MEDICARE PLANS
Medicare advantage plans Medicare is a national government health insurance program that began in 1965 under the Social Security Administration (SSA). It is administered by the Centers for Medicare and Medicaid Services (CMS). It is primarily for Americans that are 65 or older, but also for Americans with disability status as determined by the SSA, and also includes people with end state renal disease and amyotrophic lateral sclerosis (ALS). Medicare consists of Part A, B, C & D. Parts A & B are the Medicare health insurance program. Part A covers hospitalization, skilled nursing and hospice services. Part B covers outpatient procedures, doctors charges, office visits and most professionally administered prescription drugs. Part C is an alternative to A & B offered through private insurance companies, where out of pocket exposure is reduced. Part D is a stand alone prescription drug program. Medicare Part A is typically no cost to enrollees that that have been citizens of the United States for at least 5 years and paid Medicare Taxes for at least 10 years. The premium is also waived for citizens on disability for at least 24 months, or are receiving continuing dialysis or need a kidney transplant. CMS has reported that on average most enrollees using Medicare A & B as their health insurance typically end up paying about half of their medical expenses. Parts A,B,C,& D Part A: Hospital Insurance Medicare health insurance program that covers inpatient hospital stays where the beneficiary has been admitted to the hospital. There is a deductible that covers the first 60 days of a hospital stay, then begins charging a daily copay up to 90 days. After 90 days, it will cover up to 150 days at a higher daily copay, but those last 60 days can only be used once in an enrollees lifetime. Part A will also cover brief stays for rehabilitation after a hospital stay. Also, it will cover hospice services for terminally ill patients that have been determined by their physician to have less than 6 months to live. Part B: Medical Insurance Medicare health insurance program that covers some services and products not covered by Part A. It is generally for outpatient services, doctors services, office visits and covers many prescriptions/injections provided in the doctor's office. There is an annual deductible for services under Part B, then the patient is responsible for 20% of all remaining costs. This would include services such as x-rays, diagnostic tests, some vaccines, limited ambulance transportation, and many other services administered in a doctor's office. Chiropractic care is also covered under Part B. Preventive services are covered under Part B at no cost to the patient. Part B is optional. Beneficiaries are required to pay an additional monthly premium to have Medicare Part B. Part C: Medicare Advantage In 1997, the Government passed the Balanced Budget Act of 1997, formally giving Medicare beneficiarries the option to receive benefits through private insurance companies. These plans were known as "Medicare+Choice". In 2003, the Medicare Modernization Act of 2003 re-branded the plans as "Medicare Advantage" plans. These plans, offered through private insurance companies, are required to offer benefits that meet or exceed the standards set by Original Medicare. The plans must be approved every year by CMS. These plans are typically contracted HMO and PPO plans that offer services at fixed copays and offer networks of doctors and hospitals that accept the plans benefits. This is a big "advantage" over Part A & B as it limits the exposure of medical expenses to the enrollee by setting a maximum out of pocket (MOOP) for medical services. The plans are allowed to offer both the medical services along with many ancillary services, such as dental, vision, hearing, over-the-counter, meals, transportation and other benefits. These plans are typically referred to a MA (Medicare Advantage) or MAPD (Medicare Advantage with Prescription Drugs). Part D: Prescription Drug Plans Medicare Part D went into effect on January 1, 2006 to offer services to cover the costs of self administered prescription drugs. In order to enroll in Part D, a beneficiarry must have Medicare Part A, and be eligible (but not necessarily enrolled) for Part B. Part D is not standardized, but it is heavily regulated by CMS. There are approximately 150 different defined categories of drugs, and each plan must cover at least 2 drugs in each category. They are allowed to select which drugs they choose to cover. There is a late enrollment penalty applied to the plan premiums for those that go a period of time without a Part D plan. The penalty is 1% per month without coverage applied to the national average Part D premium every year. Enrollees are not penalized if they had other qualifying coverage over that period.
medicare supplement plans MeDICARE SUPPLEMENT INSURANCE IS KNOWN AS MEDIGAP AND IS AN EXTRA INSURANCE PLAN FROM A PRIVATE COMPANY TO HELP PAY YOUR SHARE OF COSTS LEFT AFTER ORIGINAL MEDICARE. THERE ARE STIPULATIONS TO PURCHASING A MEDIGAP PLAN. THERE ARE 10 DIFFERENT TYPES OF MEDIGAP PLANS. MAKE AN APPOINTMENT WITH HEATHER TO DISCUSS OPTIONS AVAILABLE IN YOUR AREA.
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