Medicare, the federal health insurance program that covers 48 million elderly and disabled Americans, has played a central role in the U.S. health system since it was established in 1965. Medicare is run by the Centers for Medicare & Medicaid Services. The Social Security Administration helps CMS by enrolling people in Medicare and by collecting Medicare premiums.
Medicare is available for persons 65 years of age and older (if they or their spouse made payroll tax contributions for 10 or more years) , certain younger disabled people and people with permanent kidney failure. People under the age of 65 qualify for Medicare after 24 months of receiving social security disability payments, or if they have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
Medicare is divided into two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). Part A helps pay for care in a hospital, skilled nursing facility, some home health care, and hospice care. Part B helps pay for doctor bills, outpatient hospital care and other medical services not covered by Part A. Your Medicare card shows the Medicare coverage you have; Hospital Insurance (Part A), Medical Insurance (Part B), or both, and the date your coverage started.
What are Medicare Advantage plans?Medicare Advantage health plans provide different ways to get your health care coverage in the Medicare program. The Medicare Advantage health plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality. Medicare Advantage Plans are available in many areas. If you have one of these plans, you don’t need a Medigap policy. If you decide to join a Medicare Advantage Plan, then you will use the health care card that you get from your Medicare Advantage Plan (provider) for your health care. These plans often give you more choices and, sometimes, extra benefits, like extra days in the hospital. To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. If you’re in a Medicare Advantage Plan, you don’t need a Medigap policy because Medicare Advantage Plans generally cover many of the same benefits that a Medigap policy would cover, like extra days in the hospital after you used the number of days that Medicare pays for. Medicare Advantage Plans (PPO & HMO) are now available in many parts of Washington. These are the Medicare HMO and PPO Plans which have co-payments for Doctors office visits and Hospitals. Unless you are in Final Stage Renal Failure, these plans are “Guaranteed Issue”. We like to remind people that these are “managed care plans”, and that Medicare is no longer your primary insurance, the HMO is. So if you do not follow the rules of the plan…you do not have coverage.
What is Creditable Coverage?Medicare beneficiaries will have the opportunity to receive subsidized prescription drug coverage through the new Medicare Part D program. Beneficiaries who choose not to sign up at the first opportunity may have to pay more if they wait to enter the program later after the open enrollment period. For information on this type of plan, or to see what might be available in your area, please call 800.884.2343, send us an email for information, or complete this contact form.
Standard Medigap Plans.To make it easier for you to compare Medigap insurance policies, all states (except Minnesota, Massachusetts and Wisconsin), U.S. territories and the District of Columbia limit the number of different Medigap policies that can be sold in any of those jurisdictions. The plans were developed by the National Association of Insurance Commissioners and incorporated into state and federal law. They have letter designations,” with Plan A being the “basic” benefit package. Each of other plans includes package plus different combination additional benefits. Insurance companies are not permitted to change benefits letter designations of any of the plans.
Enrollment.Enrollment in Medicare is handled in two ways: either you are automatically enrolled or you must apply. If you are getting Social Security or Railroad Retirement Board benefits before you turn 65, you are automatically enrolled and your Medicare card will be mailed to you about three months before your 65th birthday. If you are not receiving retirement benefits, you must apply by contacting a Social Security Administration office or, if appropriate, the Railroad Retirement Board. You should apply three months before your 65th birthday to avoid a possible delay in the start of your coverage. If you have been a disabled beneficiary under Social Security or Railroad Retirement for 24 months, you will automatically get a Medicare card in the mail.
Medicare Part D
Medicare Parts A and B do not include prescription drug coverage. On January 1, 2006, Medicare began coverage of an outpatient prescription drug benefit to all Medicare beneficiaries. The new benefit, called Part D of the Medicare Program, is designed to lower the cost of prescription drugs for most senior and disabled Medicare beneficiaries.
People on Medicare, Part A or B, who would like to receive prescription drug coverage under Part D have to enroll in a private insurance policy that offers Part D coverage and is approved by Medicare. These plans are called Medicare Prescription Drug Plans (PDPs). You can sign up for the drug benefit from time to time based on needs and Medicare coverage.
Signing up for Basic Medicare Part D
Medicare Part D offers prescription drug coverage. If you already have an insurance policy that covers prescription drugs when you sign up, you will have to choose between your current policy or a new policy and basic Medicare Part D. You will receive notification of whether or not your existing coverage is “creditable” (equal to or better than Medicare Part D).
Signing up for Medicare Prescription Drug Plans (PDP)
Medicare Prescription Drug Plans (PDPs) offer prescription drug benefits. Drug plans vary in what prescription drugs are covered, how much you have to pay and which pharmacies you can use. Like any other insurance, if you join you pay a monthly premium and pay a share of the cost of your prescriptions.
Advantages of a PDP vs. Basic Medicare Part D
PDP plans offer possible advantages in cost value, types of drugs and combinations of services, such as preventive care. Premiums might be equal to or more than those of the basic Medicare Part D Program. In any case, they must at least offer the same basic coverage as Medicare Part D.
Medicare is the basic health insurance plan Americans over 65 (and some younger for disability Medicare) rely on for the bulk of their health care needs. However, this care is limited, and Medicare supplemental insurance also known as Medigap is a means of extending coverage and reducing out-of-pocket expenses.
Medicare Supplemental insurance or Medigap comes in 10 standardized Medigap plans. The plans are referred to by letter (Plan A, B, C, D, E, F, G, H, I, J) and vary in both price and coverage. Plan J has the most coverage, and Plan A the least.
Each plan is standardized across the nation. This system makes it very easy to compare policies, because every plan must carry the same coverage, no matter who is selling it. Plan J from one insurer offers identical coverage to Plan J from another insurer, plan A from one is equal to A from another, and so forth. Not every plan is offered in every state.
Coverage includes approved medical expenses for physician services, medical and surgical services and supplies diagnostic tests, and much more. In addition, our C and F plans also cover your Medicare deductibles, co-payments for hospitalization, emergencies while traveling, and skilled nursing care.
Medicare Advantage (formerly known as Medicare + Choice) is a term for managed care plans offered through Medicare, and is an alternative to Original Medicare (Parts A and B) to cover medical expenses. Starting this fall, many Medicare Advantage plans will offer a Prescription Drug benefit as part of the overall plan. Senior Educators can help you Select a Medicare Advantage Plan that fits your needs.
About Medicare Advantage Plans
In Medicare Advantage plans, the government contracts with private insurance companies to add Medicare beneficiaries to the rolls of those covered under the insurance company’s plan. Payments to the plan are from Medicare (diverting the Part B premium payments), and potentially from the enrollee if the plan costs more than the Part B premium. Enrollees in Medicare Advantage plans are still part of Medicare.
County and Regional Medicare Advantage Plans
Not every Medicare Advantage plan is available in every county, and not every plan is right for every person. However, these plans are growing in popularity and availability, making them a very strong option for most people.