Click the statement that represents your current status:

I’ll be age age 65 soon or I’m getting an early start on all things Medicare.
I’m in my 65th birth month or within 3 months after and have not enrolled in Medicare.
I’m over age 65 and planning to leave a group health plan.
I’m in or beyond the 4th month past the month I became age 65 and never enrolled in Medicare.

Do you have employer group health coverage as an employee or dependent you plan to keep beyond age 65?

Yes No

Are you enrolled in Medicare Part A and/or part B?

Neither A or B
Part A Only
Part A & B

Part A

Enroll in Part A by calling Social Security. If you’ve paid 40 quarters of FICA your Part A coverage will be back dated 6 months.
Call Social Security at 800-772-1213

Part B

Enroll in Part B by Submitting these forms to Social Security. Any agent at Senior Insurance can send them to you or you can search the web.
Submit forms to Social Security:
Form CMS-40B (To be completed by you)
CMS-L564 (To be completed by employer)

Next you’ll want to decide if a Medicare Supplement and Part D Rx plan or a Medicare Advantage Plan fits your needs.

Next

Part B

Enroll in Part B by Submitting these forms to Social Security.
Any agent at Senior Insurance can send them to you and explain how they’re submitted.
Or you can search the form numbers on ssa.gov
Submit forms to Social Security:
Form CMS-40B (To be completed by you)
CMS-L564 (To be completed by employer)

Next you’ll want to decide if a Medicare Supplement and Part D Rx plan or a Medicare Advantage Plan fits your needs.

Next

Active Employee Group Coverage

If Employer is Less than 20 Employees:
Medicare is Primary

Carrier can “force” Medicare enrollment but none we are aware of do.

We Recommend

Enroll in part A
If $0 premium and no contributions to Health Savings Account.

Consider Medicare part B & Coverage Options based on:
1. Group plan premium.
2. How does group plan pay AFTER Medicare pays?

If Employer is More than 20 Employees:
Medicare is Secondary

Carrier cannot “force” Medicare enrollment.

We Recommend

Enroll in part A
If $0 premium and no contributions to Health Savings Account.

Enroll in part B
Only if health care costs are more than part B premium

Compare Group Benefits/Premium
vs.
Medicare Benefits/Premium

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Are you collecting social security income?

No
You will need to enroll in Medicare A & B during the Initial Election Period.
Next
Yes
You will be auto enrolled into Medicare parts A & B and should receive your ID card about 3 months prior to your month of birth.
Next you’ll want to decide if a Medicare Supplement and Rx plan OR a Medicare Advantage plan fits your needs.
Next
Enroll in part A now by calling Social Security. If you’ve paid 40 quarters of FICA your part A coverage will be back dated 6 months.

Part A

Visit your local Social Security office or call 800-772-1213
You must enroll in part B during the General Enrollment Period, January 1st through March 31st

Part B

Submit form to Form CMS 40B to Social Security. Contact us for form CMS 40B.

Part D

General Enrollment Period not applicable to part D

Once enrolled, you’ll want to decide if a Medicare Supplement and Part D Rx plan or a Medicare Advantage Plan fits your needs.

Next

You have two ways to lower your Original Medicare costs

Medicare Supplement (Medigap), Part D Rx Plan

Any Medicare Provider
Little Cost For Care
Rx Plan Choice
Portability
Higher Premium

Dental Not Included
Vision Not Included
Plan Will Not Change
Private Insurance Policy
No Value Added Benefits

Medicare Advantage

Provider Limitations
Point of Service Cost Sharing
Part D Rx Included
Not Portable
Low or $0 Premium

Dental Might Be Included
Vision Usually Included
Plans May Change or End
Government Funded
Value Added Benefits

First, let’s look at Medigap & Rx plans

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Two Popular Medigap Plans: G & N

Appx. monthly Premium:

MaleFemale
Plan GPlan NPlan GPlan N
Age 65$135$115$125$100
Age 70$155$130$135$110
Age 75$185$155$160$130
Age 80$210$180$185$150

Non-smoker average premiums N-NV. Household discount not applied.

G

You Pay Medicare’s Part B deductible, that’s all for the year.

N

You pay Medicare’s Part B Deductible, then up to a $20 copay per doctor’s visit, $50 copay per Emergency Room Visit and 15% excess charges if you see an unassigned provider.

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Part D Rx

Initial Stage

You pay Deductible, if applicable, then a flat Copay or percentage of the prescriptions cost up to the Government set amount in Rx purchased. ($5030 in 2024)

Gap/Donut Hole

You pay 25% of Negotiated Price.

Catastrophic

When the amount you’ve paid, plus brand discounts in the “Gap” total the Government set amount, $8000 in 2024.

You pay $0 the remainder of the year.

Starting in 2025 The Maximum Out-of- Pocket for all prescriptions will be $2000.

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Part D Rx

Initial Stage Plan Examples

$0

Deductible, then

$0

Tier 1 Generic

$0

Tier 2 Non Pref Generic

$47

Tier 3 Pref Brand

50%

Tier 4 Non Pref Brand

33%

Tier 5 Specialty

Two Plan Examples. Monthly premiums vary by plan.

Higher premiums may not reflect greater coverage.

$0

Deductible, then

$0

Tier 1 Generic

$5

Tier 2 Non Pref Generic

$545

Deductible, then

25%

Tier 3 Pref Brand

47%

Tier 4 Non Pref Brand

25%

Tier 5 Specialty

Now, let’s look at Advantage Plans

Medicare Advantage Plan Types

Health Maintenance Organization (HMO) Plans

You must use doctors, other health care providers, or hospitals in the plan’s network except in an emergency.
You may also need to get a referral from your primary care doctor.

Health Maintenance Organization (HMO) D-SNP Plans

For people with Medicare and Medicaid.

Chronic Special Needs (C-SNP) Plans

Plans that are designed to help people with certain chronic illnesses: heart conditions, diabetes, etc. You must have a qualifying chronic condition to join this plan.

Preferred Provider Organization (PPO) Plans

You pay less using doctors, hospitals, and other health care providers “in” the plan’s network. You pay more if you use doctors, hospitals, and providers out-of-network.
Out-of-network providers are not required to accept the plan.

Private Fee-for-Service (PFFS) Plans
Medical Savings Account (MSA) Plans
HMO Point-of-Service (HMOPOS) Plans

Few plans available in Northern Nevada.
Call for Details.

Medicare Advantage

Cost Sharing Examples

Washoe CountyHMOPPO
In NtwkOut Ntwk
Monthly Premium$0$20N/A
Max Out-of-Pocket$3,000$5,900$5,450
Ambulance$300$300$300
Office Visit$0/$35$0/$20$50
Inpatient Hospital$0$300/1-5 days50%
ER/Urgent Care$125/$10$125/$30$125/$30
Routine Lab$0$050%
Outpatient Hospital$350$35050%
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Other considerations when comparing Supplements to Advantage plans

Medigap & Part D Rx

Medicare Advantage

Will Premiums Increase?

Medigap & Part D Rx

Yes, but the birthday rule allows a plan change yearly

Medicare Advantage

Depends on government funding & star ratings

If I Move, Can I Stay On The Plan?

Medigap & Part D Rx

Medigap: Yes
Part D: No, same as MA

Medicare Advantage

No, unless move is within the plan service area.

Will Plan Change?

Medigap & Part D Rx

Benefits Never Change

Medicare Advantage

Plans may change yearly on Jan 1.

Note: With a few exceptions, if you’re a Medicare Advantage plan member and want to return to original Medicare, you must wait for annual enrollment, then medically qualify for a Medigap plan.
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Compare Your Options

Medigap & Part D Rx

checked checkbox
Pay More Premium
checked checkbox
Use any Medicare Provider
checked checkbox
Pay very little for Care
checked checkbox
No Plan Changes
checked checkbox
Select From Multiple Rx plans

Medicare Advantage-HMO or PPO

checked checkbox
Pay Little or No Premium
checked checkbox
Use Network Providers
checked checkbox
Medical Cost Sharing
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Plan changes annually
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Perks, Gym Membership
OTC Benefit – Dental – Vision
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Use this chart to help you compare or give us a call at (775) 829-9600!

Group Plan

$_______ B
$_______ B-IRMAA
$_______ Group


$_______ Total

Annual Out of Pocket Max

$

Provider Choice

Determined By Plan

Rx Benefit

Included

Medigap & Part D

$_______ B
$_______ G or N-Sup
$_______ D-Rx
$_______ B-IRMMA
$_______ D-IRMMA
$_______ Total

Annual Out of Pocket Max

G & N: B Ded. | N: $20 Dr $50 Er

Provider Choice

Any Medicare Provider in USA

Rx Benefit

Multiple Plans

MA-HMO or PPO

$_______ B
$_______ Plan Premium

$_______ B-IRMMA
$_______ D-IRMMA
$_______ Total

Annual Out of Pocket Max

Copays for Care. Max Varies By plan

Provider Choice

HMO: Network Only | PPO: In/Out Unless Er

Rx Benefit

Included with plan

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A&B Initial Election Period

The 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

If you enroll:Part A starts:Part B starts:
3 months before age 651st of the month you’re 65*1st of the month you’re 65*
The month insured turns 651st of the month you’re 651 month after you sign up
1 month after insured turns 651st of the month you’re 651 month after you sign up
2 months after insured turns 651st of the month you’re 651 month after you sign up
3 months after insured turns 651st of the month you’re 651 month after you sign up
* If born on 1st day of month, effective 1st of the prior month.

Apply online at:

https://secure.ssa.gov/iClaim/rib

Apply in person at:

Any Social Security Office

Call Social Security:

1-800-772-1213

Now you’ll want to decide if a Medicare Advantage Plan or Medicare Supplement and Part D Rx plan fit your needs.

Next

We do not offer every plan in your area. Currently, we represent (See Below) organizations which offer (See Below) products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Carson City 7 organizations which offer 34 products in your area - Churchill 5 organizations which offer 21 products in your area - Clark 8 organizations which offer 50 products in your area Nye 7 organizations which offer 43 products in your area - Douglas 6 organizations which offer 27 products in your area - Lyon 6 organizations which offer 24 products in your area - Mineral 1 organizations which offer 4 products in your area - Storey 7 organizations which offer 31 products in your area - Washoe 9 organizations which offer 43 products in your area - NV 7 organizations which offer 20 PDP products in your area