Medicare Q & A

Just deciding which way to go when choosing from the combination of different types of healthcare coverage is confusing for many people eligible for Medicare. For most people, having choices is a very good thing. But what about when you have thousands of plans to choose from?

When it comes to Medicare, you have nothing but choices. Depending upon your circumstances, you may want to stay with traditional Medicare, or Medicare Parts A and B. If you choose this path, you’ll probably want to get a Medicare Part D (prescription drug) plan, too, to ensure your medications are covered. Or, you might be more interested in a Medicare Advantage plan, which can combine traditional Medicare with drug coverage and other benefits. You also may be interested in even more coverage, such as that offered through a Medigap (supplemental) plan.

Fortunately, help is available. A Medicare advisor offers education on available Medicare programs, answers questions, and offers detailed plans of action to get the most out of your insurance choices. You also should know the basics beforehand.

Traditional Medicare

Medicare Parts A and B, also known as traditional or original Medicare, have been around since 1965. Medicare Part A is free to most people who’ve worked and paid Medicare taxes for at least 10 years and provides people with inpatient hospital coverage.… Read more

Social Managed Care Plan is an organization that provides the full range of Medicare benefits offered by standard Managed Care Plan’s plus additional services which include care coordination, prescription drug benefits, chronic care benefits covering short term nursing home care, a full range of home and community based services such as homemaker, personal care services, adult day care, respite care, and medical transportation. Other services that may be provided include eyeglasses, hearing aids, and dental benefits. These plans offer the full range of medical benefits that are offered by standard Managed Care Plan’s plus chronic care/ extended care services. Membership offers other health benefits that are not provided through Medicare alone or most other senior health plans.

There are currently four Social Managed Care Plan’s participating in Medicare and each Social Managed Care Plan has eligibility criteria. These Social Managed Care Plans are located in: Portland, Oregon; Long Beach, California; Brooklyn, New York; and Las Vegas, Nevada. Listed below are the four plans and the criteria for joining each plan.

Kaiser Permanente, Portland Oregon

The enrollee must be 65 years of age or older, must have Medicare Part A and Part B, must continue to pay the Part B premium and must live in Kaiser Permanente’s Social Managed Care Plan service area.… Read more

Medicare is about helping you and those around you deal with the conditions that you have so you can enjoy your life. There is a big part of the coverage that has to do with your physical well-being, but Medicare also covers the mental side of things. Medicare Part B, as a matter of fact, will pay for services to treat your mental health condition so you can live a normal life.

Medicare Part B will cover a psychiatric evaluation that may be necessary to diagnose your treatment so that you may seek assistance. This is a great service that can help you understand what your situation is and how you can deal with it on your own terms.

Medication management is also offered by Medicare Part B as a way of helping you understand what drugs you should use and why. This is a great way to learn about the effects that certain types of medication can have on you and can be beneficial for family as well.

Occupational therapy that is part of your mental health treatment is covered by Medicare Part B so that you can function as close to normal as possible. The better you can get around in your normal life, the better your quality of life will be and that is the entire point of Medicare.… Read more

Since January 1, 2011, Medicare is phasing in a new competitive bidding program in some areas of the country. This program will change
the amount Medicare pays suppliers for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) and make changes to who
can supply these items.

If you have Original Medicare and live in one of these areas and use equipment or supplies included in the program (or get the items while visiting one of these areas), you will almost always have to use a Medicare contract supplier if you want Medicare to help you pay for the items. Medicare contract suppliers are suppliers that meet Medicare quality and financial standards and had successful bids to participate in the program.

If you rent oxygen or certain other durable medical equipment, and your current supplier isn’t a contract supplier, you may be able to continue renting these items from your current supplier when the program takes effect, if the supplier decided to participate in the program as a grandfathered supplier.

If you live in these areas (or get these items while visiting them) and don’t use a Medicare contract supplier or a grandfathered supplier, Medicare usually won’t pay for the item and you will likely pay full price.… Read more

Determine Your Eligibility For Medicare

You should meet the Medicare eligibility requirements if you can answer yes to one of the following questions:

• Are you age 65 or older?
• Are you under 65 with certain disabilities?
• Do you have End-Stage Renal Disease (kidney failure that requires transplant or dialysis)?

If you already receive Social Security Benefits, you will automatically be enrolled in Medicare Part A and B the month you turn 65. Three months prior to your birth date you should be receiving your Medicare card in the mail.

If you want to opt out of Part B coverage, you will need to follow the instructions with your Medicare card.

If you not receive Social Security Benefits, you will not be automatically enrolled. You need to apply at the beginning of your seven-month initial enrollment period (90 days prior to your 65th birthday) to make sure your coverage start date will not be delayed. At this time you have also the option to apply for Social Security Benefits.

Part A of the original Medicare program provides – with specific limitations – coverage for medically needed services for inpatients in a hospital or a skilled nursing facility for a short amount of time (not long-term care!).

Most Medicare beneficiaries don’t need to pay a monthly premium for their Part A coverage. This is also called “premium-free Part A.” You can get premium-free Part A at 65 if:

• You already get retirement benefits from Social Security or the Railroad Retirement Board.
• You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
• You or your spouse had Medicare-covered government employment.

If you’re under 65, you can get premium-free Part A if:

• You got Social Security or Railroad Retirement Board disability benefits for 24 months.
• You have End-Stage Renal Disease (ESRD) and meet certain requirements.

If you aren’t eligible for premium-free Part A, you may be able to buy Part A if:

• You’re 65 or older, and you have (or are enrolling in) Part B and meet the citizenship and residency requirements.
• You’re under 65, disabled, and you returned to work – therefore your premium-free Part A covered was canceled. (If you’re under 65 and disabled, you can continue to receive premium-free Part A for up to eight years and six months after you return to work.)

In most cases, if you choose to buy Part A, you must also enroll in Part B.… Read more

Medicare Benefits

The coverage you have in a Medicare insurance plan. The costs that are paid by the insurance plan are your benefits, or coverage.

Brand Name Medication Drugs

Prescription drugs sold under a trademarked brand name.

Medicare Part D Catastrophic Coverage

A name for the step of a Part D plan in which the plan pays nearly all of your drug expenses until the end of the year, with no upper limit. You pay only a small share of your drug expenses (about 5%).

Centers for Medicare and Medicaid Services (CMS)

The federal agency that runs the Medicare program and works with the states to manage the Medicaid program. CMS sets standards for Part D insurance plans.

Co-Insurance

A way of cost sharing where your medical costs are split on a percentage basis with your plan provider. For example, if your Medicare plan pays 75 percent, you would pay 25 percent.

Co-Payment

A way of cost sharing where you pay a pre-set, flat amount for your medical services. For example you might pay $10 for each prescription you receive and your Medicare Part D plan would pay the remaining cost of the drug.

Cost Sharing

A term for the way a Medicare insurance plan shares its costs with a subscriber.… Read more

Original Medicare includes Part A and Part B. It is a good ‘safety net’, although these plans do not cover everything, and only 80% of charges for covered medical services are paid. Beneficiaries have to share the costs for most medical services they receive with original Medicare including deductibles, co-pays and co-insurance. Medicare also does not cover routine dental, hearing and vision. For many persons on Medicare it is difficult to afford the 20% that are not paid by Medicare.

Fortunately, if you want more or better coverage, or put a cap on high medical expenses, there is additional insurance you can add to your original Medicare such as Medicare Advantage Plans or Medicare Supplemental insurance.

Medicare Advantage plans often include additional benefits such as prescription drugs, for a premium that may not higher than what you already pay for your plan B premium, while Medicare Supplement plans help you cap costs for copayments, coinsurance and your annual deductibles.

Following are the services that are included in original Medicare:

Medicare Part A Services:

Medicare Part A helps cover your inpatient care in hospitals and skilled nursing facilities. It also covers hospice care and some home health care. You must meet certain conditions, and the services must be approved and rendered by health care providers that are accepted by Medicare.… Read more

Do you care for someone who is terminally ill? It isn’t always easy to care for a loved one in difficult times, but Medicare can help -  you don’t have to do it alone. Medicare covers care for people who are terminally ill, and we have resources to help you.

Hospice is a program of care and support for people who are terminally ill. The focus is on comfort, or palliative care, not on curing an illness. Hospice care can include doctor and nursing services, counseling, medical supplies, pain medications, and other services.

If your doctor has certified that your loved one is terminally ill, Medicare covers hospice care, which is usually provided in the home. Medicare will still pay for covered benefits for any health problems that aren’t related to your loved one’s terminal illness. Get more details about Medicare coverage.

Remember, you are not alone – Medicare is here to help. You can also get information about long-term planning, managing stress, and much more.

Original post:
Medicare Covers Hospice and Comfort Care… Read more

If you are still working when you first become eligible for Medicare and are insured under your company’s group health insurance plan, you may wish to delay enrolling into Part B.

While there is usually a Late Enrollment Penalty added to your premiums if you miss to enroll in Medicare at the time you are first eligible, there are certain cases, where you are officially allowed to delay your Medicare Part B enrollment without being penalized for it and having to pay higher monthly premiums for the future years. If you didn’t take Medicare Part B when you were first eligible because your spouse or you were still working, and had a group health plan coverage through your or your spouse’s employer or union, you are allowed to enroll in Medicare Part B in a so called ‘Special Enrollment’ and usually are not subject to a late enrollment penalty.

Special enrollment periods (SEP) describe the opportunity for Medicare beneficiaries to do changes to their plan if certain events happen in their life. The Special Enrollment Period rules also applies to disabled Medicare beneficiaries who are working or are insurance with a working spouse or family member.

If you miss to enroll in Medicare Part B during your Special Enrollment Period, you will have to wait until the next General Enrollment Period, which is January 1 through March 31 of each year.… Read more