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Assisting people with their Medicare and Health Insurance needs for over 30 Years.
George and Terri Litchfield have been helping people with their insurance needs for over 30 years. At Litchfield Insurance Associates, we have assisted thousands of seniors and individuals with their Medicare Plan choices. We also offer Individual health insurance options for those who are not Medicare eligible. Our goal is to get you into the best plan for your specific needs. There is No Charge for Our Services.
Contact us today: (951) 769-0005 info@litchfieldins.com to speak with our team and to get started today
Everything you need to know about Medicare
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Explaining the ABC's of Medicare
Original Medicare is coverage managed by the federal government. Part A is Hospital Coverage and Part B is Medical (ex. outpatient Dr. Visits). Generally, there's a cost for each service. In most cases you can go to any doctor, health care provider, hospital, or accepts Medicare and are accepting new Medicare patients. With few exceptions, most prescriptions are not covered in Original Medicare. You can add drug coverage by joining a Medicare Prescription Drug Plan, or by enrolling in a MAPD Plan (Medicare Advantage with Prescription Drug Coverage).
Enrollment Periods
1. IEP (Initial Enrollment Period) When you turn 65, you have a 7-month window to apply for your Medicare Part A & B (3 months before your birth month, the month of your birthday and 3 months after your birth month).
2. AEP (Annual Enrollment Period) From October 15th - December 7th (You can change your Medicare Part C and Part D plans for the upcoming year or enroll into a Supplement Plan)
3. OEP (Open Enrollment Period) From January 1st – March 31st (You can change from an Advantage Plan to another Advantage Plan, or return to Original Medicare and add a Part D Drug Plan)
4. SEP (Special Enrollment Period) This allows you to change your plan if: You retire / lose Group Coverage, move into a new service area, have been diagnosed with certain chronic health conditions or qualify for LIS / Extra Help, or have Medi-Cal (you can change your plan monthly if changing to a fully integrated Dual Eligible Plan).
Medicare Part C Advantage Plans
MAPDs are health plans put out by Medicare-Approved Insurance Companies. These plans combine the benefits of A&B. They include Part D (Prescription Drug Coverage) and provide additional benefits (such as vision, hearing, dental, chiropractic, over the counter allowance, gym membership, etc.). In our area, in most instances the cost is $0.
Medicare Supplement Plans
Also called “Medi-Gap”, these are letter plans such as A, C, N, G. These plans help fill in the holes and gaps that Medicare A&B don’t pay like hospital deductible and percentages. Letter G is common. The average cost for a 65 year old is $150 - $200 per month (this premium goes up each year). There is a 6-month guaranteed issue period, otherwise you do need to go through the underwriting process to qualify. These plans give you the freedom to see any Dr. that accepts Medicare without a referral. You will also need to add a Prescription Drug Plan.
C-SNP/D-SNP Plans
C-SNP (Chronic- Special Needs Plan) are plans for those who have qualifying chronic health conditions (such as diabetes, heart conditions or some respiratory diseases). These plans have extra services/benefits designed to help you better manage your chronic condition.
D-SNP (Dual-Special Needs Plan) are for people who have both Medicare and Medi-Cal. A Dual plan will help coordinate care; you may get extra benefits not provided by Medicare/Medi-Cal for a $0 premium for members with Extra Help (Low Income Subsidy).
Medicare Part D Prescription Drug Plan:
These plans help cover the costs of your medications. If you have a MAPD, prescription drug coverage is included and you do not need an additional plan. If you have a Supplement Plan or Original Medicare, you will need to enroll in a PDP to get prescription drug coverage and avoid a late enrollment penalty (1% each month you are not covered, this penalty follows you for the rest of your life). The average cost is $80 per month. There is an annual deductible / copays / co-insurance with an annual $2,000 maximum out of pocket on Medicare covered drugs.
Frequently Asked Questions
How do I apply for Medicare?
A. You can apply for Medicare Part A & B online at www.SSA.gov, in person at your local Social Security Office or by making an appointment with one of our Agents. We can help you apply online and advise you on the next steps of choosing the right plan for you. Call us at 951-769-0005 for a NO COST appointment.
What if I missed my Initial Enrollment Period?
A; If you miss your Initial Enrollment Period, you will likely incur a penalty. There is an annual 10% penalty for each year you do not enroll in part B. Likewise, if you do not enroll in a Part D (Drug Plan such as a Stand-Alone Prescription Drug Plan or a Medicare Advantage Plan with Prescription Drug Coverage) you will incur a Penalty of 1% each month you do not enroll. If you have Credible Coverage, such as group coverage through an employer, you can avoid paying a penalty for delaying enrollment.
What if I have group coverage through my employer?
A. You can continue your coverage through your employer and delay enrollment in Medicare Part B as long as it is “Credible Coverage” deemed by the Government. Creditable coverage must provide you with benefits that are as good as or better than Medicare’s coverage. Not all employer coverage is considered creditable.
Common types of credible coverage include:
- Large employer Group Coverage (more than 20 employees)
- Union-sponsored health plans
- Federal Employee Health Benefits (FEHB)
Remember, delaying Medicare Part B without creditable coverage can be detrimental to your wallet in the future. If you do not enroll in Medicare Part B as soon as you become eligible for Medicare, you may be subject to a penalty. This penalty increases incrementally for every year you lack creditable coverage. When you eventually enroll in Medicare Part B, you will pay the penalty plus your Part B Premium each month.
What is the difference between Original Medicare and an MAPD Plan?
A. Original Medicare is coverage managed by the federal government. Generally, there's a cost for each service. In most cases you can go to any doctor, health care provider, hospital, or facility that is enrolled in Medicare and are accepting new Medicare patients. With few exceptions, most prescriptions are not covered in Original Medicare. You can add drug coverage by joining a Medicare Drug Plan (see more on this under Part D Prescription plans). You generally pay a set amount for your health care (deductible) before Medicare pays its share. There is no yearly limit for what you pay out-of-pocket. A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare.
MAPD plans provide Part A and Part B Medicare benefits and in California they include Part D prescription coverage as well. These plans can include HMO’s (Health Maintenance Organizations), PPO’s (Preferred Provider Organizations), PFFS (Private Fee-for-Service Plans), SNP’s (Special Needs Plans), CSNP’s (Chronic Special Needs Plans). If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and are not paid for under Original Medicare. There is a cap for out of the pocket expenses, which varies from plan to plan. They also include benefits that Original Medicare does not (such as vision, hearing, dental, chiropractic, over the counter allowance, gym membership, etc.)
How much does a Medicare Advantage Plan cost?
A. The amount you pay for your Part B Medicare is based on your specific financial situation and determined by Social Security. With most Medicare Advantage Plan there is no additional cost for the plan itself.
How does Drug Coverage work in a Medicare Advantage Plan?
A. Under the Part D benefit, you get prescription drug coverage through the MAPD plan. Typically, the copay is zero dollars for tier 1 and 2 prescription drugs. There can be some cost to the individual for prescription drugs that fall under Tier 3, 4 and 5.
Does it cost anything to enroll in Original Medicare Part A and Part B?
A. Part A is usually no cost, as long as you have worked 10 years (40 quarters) throughout your life.
Part B does have a premium. It fluctuates year to year. For 2025 the premium in most cases is $185 per month depending on your income.
When should I apply for Medicare?
A. IEP (Initial Enrollment Period) When you turn 65, you have a 7-month window to apply for your Medicare Part A & B (3 months before your birth month, the month of your birthday and 3 months after your birth month). You may choose to delay enrollment if you have credible coverage such as group insurance through your employer.
Is there a penalty if I do not enroll when I turn 65?
A. Yes. If you do not enroll in Part B when eligible, there is a 10% penalty for every year you do not enroll, this penalty will follow you throughout your life. If you do not enroll in a D Plan (either a standalone Prescription Drug Plan or a Medicare Advantage Plan with Prescription Drug Coverage) you will incur a 1% penalty each month you do not enroll, this penalty will also follow you through out your life.
Can I get help applying for Medicare?
A: Yes! If you need assistance applying to your Medicare, we would be happy to help you. Call our office at 951-769-0005 and we will schedule a NO COST appointment to get you enrolled.
Common types of credible coverage include:
- Large employer Group Coverage (more than 20 employees)
- Union-sponsored health plans
- Federal Employee Health Benefits (FEHB)
Remember, delaying Medicare Part B without creditable coverage can be detrimental to your wallet in the future. If you do not enroll in Medicare Part B as soon as you become eligible for Medicare, you may be subject to a penalty. This penalty increases incrementally for every year you lack creditable coverage. When you eventually enroll in Medicare Part B, you will pay the penalty plus your Part B Premium each month.
Do Medicare Advantage Plans cover all Medicare Services?
A. Medicare Advantage Plans provide services that fall under Part A, Part B and Part D benefits to those enrolled. Additionally, there is typically some coverage for transportation, vision, dental, hearing and other Medicare support needs that may arise.
MAPD plans provide Part A and Part B Medicare benefits and in California they include Part D prescription coverage as well. These plans can include HMO’s (Health Maintenance Organizations), PPO’s (Preferred Provider Organizations), PFFS (Private Fee-for-Service Plans), SNP’s (Special Needs Plans), CSNP’s (Chronic Special Needs Plans). If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and are not paid for under Original Medicare. There is a cap for out of the pocket expenses, which varies from plan to plan. They also include benefits that Original Medicare does not (such as vision, hearing, dental, chiropractic, over the counter allowance, gym membership, etc.)
Are there any additional costs with a Medicare Advantage plan?
A. Yes. Sometimes there is a copay with a provided service, however, many of the services have a zero-dollar copay. Copays differ from plan to plan, so it is important to discuss with your agent your Medicare history; this way he/she can recommend to you the plan that will best meet your specific needs.
What is the function of CMS?
A. The Centers for Medicare & Medicaid Services (CMS) is the agency within the U.S. Department of Health and Human Services (HHS) that administers the nation’s major healthcare programs. The CMS oversees programs including Medicare, Medicaid, CHIP (Children’s Health Insurance Program), and the state and federal health insurance marketplaces. CMS releases updated Medicare premium and deductible information each year. CMS pays a fixed amount for your care each month to the companies that offer the MAPD plans. These companies much follow the rules set by Medicare.
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Our Main Office in Beaumont
The Sundance Corporate Center
835 N. Highland Springs Ave. Ste. 305
Beaumont, CA 92223
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Our Satellite Office in Redlands
1447 Ford St. Ste. 102
Redlands, CA 92374
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area.
Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.