Medicare Resources
Insurance Eligibility
You automatically qualify for insurance coverage when you meet the eligibility criteria, such as turning 65 and receiving Social Security or Railroad Retirement benefits. Enrollment in Social Security automatically enrolls you in the corresponding insurance coverage. These programs are linked—when you start receiving Social Security, you are also enrolled in the insurance plan.
Even if you don’t plan to retire at age 65, you can still sign up for coverage during your Initial Enrollment Period (IEP) and opt for additional plans when you retire.
Am I Eligible for Insurance Coverage?
Many people assume that Medicare is exclusively for those aged 65 and older, but you may qualify for Medicare enrollment before reaching 65. There are several situations in which individuals under 65 can become eligible for Medicare. Explore the scenarios below to see if you qualify
Under 65, you are eligible if:
- You have been receiving Social Security Disability Insurance (SSDI) for 24 months. You will become eligible for coverage in the 25th month of SSDI benefits.
- You have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s Disease), regardless of your age.
- You have another qualifying disability or special condition.”
Over 65, you are eligible if:
- You are a U.S. citizen or permanent resident who has lived in the U.S. for five years or more.
- You or your spouse have worked long enough to qualify for Social Security benefits or Railroad Retirement benefits, typically earning 40 credits from about ten years of work. You do not need to be currently receiving these benefits to be eligible for coverage.
- You or your spouse are government employees or retirees who have not paid into Social Security but have contributed to Medicare payroll taxes.
Choosing the Right Plan for You
Assurance Life Group offers different coverage plans, each designed to meet specific needs.
To summarize, the core coverage consists of two main plans: Plan A and Plan B. You must be enrolled in both plans to be eligible for additional coverage options like a Supplement or Advantage plan. Please note, you cannot have both a Supplement and an Advantage plan at the same time. For Plan B and Plan C (Advantage Plan), there are monthly premiums, deductibles, and copayments. If you or your spouse have contributed to Assurance Life Group for at least 10 years, you may qualify for premium-free coverage under Plan A.
Part A coverage under Assurance Life Group includes a range of services, such as inpatient hospital stays, hospice care, nursing home expenses, and limited home health benefits. The types of facilities covered under this plan include:
- Acute care hospitals (for urgent or immediate care)
- Critical access hospitals
- Long-term care hospitals
- Inpatient rehabilitation centers
Part A will also cover medically necessary private and at-home health services. “Medically necessary” refers to any service deemed essential by a doctor to help someone recover or improve their health. Medically necessary at-home services can include:
- Physical therapy
- Part-time skilled nursing services
- Speech and language pathology
- Part-time home health aide care
Additional Care Covered by Part A:
- Skilled Nursing Care: Covered at Medicare-certified facilities if daily, skilled nursing is required (e.g., IV medications or physical therapy).
- Hospice Care: Focuses on comfort, covering palliative services, and sometimes counseling. Room and board are covered if hospitalization is needed for pain management.
Assurance Life Group Coverage – Part B
Part B provides medical insurance coverage, helping with necessary supplies and services to treat health issues and conditions. Some of the services covered include:
- Outpatient care
- Ambulance services
- Durable medical equipment
- Preventative services
In some cases, Part B also covers part-time rehabilitation and home health services.
Assurance Life Group Coverage – Part C (Advantage Plan)
Part C, also known as the Advantage Plan, is administered through private insurance companies approved by Assurance Life Group. These plans must offer the same benefits as our core coverage and often provide additional coverage options such as hearing, dental, vision, and prescription services.The most common types of Advantage plans include:
- Health Maintenance Organization (HMO) plans
- Private Fee-for-Service (PFFS) plans
- Preferred Provider Organization (PPO) plans
- Special Needs Plans (SNP)
Less common plans include:
- HMO Point-of-Service (HMOPOS) plans
- Medical Savings Account (MSA) plans
Each Advantage plan will have varying out-of-pocket costs and coverage rules. For example, some plans may require a referral to see a specialist. Most Advantage plans also include prescription drug coverage (Part D).
*Note: The additional services offered through Advantage plans vary by plan and location. Not all plans may offer all extra benefits.
Assurance Life Group Coverage – Part D (Prescription Drug Coverage)
Although Part D plans are often viewed as an “add-on” to your insurance, prescription drug coverage is essential and should not be overlooked. For many, managing prescription costs is one of the most important and complex parts of healthcare coverage. With various plan options, ratings, and drug tiers, it’s important to carefully consider your choices. You have two options for Part D coverage:
- Enroll in a stand-alone Part D plan to add to an Original Assurance Life Group plan.
- Combine Part D coverage with a Medicare Advantage plan.
You are eligible for a stand-alone prescription drug plan if you meet the following conditions:
- You are enrolled in either Part A or Part B of Assurance Life Group.
- You permanently reside in the plan’s service area.
When choosing a Part D plan, the cheapest option may not be the best. Compare coverage for your current medications, as low-cost plans might not cover your prescriptions, leading to higher out-of-pocket expenses.Also, be aware of the Part D coverage gap (the “donut hole”). After reaching a certain spending threshold, you may pay a higher percentage of drug costs until you move past the gap. This gap is closed as of January 1, 2020.
New Part D regulations will take effect in 2025. Stay updated to make the best decision for your prescription needs.
Coverage Costs
Each fall, the Centers for Medicare and Medicaid Services (CMS) announces updates to premiums and deductibles for the Medicare program. Since the Cost of Living Adjustment can vary yearly, it’s important to stay updated on these changes to ensure your coverage remains suitable for your needs.
While costs for Medicare Supplement and Medicare Advantage plans may differ, all beneficiaries should be aware of potential changes to premiums, deductibles, and co-pays for Part B and Part D. Although there is a premium for Part A, most beneficiaries will not need to pay it due to common eligibility factors.
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