James Tomlinson

James Tomlinson

Insurance Broker

215-801-4979

James.tomlinson@bgainsurance.net

On this page you can review the basics of Medicare including important enrollment dates, you can explore the differences between Medicare Supplements and Medicare advantage plans, you can follow a link to cost compare plans yourself, and you can book an appointment with James.

The A, B, C’s and D of Medicare

Part A

Medicare Part A is known as the Hospital portion of Original Medicare. Together Part A & B make Original Medicare. Part A in general covers:

  • Impatient care in a hospital
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility (non custodial or long-term care
  • Hospice Care
  • Home Health Care
Part B

Medicare Part B is known as the Medical portion of Original Medicare. Together Part A & B make Original Medicare. Part B in general covers:

  • Medically necessary services (outpatient, doctor visits, medical
    equipment, etc.)
  • Preventive services
Part C

Medicare Part C is also known as a Medicare Advantage Plan (like an HMO or PPO) Medicare Advantage Plans, sometimes called “MA Plans,” are offered by private insurance companies approved by Medicare. If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.

Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). You can only enroll in Medicare Part C if you already have Original Medicare.

Part D

Medicare Part D is the prescription drug portion of Medicare. Part D plans are offered by private insurance companies approved by Medicare. All plans must follow Medicare’s Part D standard. You can only enroll in Medicare Part D if you have Part A or Part B of Medicare.

Costs of Original Medicare

Medicare Part A - Hospital
  • $0 Premium (If taxes paid for 40 quarters)
  • $1,364 deductible per benefit period
  • $0 copay Days 1-60 per benefit period
  • $341 copay Days 61-90 per benefit period
  • $682 copay Days 91+, Only 60 days in a lifetime
Medicare Part B - Medical
  • $135.50 Standard Premium
  • $185 Annual deductible
  • 20% coinsurance after deductible

Secondary Coverage to Original Medicare

Medicare Supplement - "Medigap"

Medicare Supplements, also known as Medigap, are plans offered by private insurance companies that cover most if not all the holes in Original Medicare. When you enroll in a Medigap plan, Medicare remains your primary insurance so you can see any doctor that accepts Medicare. Below are some of the benefits of a Medigap plan.

  • No network (see any doctor that accepts Medicare)
  • Little to no out of pocket
Medicare Advantage - Part C

Medicare Advantage Plans, also known as Part C of Medicare, are plans offered by private insurance companies that take over the benefits given by Original Medicare. For more information on Medicare Advantage plans see “Part C” under “The A, B, C’s and D of Medicare” above. Below are some of the benefits of a Medicare Advantage plan.

  • Low to no premiums
  • Prescription drug coverage included in most plans
  • Many include preventative Dental, Vision & Hearing coverage

Important Medicare Timeframes (click to view)

Initial Enrollment Period (IEP): 3 months before, the month of, and 3 months after you turn 65
The Initial Enrollment Period (IEP) is the 7-month window when you first become eligible for
Medicare. i.e. If your birthday is May 21 st , then your IEP would begin February 1 st and end on August 31 st .
During this period, you can enroll in Medicare Part A and Part B. As long as you enroll in Medicare Part A
or B you can also enroll in a standalone prescription drug plan, Part D, during this time.
General Enrollment Period: January 1st – March 31st
The General Enrollment Period is the time of year you can enroll in Medicare Part A and/or Part
B if you did not enroll when you were first eligible. If you enroll during this time, your Medicare coverage
will begin July 1 st of that year. Note: If you are retiring and/or coming off your employer coverage, you
will get a Special Enrollment Period (SEP). This SEP is an 8-month window beginning the day you lose
employer coverage in which you can enroll in Medicare Part A & B. Coverage typically begins the same
day you lose your employer coverage.
Initial Coverage Election Period (ICEP): Same as IEP or the 3 months prior to enrolling in Part B

Same as IEP or the 3 months prior to enrolling in Part B” collapse_text=”Show Less” ]The Initial Coverage Election Period (ICEP) is a time in which you can enroll in a Medicare Advantage Plan also known as Part C of Medicare. This period typically coincides with the Initial Enrollment Period. If you enroll in Medicare Part B during the General Enrollment Period, then your ICEP will begin April 1st and end on June 30th.

Annual Election Period (AEP): October 15th – December 7th

The Annual Election Period (AEP), also known as Medicare Open Enrollment Period (OEP), is the time of year you can do the following:

  • Enroll in a Medicare Advantage Plan
  • Change from one Medicare Advantage Plan to another Medicare Advantage Plan
  • Enroll in a Prescription Drug Plan
  • Change from one Prescription Drug Plan to another Prescription Drug Plan
  • Drop/Disenroll from a Prescription Drug Plan or Medicare Advantage Plan

Any changes you make during the Annual Election Period will become effective January 1st.

Medicare Advantage Open Enrollment Period: January 1st – March 31st

The Medicare Advantage Open Enrollment Period is the time of year you can do the following:

  • Change from one Medicare Advantage Plan to another Medicare Advantage Plan
  • Drop/Disenroll from your Medicare Advantage Plan
  • Enroll in a Standalone Prescription Drug Plan (Only if you Drop a Medicare Advantage Plan)

Any changes will typically become effective the 1st of the month following the change.

Medigap Open Enrollment Period: 6-month period after you turn 65 and enroll in Part B

The Medigap Open Enrollment Period is the time in which you can enroll in a Medicare Supplement Plan, also known as a Medigap Plan, without going through underwriting.

During this period an Insurance Company cannot refuse to sell you any Medigap Plans it offers, charge you a higher premium than they charge other people your age in your area, nor delay the start of your coverage.

This period occurs twice; once when you first turn 65 and then again when you first enroll in Medicare Part B. i.e. If your birthday is March 17th, then your Open Enrollment Period runs from March 1st – August 31st. If you enroll in Part B of Medicare when you turn 65 then you only get this period once.

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More about James

James has been working with BGA Insurance Group for over 5 years. Before then he worked in title insurance. In June 2018, James got married to his wife Cara. They reside in Trevose, PA with their daughter Anya. James has lived in lower Bucks county his entire life and spends most of his time in the area. Most of his free time is spent outside exercising or inside playing games with friends. James loves helping other people, so give him a call today!

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