Medicare Coverage (continued Part 2)

Medicare gap (also called Medicare Supplement Insurance)

"Visit any doctor, any hospital, anytime, and anywhere without getting permission from the insurance company"

Consider these facts in deciding if Medicare Supplement insurance for hospital and medical coverage is right for you:

• Medicare does not cover all health care bills.


• Medicare has deductibles, co-payments, and co-insurance for some services.


• The insured is responsible for paying the costs of services not covered by Medicare.

You can buy a Medigap plan from a private insurance companies that's designed to help pay your out-of-pocket costs (the gaps in Part A & B coverage). Each medigap policy only covers one person, so if you and your spouse both want coverage, you each must buy separate policy.

Each standardized medigap policy, however, must offer the same basic benefits, no matter which insurance company sells it. Premiums will vary depending on the plan you choose and the comapny you buy it from, but usually the only difference among Medigap policies sold by different insurance companies is the cost.

The best time to buy a medigap policy is during your "Medigap open-enrollment period" In all states, there is an open enrollement period that lasts for six (06) months and it begins on the first day of the month in which you are both age 65 or older and enrolled in Part B (some states have additional open enrollement periods). For more information about buying a Medigap policy, call your State Health Insurance Assistance Program.

All Medigap policies must follow federal and state laws that are designed to protect consumers and every Medigap policy must be clearly identified as "Medicare Supplement Insurance". Furthermore, Medigap Insurance companies can only sell you a "standardized" Medigap policy. There are 12 such policies identified by letters (A to L).

Note that there are numerous changes for the policies sold in 2010. For the first time, Standardized plans have beeen revamped in most 20 years. Please check back to this blog for the updated information anf free quotes for the plan fits you best.

Medicare Coverage (continued)

Medicare Part C: Medicare Advantage Plans

Formerly known as Medicare+Choice, Medicare Advantage plans are alternatives to the original Medicare plan and are notthe same as "suplemental insurance". Sometimes called Part C or "MA plans", these plans are run by private companies and are part of the medicare program. For many people, Medicare Advantage plans are a good value because they can offer health benefits at low or no additional monthly plan premium beyond the Medicare Part B.

Basically, Medicare pays an amount of money for your health care into these private medicare Advantage plans every month. In return, these plans must provide all of your Part A and Part B benefits, and they must cover at least all of the medically necessary services that the original Medicare plan provides.

MA plans can change different co-payments, co-insurance and deductibles for their services and generally have set provider networks. This means you will likely be limited to seeing those doctors (Primary Care Physician - PCP) who belong to the plan, going to certain hospitals for covered services and getting referrals to see Specialists. If you use providers who aren't in the netwaork, you may have to pay the entire cost of the services rendered. However, MA plans can offer extra benefits, such as vision, hearing, dental, and health and wellness programs. Most include medicare Part D, prescription drug coverage (usually for an extra cost).

Mmedicare Advantage plans come in several forms: HMOs, PPOs and SNP - are often referred to as " coodinated care" plans.These plans are build on the ideas of doctors and hospitals working together to coordinate and faclitate your care. Each plan create its own network.

1. HMO (Health Maintenance Organizations) plans - Your PCP may oversee your care and, in some cases, refer you to specialists as necessary.
2. PPO (Preferred Provider Organizations) plans - generally provide more flexibility to let you choose your doctors and hospitals. These plans typically don't require you to have a referral to se specialist, and you can see doctors outside the network without having to pay the entire cost yourself. If you do visit a doctor or hospital outside the network, though, you'll usually pay a larger share of the cost of your care.
3. SNP (Special Needs Plans) offer individual attention for people with complex health needs. These plans are designed to serve people with special needs like those living in nursing homes, those with chronic conditions such as Diabetes, COPD, CVD , Arthritis, Dementia - those who qualify for both Medicare and Medicaid.
4. PFFS( Private Fee-For-Services) Plans - will allow you go to any doctor if the doctor agrees to accept the plan's term of payment before treating you. It's important to confirm the doctor's agreement. Otherwise, you may have to pay up the full amount of the cost of your care.

It's very important to call any plan before joining to find out what your services will cost and to make sure that a plan will meet your needs. To enroll in medicare Advantage plan, send to me your contact info, I will send to you the application or simply get you enrolled by telephone or online. Be aware that there are limitations as to when you can join, switch or drop a MA plan.

Remember, when you join a Medicare, you will have to provide your medicare Number from your Medicare card and the date your Part A and Part B coverage started. You will also generally still pay the monthly Part B premium along with MA plan's premium (if any). That include coverage for Part A and Part B benefits, prescription drug coverage (Part D, if offered) and any other extra benefits.

Remember

Medicare Coverage

For most Americans, Medicare is on the distance horizon. But as you approach retirement age, knowing about medicare and what it can or cannot do for you could be very important to you physical and financial well-being.

You will be automatically enrolled in the program if you're already collecting Social Security or receiving benefits from the Railroad Retirement Board when you turn 65 - or if you 'vs beeen collecting disability for more than two years. But if you're working and not collecting government pension benefits, you need to sign up three months before your 65th birthday.

Medicare program isn't exactly "free" government-sponsored health care. You'll have to pay dedectibles and copayments out-of-pocket, and certain services aren't covered at all.

What you'll ultimately pay for your future medical care will depend on the type of Medicare plan you choose, whether you'll have additonal health insurance coverage from a former employer or you've puchased "supplemental coverage", and how often you make use of the medicare services offered by your doctors or hospitals.


Medicare ABC's

You have several options, and they're not cut-and-dry. Here's what you need to know to make inteliigent decisions about your insurance coverages. Let's start with the basics. You can choose between two (02) ways of receiving your Medicare benefits:

1. The Original Medicare (Part A & B) with options for additional insurance such as Part D and Medicare Supplemental insurance (Medigap)


2. Medicare Advantage Plans (Part C) that combines your benefits.

The Original Medicare Plan : Part A & B

The original medicare plan is designed to help pay for certain medical services and supplies providedin hospitals, doctors' offices and other health care settings. All citizens and legal residents of the United States who have paid Medicare payroll taxes for a minimum of 10 years will be eligible for Part A and Part B coverage upon reaching age 65.

You usually don't pay a monthly premium for Part A coverage if you (or your spouse) paid medicare taxes while working at least 40 calendar quarters. But if you aren't eligible for premium -free Part A coverage - meaning you have worked fewer than 40 calendar quarters - you may be able to buy Part A coverage if you meet a certain conditions.

Those enrolled in Part B have to pay a monthly Part B premium and an annual deductible. Most plan participants will pay the standard monthly premium amount, which is $96.40 in 2009 (normally deducted from your monthly Social Security checks). The monthly premium amount, however, will be higher for people above certain income thresholds. Financial hardship cases can get this premium covered with governmental help.

• Part A - basically helps people better absorb the costs associated with inpatient care in hospitals (including inpatient rehabilitation facilities) inpatient stays ina skilled nursing facility (but not custodial or long-term care), inpatient mental health in a psychiatric hospital (limited to 190 days ina lifetime), as well as hospice are services and home health care services. Some of the costs associated with these services and procedures will be covered completely by Medicare Part A. Others will required out-of-pocket co-payments or the satisfaction of annual deductibles.

• Part B - coverage helps pay for "medically necessary" services such as doctor's services, outpatient care and other medical services not covered by Part A. Part B also helps pay for some preventive care services that are designed to prevent or detect illness at an early stage, when treatment is likely to work best. Part B has its own separate annual deductible-$135.00 for 2009 - as well as its own co-payment and co-insutrance costs. General speaking, Medicare will pay about 80% of the expenses for part B-covered services and supplies.

"You need to be aware of that fact that you will spend money out-of-pocket, either for the cost sharing un der medicare, or for the cost of supplemental insurance if you don't have that through an employer or if your income isn't low enough to qualify for additional assistance through Medicaid (Medical in California). And it's important to remember that Medicare doesn't have any annual out-of-pocket limits."

• Medicare Part D: Prescription Drug Benefit - Medicare offers prescription drug coverage for everyone with Medicare under Part D. But to get Medicare drug coverage, you must take the initiative and join a medicare drug program. Medicare drug plans are run by insurance companies and other private companies approved by medicare. Each plan varies in cost and drug covered. Even if you don't take a lot of prescription drug now, you should still consider joining a medicare drug plan because , if you decide not to join such a plan when you are first eligible, you will pay a late-enrollment penalty if choose to join later. The penalty is one percent (1%) of the monthly premium for each month you don't enroll and it's applied to all future month premiums. There are 2 ways to get Medicare Part D coverage:

1) Stand-alone Mdicare Part D Plan: Enrolling these plans, sometimes called PDPs, add drug coverage to the original Medicare plan and to some medicare Private Fee-For-Service (PFFS) plans.

2) Join Medicare Advantage Plan (such as an HMO, PPO, or SNP). Through these you will get all your medicare coverage (part A & B), including Part D. These plans are sometimes called "MA-PD" and you will usually pay a separate monthly premium (if any) in addition to your Part B premium.