Congratulations, you turn 65 and are eligible for Medicare. Your monthly benefits from the federal government include Social Security and Medicare Part A and B deductions. Below, we’ll give you a brief summary and walk you through the first steps to understanding the Medicare options available to you. This is by no means a thorough review. To fully understand the benefits you receive under Medicare, read the comprehensive brochure for seniors “Choosing a Medigap Policy: A Health Insurance Guide for People With Medicare.”
Original Medicare Parts A & B
As we know it, there are 3 parts to Medicare part A, B, and D. Administered by the federal government, Part A (Hospital Insurance) covers hospital expenses and helps cover skilled nursing facilities, hospices, and some home health care costs. Medicare Part B includes doctors and services, outpatient care, and some preventive services to maintain your health when you are sick. The Part A premium is $443.00 per month and unless you are disabled or have a survivor’s benefit from a spouse who was covered by Social Security, these costs are the same for everyone and are part of the benefit. Part B premium starts at $96.40 (could cost more depending on your annual income) and is deducted directly from your Social Security check. You can opt out of Part B coverage if you wish. Both A (hospital benefits) and B (Doctor and medical benefits) have deductibles, co-insurance/co-payments and maximum benefits with additional lifetime reserve days. There are gaps in government plan and payments you are directly responsible to pay. Selecting a supplemental plan from a private insurer can fill some of these gaps.
Medicare Prescription Drug Coverage (Part D)
Section D, added to the law effective January 1, 2006, was enacted under the Bush administration and is funded by taxpayers’ money. If you had a Medicare plan before January 2006, you may have a Medicare Supplement policy that includes drug coverage. If you are new to Medicare, you can select a separate plan for medications. There are two ways to purchase a drug plan: as part of a Medicare Advantage Plan or as a separate Medicare Prescription Drug Plan. Since Part D provides basic coverage with large deductibles and co-payments in addition to premium differentials, these drug add-on policies must provide Formulary or Generic Drugs in each category of treatment. Deciding which drug plan is best for you can be challenging. It is helpful to know your medications and dosages before selecting the plan. For approved drug plans, visit the website of the insurance department in your state.
Medicare Advantage Part C Plans
Included in Medicare’s description is Part C, which you might assume is an added benefit you receive – it’s not. Part C is coverage you can select in lieu of traditional Medicare. Medicare Advantage Plans (MA) are offered by private insurance companies and are private plans approved by the federal government. Choosing an MA plan means that you are denying coverage through traditional Medicare. The insurance company must follow strict rules and regulations and may be suspended for misleading material or violations. An independent agent must be separately certified to sell Medicare Advantage Plans, as they are seen as an extension of the federal government. These plans can be HMO (Health Maintenance Organizations), PPO (Preferred Provider Organizations), PFFS (Private Fee for Service), MSA (Medical Savings Accounts, or SNP (Special Needs Plans). With MA plans, you do not buy a Medicare Supplement plan as the additional benefits are included in the Part C, MA plan.
Which plan suits you best? Below are some differences between Medicare Advantage (MA) and Medicare Supplement (aka Medigap).
The doctor you choose
Your real choice with an MA versus a traditional Medicare supplemental plan is to make sure you get the doctors and hospitals you want. Most MA plans are regional, and the insurance company may not offer an MA plan in your zip code, but may offer a Medicare Supplement plan in your area. MA plans specify the hospital and doctor you need to see. If you like HMO plans, you would probably be happy with an MA plan. If you prefer to choose your own doctor and hospital, you are best served with a PPO/Medicare Supplement plan. Many doctors will take Medicare patients but are not on the list to take Medicare Advantage patients. Do your homework first and find out what type of plan your doctor will respect.
Guaranteed rules issued
A law that is strictly regulated with Medicare is a guaranteed problem. You are eligible for Medicare, Medicare Supplement, or a Medicare Advantage plan even if you have health problems (pre-existing conditions) in the first month of eligibility for coverage under Medicare Part B age 65 or older. However, this guaranteed issuance right is only valid for 6 months after you become eligible. After that, the insurance company can endorse your medical history and you can be rejected, excluded for pre-existing conditions or benefits. If you have group health insurance at work after you become eligible for Part B, you can wait until your group insurance has expired before opting for supplement or MA insurance, guaranteed to be issued. You must be able to provide proof of enrollment from Medicare parts A and B to purchase a supplement. (There are a few other exceptions to a guaranteed issue.) Either way, if you plan to choose a supplemental plan to fill Medicare’s gaps or want to take an Advantage plan, you can extend the coverage it choose best when you are. is first eligible or when the group benefit ends with your employer.
Medicare Supplement Plans (Medigap Policy)
Medicare Supplement policies are available to fill the gaps of the traditional parts A and B. These plans are standardized and called Plans A through L and should provide the same benefits regardless of which company sells the plan. Not all companies sell A – L. Premiums and contracted doctors and hospitals are usually the big differences in these plans. Plans F&J offer the richest coverages for Medigap plans and also cover emergencies abroad that can be important if you are traveling outside of the US. The Department of Insurance in your state can provide a list of companies that offer Medicare supplemental plans. These supplemental plans are usually less than $180 per month, depending on the company you select, and most doctors who accept Medicare will accept the supplemental plan benefits you choose, as long as the plan is not an HMO or MA plan. Again, talk to your doctor’s billing department to make sure your plan is accepted before you make a final decision.
Resume
There are benefits that are not covered by Medicare. These include: long-term care, vision, dentistry, hearing aids, eyeglasses, and nurses on private duty during recovery from illness. As you approach age 65, your mailbox will explode with offers for Medicare Advantage and Medicare Supplement plans. Marketing materials from AARP and other senior organizations can be confusing. Understanding the differences can save you time and money. Choosing an independent agent contracted to sell both Medicare Supplement and Medicare Advantage Plans is to your advantage. Call or contact our agency for more information and for your free guide to “Choosing a Medigap Policy: A Guide to Health Insurance for People on Medicare”.
Unraveling Medicare and Medicare supplement
World News,Next Big Thing in Public Knowledg
#Unraveling #Medicare #Medicare #supplement
