Frequently Asked Questions

The arrival date of your Medicare Advantage ID card may vary depending on your insurance carrier, but you should receive it before your plan starts. 

 

If you haven’t received your card by the time your plan starts, feel free to call our Member Services Team at 1-844-796-2062 (TTY 711), Monday-Friday, from 9 a.m. to 5:30 p.m. EST.

Your insurance carrier will send you your plan information and benefits, but certain delays may occur depending on the time of year (i.e. holidays or the Medicare Annual Enrollment Period).

Please call the number on the back of your Medicare Advantage ID card to connect directly with your insurance carrier with questions about your plan’s coverage and benefits.


You can also call our Member Services Team at 1-844-796-2062 (TTY 711), Monday-Friday, from 9 a.m. to 5:30 p.m. EST to review your plan benefits.

The required essential benefits are designed to ensure everyone in the individual and small employer group major medical health insurance markets has comprehensive coverage for specific services in accordance with ACA guidelines. These benefits are:

  • Outpatient services (e.g. office visits)
  • Emergency room services
  • Inpatient services (hospitalization)
  • Maternity
  • Mental health and substance abuse
  • Prescription drugs
  • Rehabilitative and habilitative services (e.g. physical and occupational therapy)
  • Lab services
  • Preventive services (e.g. https://www.healthinsurance.com/insurance/aca-health-insurancephysicals, mammograms, etc.)
  • Pediatric dental and vision

ACA health insurance is the federally mandated health insurance law of the land, also known as Obamacare. It governs individual and family plans and requires ten minimum essential benefits. Anyone can apply, and those that are under the 400% poverty line can receive a financial subsidy to curb the cost of their health insurance. Enrollment is available November 1-December 15 in most states. If you have a life situation that leaves you uninsured, you might be eligible for the special enrollment period to get coverage.

Short term medical insurance is not ACA insurance. It is temporary insurance for those who need immediate coverage. Like ACA insurance, Short term health insurance includes benefits such as hospital, lab and x-rays, but it does not include all ten of the minimum essential benefits and it does not cover pre-existing conditions.

Many individuals apply for both Medicare Part A and Part B so they have doctor coverage and hospital coverage. However, if you are interested in additional benefit structure and pricing, check out Medicare Advantage Plans, which is known as Part C to see if it fits for your life situation. Medicare Part C includes Part A and B benefits, but is offered through a private health insurance company instead of the federal government and may offer additional benefits and may have some other varying differences. If you take prescription drugs, it’s smart to look into Part D, which is the prescription drug benefit of Medicare.

Indemnity insurance such as a health benefit indemnity (a hospital indemnity often combined with other supplemental insurance services) is not major medical insurance Instead, it provides a cash payment directly to you (or to the provider you identify) when you experience a covered event, like unexpected hospitalization. You can choose how to use your benefit dollars and it helps defray the cost of medical expenses, both the expected like co-pays and deductibles, and the unexpected, like lost wages. Indemnity plans help protect you financially.

Dental insurance is an added benefit that is not covered by your health insurance plan. Cleanings, crowns or root canals are not covered by your health insurance plan. But dental insurance will help ease the cost of these types of medical expenses. However, unless you have employer group health insurance, dental insurance is not available unless you purchase coverage on your own. It’s a good idea to determine what kind of coverage you might need for you and your family.

Telemedicine is low-cost access to U.S. board-certified doctors who can treat symptoms and prescribe medications over the phone or through video chat, just like a visit to Urgent Care. Unlike the doctor's office, you get a personal visit from the comfort of your home 24/7, even on holidays! If you have a high deductible or don't have a doctor's office copay option on your health plan, telemedicine is much more affordable than paying out-of-pocket for a doctor's office visit that takes you away from work or home.

Health insurance can help protect you financially from the medical bills - like an accident or illness diagnosis you were not expecting. Paying for medical care out of pocket 100% can get extremely expensive. Surgical treatment for a broken arm averages $16,000. But with health insurance coverage, you will be able to manage your expenses. Not only does health insurance help you access providers like hospitals and doctors, it helps cover your expenses. Depending on your plan, you may have to meet a deductible and pay a co-pay amount for doctor’s visits, but insurance can cover a significant portion of your insurance bills. For example, the average ACA bronze level plan deductible is $5,900, but there is no lifetime max (e.g. an amount beyond which, insurance doesn’t have to pay). You can secure lower deductibles with higher level ACA plans (silver, gold, platinum) and with Short term health insurance. Short term life insurance plans do have a lifetime maximum, so if choosing a short term plan, check the amount. Often, for a few extra dollars, you can secure a lifetime maximum of $500,000 or more.

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Medicare is health insurance for:

  • People who are 65 or older.
  • People under 65 years old who are disabled and have been receiving Social Security disability benefits for at least 24 months.
  • People suffering from End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis, also known as ALS or Lou Gehrig's disease.

Learn more about Medicare.

If you are a US citizen 65 or older, or a permanent resident of the US who has been in the United States for more than five years, you qualify for Medicare. You may also qualify for Medicare if you are younger than 65 but have certain chronic conditions.

Learn more about whether you may qualify for Medicare.

You are only allowed to enroll in Medicare during certain life milestones and certain times of the year. Here are the dates to mark on your calendar:

If you are a first-time enrollee, you can sign up for Medicare in the period of time starting 3 months before and the 3 months after your birthday.

Anyone 65 and older can sign up for original Medicare from January 1 to March 31. Coverage would begin on July 1.

If you want to make a change to your coverage, you can do so from January 1 to March 31.

If you want to enroll in a Medicare Advantage Plan, you can do so from October 15 to December 7, which is open enrollment. Your coverage would begin in January.

Learn more about enrollment deadlines.

The Medicare Annual Enrollment Period (AEP) - also called the Medicare Open Enrollment Period - is an election period that allows you to make changes to your Medicare coverage each year. Your new coverage would take effect January 1 of the following year.

What changes can you make during AEP?

  • Change from Original Medicare (Part A and Part B) to a Medicare Advantage plan.
  • Change from one Medicare Advantage plan to another.
  • Disenroll from your Medicare Advantage plan, go back to Original Medicare, and add a Prescription Drug plan if needed.
  • Disenroll from Medicare Advantage, go back to Original Medicare, add a Medicare Supplement plan, and add a Prescription Drug plan if needed.
  • Change from one Prescription Drug plan (Medicare Part D) to another.
  • Enroll in a Prescription Drug plan.
  • Cancel your Prescription Drug plan coverage.

Learn more with our 2024 annual enrollment guide.

There are two main categories of Medicare coverage including Original Medicare (with optional Medicare Supplement and prescription drug insurance) and Medicare Advantage (which provides benefits through private insurers).

Part A (Original Medicare) provides coverage for inpatient and hospital care.

Part B (Original Medicare) provides coverage for doctors and outpatient services.

Part C (Medicare Advantage Plan) typically covers Parts A, B and D with one bundled insurance policy for all Medicare coverage.

Part D (Medicare Prescription Drug Plan) provides coverage for the cost of your medications.

Plans A-N (Medicare Supplement or Medigap) coverage varies by plan benefits, but these plans help pay the costs that Medicare A and B don't cover. Plans C, E, F, H, I and J are no longer sold to new enrollees.

You can enroll in Medicare Prescription Drug (Part D) plans and Medicare Advantage (Part C) plans directly through our site. Get started by exploring how to apply or comparing medicare quotes

If you're over 65 or turning 65 in three months and not receiving Social Security benefits, you need to sign up on your own. There are 3 ways to enroll:

Go online to www.SocialSecurity.gov.

Call Social Security at 1-800-722-1213 (TTY 1-800-325-0078).

Visit your local Social Security office in person.

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