit.

Annual Election Period (AEP):

Runs from October 15th to December 7th.

It allows you to change or enroll in Medicare Advantage and prescription drug plans.

Medicare Advantage Open Enrollment Period (OEP):

January 1st to March 31st.

For those already in a Medicare Advantage plan, it allows them to switch plans or go back to Original Medicare.

Special Election Periods (SEPs):

 Triggered by specific life events like retiring after 65 or moving to a different county or state. 

This applies for individuals to enroll in Medicare or make changes outside regular periods.

Initial Election Period (IEP):

7-month period: Begins 3 months before, includes the month of, and ends 3 months after your 65th birthday.

Enroll in Original Medicare (Part A and/or Part B) for the first time. 

For those who didn’t enroll when they first turned 65, they can sign up during the General Enrollment Period, which runs from January 1st to March 31st each year, but penalties may apply.

    Aetna: Aetna Website

    Blue Shield: Blue Shield of Ca Website

    Humana:  Humana Website

    Scan:  Scan Health Plan Website

    United HealthCare: United Healthcare Website

Call customer service and let them know you’d like to make changes to your Primary Care Provider and/or medical group. It will take effect the following month.

You will receive your member ID cards 7-10 days after enrollment.  If you need a replacement card, call member services or go online to your member account.  Please click on your carrier to create an account if you have not already done so.

Aetna: https://www.aetna.com/about-us/login.html

Blue Shield: https://www.blueshieldca.com/bsca/bsc/public/member/mp/login

Humana:  https://account.humana.com/

Scan:  https://www.scanhealthplan.com/

United Health Care: https://www.medicare.uhc.com/?_gl=1*t3zibb*_ga*NTUxNDE5MDkyLjE2MzQzMzgzNjY.*_ga_HZQWR2GYM4*MTY1MDI5ODIwNC43LjAuMTY1MDI5ODIwNy4w

You may call customer service on the number on your membership card.  If you need assistance, we’d be more than happy to help.

It is possible to be eligible and enrolled in both Medicare and Medicaid at the same time. If you qualify for both, you are what is called dual-eligible. There are special Medicare Advantage programs available for those enrolled in Medicare and Medicaid called D-SNPs.

Medicare D-SNPs are plans specifically designed for dual eligibles. D-SNPs tailor their benefits, provider choices, and drug formularies to best meet the needs of dual eligibles. There are several Medicaid eligibility categories, and not all D-SNPs cover all categories, so it’s important to talk with your Medicare agent at West Compass Insurance Solutions, Inc. to verify your eligibility.

In general, D-SNP plans include benefits above and beyond those provided by Medicaid and Medicare. These extra benefits may include:

Dental care

Eye exams and eyewear

Hearing exams and hearing devices

Transportation to the doctor or pharmacy

Credits to buy over the counter health-related products

These D-SNP plans usually have no monthly premium, making them a low-cost choice too.

You may incur a Part D late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of the following:

A Medicare Prescription Drug Plan (Part D)

A Medicare Advantage Plan (Part C) (like a Health Maintenance Organization or Preferred Provider Organization) or another Medicare health plan that offers Medicare prescription drug coverage

Creditable prescription drug coverage

The Part D late enrollment penalty is an amount added to your Medicare Part D monthly premium once you enroll in a Part D plan. The amount of the late enrollment penalty is calculated based on how long you went without Part D or creditable prescription drug coverage. The penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2020, $33.06 in 2021) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The national base beneficiary premium can change from year to year, so your penalty amount may change as well. To avoid any penalties, get in touch with a Medicare expert from West Compass Insurance Solutions, Inc. several months before you turn 65 or if you are over 65 and are going to lose your employer group health insurance.

Do I qualify for Medicaid?

Check the Medicare official website for more information.

If you are losing your health insurance but are not yet eligible for Medicare, there are several options available.

COBRA – You may be eligible for COBRA from you or your spouse’s former employer for up to 18 months, but you will have to pay the full premium, which can be pricy. You only have a certain amount of time to apply for COBRA after your employer group coverage ends, so pay attention to deadlines.

Individual/family insurance – This is the insurance you purchase on your own. You can buy a family policy that will cover you, your spouse, and any dependent children you have. This type of health insurance can be costly, especially for older people. Your agent at West Compass Insurance Solutions, Inc. will be able to help you find out if you qualify for any subsidies through the Health Insurance Marketplace to assist with the cost.

Medicaid – Medicaid is a public health insurance program for people with low income and financial resources. Eligibility is based on income, assets, and family size. Medicaid is operated by the state in which you live, and eligibility criteria can vary widely from state to state.

We partner with Temecula Center for Integrative Medicine in helping you choose a plan they accept.  Currently they accept most Preferred Provider Organization Plans plans.  Please give us a call for more information.

If you are still working at 65 and have health insurance through your employer or a union, the answer depends on the size of the company you work for. If your employer has fewer than 20 employees, Medicare is your primary insurance. In this case, you will need both Part A & B since Medicare will pay first, with your group insurance paying secondary. If your company has more than 20 employees, there is no need to enroll in Part A or Part B as your employer group insurance will be primary. When you stop working, or your employer group coverage ends, you have an 8-month Special Enrollment Period to sign up for Medicare.

One important thing to be aware of is if you choose COBRA after you stop working and do not enroll in Medicare Part A and Part B, you may have to pay a late enrollment penalty when your COBRA ends and you enroll in Medicare. You will also have to wait until the Medicare General Enrollment Period (January 1st to March 31st every year) to enroll, which may cause a gap in your health care coverage. If you are unsure about what you need to do when turning 65, call us at West Compass Insurance Solutions, Inc., and we will review your situation and provide guidance on what you should do.

Medigap plans, also called Medicare Supplement plans, are designed to work alongside Original Medicare and reduce your out-of-pocket costs. Original Medicare only covers about 80% of your Medicare Part B health care expenses. That leaves you responsible for paying for the additional 20%, which can be costly if you are diagnosed with a severe illness. By purchasing a Medicare Supplement plan, you buy some peace of mind by minimizing your financial risk/responsibility. Medigap plans are standardized and have letter names (A-N), allowing you to easily compare various insurance companies’ plans. Medigap plans do not cover prescription drugs, so you will also need to purchase a stand-alone Part-D prescription drug plan if you enroll in one.

Call West Compass Insurance Solutions, Inc. – your local Medicare Expert about what Medicare covers or how enrolling in a Medicare Advantage or Medicare Supplement plan can improve your coverage and reduce your out-of-pocket costs.

When you turn 65 and sign up for Medicare Part B, you have a six-month open enrollment period for Medicare Supplements Plans. This period starts on the first day of the month of your 65th birthday. During open enrollment, you can purchase any Medicare Supplement policy without answering any medical questions. This is called “Guaranteed Issue” (GI). If you buy a Medicare Supplement outside your open enrollment, guarantee issue window, you may have to answer some medical questions. Depending on your answers, you may be declined or have to pay a higher premium. There can be exceptions, which is why it is so vital to work with a Medicare advisor to help you understand the options available in your unique situation.

Call West Compass Insurance Solutions, Inc. – your local Medicare Expert about what Medicare covers or how enrolling in a Medicare Advantage or Medicare Supplement plan can improve your coverage and reduce your out-of-pocket costs.

Once you create an online account, you’ll be able to look up doctors, dentists in your network.

Call member services on the number on your member ID card or call your carrier at:

Aetna: (833) 331-1573

Blue Shield: (888) 628-2770 

Humana:    (800) 379-0092     

Scan:  (877) 494-2892 

United Health Care: (833) 845-8798

If you move out of state and have Original Medicare, you don’t need to make any changes. If you have a Medicare Advantage or Part-D plan, in most cases, you will have to switch plans to one offered in the state of your new residence. Moving out of your current plans service area, will qualify you for a Special Enrollment Period (SEP) that will allow you to switch plans outside of the Annual Enrollment Period.

If you are enrolled in a Medicare Supplement plan as long as you move from one state to another but stay within the country, you should be able to keep your current Medicare Supplement plan. Assuming your plan is available in your new zip code. However, if you’re moving to Massachusetts, Wisconsin, or Minnesota, which have standardized plans unique to their states, you may have to switch plans.