Learning the Medicare Basics 

​You may know that when you turn 65 you qualify for Medicare. Most people become eligible for Medicare when they turn 65 years old.

  • But did you know that when it comes to Medicare, you have choices?
  • Do you understand the difference between Medicare plans?
  • Do you know how to compare plans and choose the right one for you? 

Medicare is not "One Size Fits All". Understanding the basics may help

you choose wisely. Your choices include: 

  • Original Medicare, which includes hospital stays (Part A) and doctor visits (Part B). 
  • ​Original Medicare with a stand-alone Prescription Drug Plan (Part D) and/or a Medicare Supplement Insurance Plan. 
  • Medicare Advantage (Part C), which often includes a Prescription Drug Plan plus extra benefits(Part D) in addition to hospital stays (Part A) and doctor visits (Part B). 

Important: Most Part C plans include vision, hearing, dental benefits and wellness programs (like gym membership). Medicare Advantage plans (Part C) can also cover more extra benefits than they have in the past, including services like transportation to doctors visits, over-the-counter drugs, adult day-care services, and other health-related services that promote your health and wellness.

Medicare helps million Americans get health benefits. Just as important, it offers you a choice of how you want to receive your benefits. 

Hello, I’m "Andy" Fernando Lopez, licensed agent (CA Lic #0659888), and I want to help you save money. With my knowledge and experience, I can help people understand how Medicare insurance works and can recommend the proper Medicare Plan for you. I can help you understand all your Medicare options.

I am here to personally help you find the plan that is best for you. One-on-one we can look at your needs, explore your choices and decide on a plan with confidence. As your advisor, I’m here when you need me, not just at enrollment, but as a partner through your membership. When you have questions, I’ll get you answers. I would be happy to meet with you one-on-one at your home, in our office or a convenient location of your choosing. 
Call me today (858) 549-6758 so you can understand the Medicare requirements and have the best coverage available that meets your needs. 

​​​​​​​​When can you Enroll? 

Initial Enrollment Period
When you turn 65 or otherwise become eligible for Medicare, you’ll have your Initial Enrollment Period (IEP) Your IEP begins three months before and ends three months after the month of your 65th birthday ( a seven month window). If you have employer or plan-sponsored coverage when you first become eligible, you won’t need to enroll until you retire or otherwise lose the coverage. Prescription drug (Part D) coverage must be creditable or you may be subject to a Late Enrollment Penalty when you enroll in a plan with Part D benefits.

If you’re still working at age 65 and covered by your employer’s health insurance, then in most cases you don’t need to sign up for Part B yet. Once you stop working, you’ll have a special enrollment period of eight months after your employment ends in which to sign up for Part B. 

October 15th though December 7th

Open Enrollment Period 
​During Open Enrollment you can add, drop or switch your Medicare plan coverage. The annual open enrollment period for Medicare is October 15th through December 7th. This is the time each year when you can switch from original Medicare to a Medicare Advantage plan; change from your Medicare Advantage plan back to original Medicare; or switch from one Medicare Advantage plan to another. 

Special Election Period 

Some individuals may also qualify for a SEP depending on certain circumstance. 
You may qualify for a Special Election Period if you:
Retire and lose your employer coverage
Move out of the plan’s service area
Receive assistance for the State
Have been diagnosed with certain qualifying disabilities or chronic health conditions​​ 

​Understanding Your Needs 

Question to Consider. Following are a few questions that may help you get closer to understanding your needs. 
Are you in good health or do you have chronic conditions?
Which prescription drugs do you take regularly? How much do you spend? 
What doctors do you you see regularly and for what kind of care? 
How would you feel about seeing a new doctor?
How much do you travel and where? 
Are you eligible for any health care coverage besides Medicare? Will you keep that coverage when you retire?
How much did you spend on health care last year? Do you expect similar costs this year?
How does health care fit into your budget? Will you need financial help to pay Medicare premiums?
How you answer the above questions can help determine which type of Medicare plan may be best for you. 

​Eligibility Checklist

Enrolled in Original Medicare
Live in the plan’s service area

​Medicare Plan Options 

Medicare Advantage
Medicare Advantage plans, typically HMO or PPO products, are insurance plans that combine the benefits of 
Part A and B and, in most cases, includes prescription drug coverage and may include extra benefits and services for an additional cost.

What is the advantage of a Medicare Advantage plan?
The payments the company receives from Medicare help with the cost of the plan. Most of the plans have provider networks that provide services at discounted rates. The plan features also give the ability to manage costs and offer the coverage of Medicare A and B at a lower cost than Original Medicare. Some of the extra benefits you could get with a Medicare Advantage plan include:
Prescription drug coverage
Access to wellness programs
Gym membership discounts
Routine hearing, vision and dental coverage and more

Prescription Drug Coverage
Medicare Part A and Part B do not cover prescription drug

benefits. For prescription drug coverage, you can enroll in

a separate Part D plan. Many Medicare Advantage plans

already offer prescription drug coverage (Part D) as part of their benefits package. 

Supplemental Coverage (Medigap Plans) 
Some people who are covered by original Medicare purchase a separate Medi-gap plan, also known as Medicare supplemental insurance. These plans help “fill the gap” by partially or fully covering expenses that original Medicare doesn’t provide.

What is the advantage of a Medicare Supplement plan?
A Medicare Supplement or Medi-gap plan offers the beneficiary more flexibility but at a higher premium. The plans range from A to F so you can choose from a range of coverage within this plan. This plan works hand and with Medicare paying the first 80% of all Medicare approved procedures and the supplement paying the other 20%. These’s plans have little to no copayments and no required network of health care facilities, doctors, and other professional. The plan gives you access to any hospital or physician that accepts Medicare in any state. Medicare supplements do not include Part D, that needs to be picked up separately.

Part D refers to the stand alone prescription drug plan. Some plans have deductibles and some don’t. These plans are based on different formularies (list of covered medications) and have different premiums and copayments. Medications are broken up into different tiers or levels including preferred and non-preferred generic and brand drugs. All plans are based on CMS (Medicare) guidelines and have the same initial coverage stage. There is a penalty for not having a credible prescription drug plan during the correct time frame.

​​​How Does Medicare Work? 

Original Medicare is made up of two parts: 
Part A provides your hospital insurance
Part B provides medical insurance for things like doctor visits and check-ups 

​When are you eligible for Original Medicare? (Part A & Part B) 

​You’re at least 65 years old, or you’re under 65 and qualify on the basis of a disability or other special situation
You’re a U.S. citizen or a legal resident who lived in the U.S. for at least five consecutive years.

Find a plan that's right for You
What is Medicare? What is Medicare part A? What is Medicare part B? What is Medicare part C? What is Medicare part D? Who qualifies for Medicare? When to apply for Medicare? How does Medicare work? What does Medicare cover? What is Medicare Advantage Plan? What is Medigap? What is Prescription Drug Plan? Call Andy Lopez (858) 549-6758

Want Additional Resources ​to help you understand your Medicare options?

Get answers to your hard questions about Medicare.
to www.medicare.gov

Want Additional Resources ​to help you understand your Medicare options?

Get answers to your hard questions about Medicare.
to www.medicare.gov 

Andy Lopez (858) 549-6758 at Office Mall Mira Mesa San Diego California 92126 USA

10717 Camino Ruiz, # 101, San Diego CA 92126. Medicare Insurance Agent Mira Mesa, Miramar, Mission Valley, Mission Village, Murrieta, National City, Normal Heights, North Park, Ocean Beach, Oceanside, Speak Filipino Medicare Supplement Insurance Agent Old Town, Pacific Beach, Paradise Hills, Point Loma, Poway, Ramona, Rancho Bernardo, Rancho Penasquitos, Rancho San Diego, Rancho Santa Fe, Speak Filipino Medicare Insurance Plans Agent Santa Luz, Solana Beach, Sabre Springs, San Clemente, San Diego, Serra Mesa, San Luis Rey, San Marcos, San Ysidro, Scripps Ranch, Santee, Temecula, Speak Filipino Medicare Sales Agent Spring Valley, Torrey Highlands, Tierra Santa, University City, University Heights, Vista, Alpine, Bonita, Speak Filipino Medicare Medigap Insurance Agent Carmel Valley, Cardiff By the Sea, City Heights, Clairemont, Carmel Mountain Ranch, College Grove, Coronado, Crown Point, Camp Pendleton, Carlsbad, Del Mar, El Cajon, Speak Filipino Medicare Advantage Insurance Agent Chula Vista, Escondido, Encinitas, Encanto, East San Diego, Fallbrook, Hillcrest, Imperial Beach, Speak Filipino Medicare Prescription Drug Plans Insurance Agent Jamul, Kensington, Kearny Mesa, La Costa, La Jolla, Lakeside, Lemon Grove, Leucadia, Logan Heights, Lake San Marcos, Speak Filipino Medicare Part D Drug Plans Insurance Agent La Mesa, Linda Vista, Mission Beach, Mission Hills, Fashion Valley, South Park. We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

New to Medicare or Age 64 Turning 65?
Medicare is not free. Neither Original Medicare nor a Medicare Advantage plan will pay for everything. The amount you will pay depends on the coverage you choose and the health care services you receive. Medicare and Medicare plans charge premiums. A premium is a fixed amount you pay each month for coverage. You also pay a share of the cost for health care services you receive. The 3 methods of cost sharing are: deductible, copay, and coinsurance. Consider the costs when comparing your Medicare choices, low premium might come with high deductibles, copays or coinsurance rates. 

When it comes to Medicare, you have choices.
Let us help you find the best plan to fit your health care needs.

Are you or a loved one enrolling in Medicare this year?
Are you thinking about retiring?
Is Original Medicare enough health coverage for you?
Are your prescriptions covered?
What do Medicare Part A, B, C, and D mean?
How much will it cost? Do you have deadlines to enroll?

No matter your situation, we can help you get answers to your Medicare questions. 

Original Medicare (Part A and B) helps pay for doctor visits and hospital stays, but it does not cover everything and it does not cover prescription drugs.

Medicare Advantage plans (Part C) put a cap on your out-of-pocket costs for Part A and Part B services covered by the plan. It is called Annual Out-of-Pocket Maximum and it provides built-in  financial protection. There is no out-of-pocket cap with Original Medicare. Many people choose additional coverage by enrolling in one or more private Medicare or Medicare related plans. We can help you to select a Medicare Advantage plan (Part C) combine Part A, Part B and often prescription drug coverage (Part D) with some plans may offer additional benefits such as: hearing tests, routine vision, dental exams, wellness programs and fitness membership, often with no additional premium. Medicare Advantage plans can also cover more extra benefits than they have in the past, including services like transportation to doctor visits, over-the-counter drugs, adult day-care services, and other health-related services that promote your health and wellness.

Medicare prescription drug plan (Part D) that help pay for medications prescribed by a doctor or other health care professional. 

A Medicare supplement insurance plan (Medigap) help pay some of the out-of-pocket costs that come with Original Medicare.

Let us guide you in choosing the right Medicare plan from several private insurance companies.
Call Andy Lopez (858) 707-0640

Neighbor, I'm here to help.
Need assistance or not sure what plan meets your needs? I am here to personally help you find the plan that’s best for you. One-on-one we can look at your needs, explore your choices and decide on a plan with confidence. As your trusted advisor, I’m here when you need me, not just at enrollment, but as a partner through your membership. When you have questions, I’ll get you answers.
Call Andy Lopez (858) 549-6758. 

What are the basic differences between
Original Medicare and Medicare Advantage?

Original Medicare
• Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
• If you want drug coverage, you can join a separate Medicare drug plan (Part D).
​• To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.
• You can use any doctor or hospital that takes Medicare, anywhere in the U.S.

Part A and Part B
You can add: Part D
You can also add: Supplemental coverage
​This includes Medicare Supplement Insurance (Medigap). Or, you can use coverage from a former employer or union, or Medicaid. 

Medicare Advantage
(also known as Part C)

• Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
• Plans may have lower out-of- pocket costs than Original Medicare.
• In many cases, you’ll need to use doctors who are in the plan’s network.
• Most plans offer extra benefits that Original Medicare doesn’t cover— like vision, hearing, dental, and more.

Part A and Part B
Most plans include: 
Part D
Extra benefits
Some plans also include:

Lower out-of-pocket-costs 

We can help you find the health plan that is right for you. Let us guide you in choosing the right Medicare plan from several private insurance companies 
​Call (858) 707-0640 or See Me Andy Lopez

Anthem Blue Cross
Aetna Medicare

Alignment Health Plan
Blue Shield of California
Brand New Day
SCAN Health Plan
Wellcare by Health Net

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.