Tag Archive for part a

Ann Cooke | 05/06/2013
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Understanding Medicare – One Plan at a Time

Understanding the Medicare process and enrolling in the plans that are right for you can be a daunting task. In this series of posts we’ll be taking a close look at each of the Medicare plans with the hope of providing the information to make this necessary step of life a bit easier.

Medicare – Part A - Hospital Insurance 

Parts A, B, and D of Medicare all serve a different purpose. Part A provides hospital insurance.  Almost everyone over the age of 65 is eligible to receive it, but some may have to pay for it.

Eligibility/Enrollment

If you qualify for Social Security benefits, you receive Medicare Part A coverage at no cost. If you never paid Medicare tax while working, you are not eligible to receive Part A free of charge but, you still may qualify to purchase coverage.

You are eligible for free coverage and will be automatically enrolled if:

  • You are 65 years old and are receiving Social Security or Railroad Retirement Board  (RBB) benefits
  • You are under 65 and have been receiving Social Security Disability benefits for 24 months(24 month waiting period is waived for sufferers of Lou Gehrig’s Disease (ALS))
  • You have End-Stage Renal Disease (ESRD) and meet certain requirements

In order to be eligible to purchase Part A, you must fall into one of these categories:

  • U.S. Citizen or Permanent Resident and at least 65 years old
  • Younger than 65 years old and your Part A coverage ended because of employment

To sign up to purchase Part A, you should contact the Social Security Administration office three months prior to your 65th birthday and tell them you’d like to enroll. You can also sign-up online at www.socialsecurity.gov/retirement. After enrolling, you will receive your Medicare Card and your coverage will begin the first day of the month that you turn 65. You can sign up during the seven month period that starts three months before your birthday and ends four months after. For information on the cost of purchasing Part A, visit – http://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html

What does it Cover?

As the name implies, Part A – Hospital Insurance covers expenses incurred from hospital visits. Coverage includes:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Home health care
  • Hospice care
  • Inpatient care in a Religious Nonmedical Health Care Institution

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

Category: Medicare News, Medicare Tips, Original Medicare | Tags: , , ,
ElizabethGHoward | 02/10/2011
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Do You Know the Difference Between Medigap and Medicare Advantage?

Do You Know the Difference Between Medigap and Medicare Advantage?

Do You Know the Difference Between Medigap and Medicare Advantage?

Both “Medigap” and Medicare Advantage plans are often referred to as “supplemental insurance” plans in Medicare articles and literature.  This language is confusing and somewhat misleading. Do you understand the difference?

Nicknamed “Medigap,” it is technically the only real “supplemental insurance”; its formal name is Medicare Supplemental Insurance. Only people enrolled in traditional Medicare can use a supplemental insurance plan.

Medigap is NOT a government run plan. Medigap is private insurance. You can buy it to defray some or most of your out-of-pocket costs. These might include:

  • The hospital deductible for Part A, which is currently $1,100 for each hospital benefit period.
  • Part B costs such as the percentage you pay for doctor’s visits and outpatient services.
  • The costs of emergencies up to plan limits you incur when traveling overseas.
  • Other costs as defined by the plan.

 

There are 10 types of medigap policies, and they are legally standardized, which means that the benefits you get are the same, regardless of who sells them to you.

However, that does not mean you will receive the same price from each insurer so it’s a good idea to check around. To compare the benefits in each Medigap plan, enter your zip code at Medicare Solutions.com to get started.

Medicare Advantage is an umbrella name for a VARIETY of private health plans which include HMOs, PPOs, PFFS (Private Fee For Service plan.)

Medicare Advantage, called “Medicare Part C” is an alternative to the traditional Medicare program. Those who enroll in Medicare Advantage may NOT purchase a Medigap plan or a stand-alone prescription drug plan.

Each Medicare Advantage plan covers all the same benefits as traditional Medicare (called “Part A” and “Part B”), but the plans operate on the copayment system and may offer extra benefits. Sometimes the copayments are lower than traditional Medicare, and sometimes not. Each plan is different.

For example, some plans may include vision and hearing services, and include prescription drug coverage at no additional cost. However, most plans will require you to go to in-network doctors, or to pay high co-pays if you go out of network.

To compare Medicare Advantage plans, go to Medicare Solutions.com and enter your zip code to begin.

Category: Medicare Advantage, Medicare Tips, Supplement Medigap | Tags: , , , , , , , , , , , , ,
Sophie Callahan | 07/17/2009
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Proposal Suggests Formation of A New Agency To Set Medicare Pay Rates

The White House has recently been circulating draft legislation that would create an executive agency for the purpose of overseeing Medicare reimbursement rates and policy changes. Under the proposal, there would be a paid five-member Independent Medicare Advisory Council whose members would serve five-year terms. They would be nominated by the president and subject to approval by the Senate. In all likelihood, the members of the council would be doctors, or other people who are highly skilled in health policy.

The members of the council would be given the authority to make broad recommendations about Medicare, but they would focus on setting appropriate payment rates for Medicare Part A and Part B. The council would give two annual recommendation reports: the one due by October 1st of each year would deal with Medicare Part A and the one due by December 31st of each year would address Part B. These recommendations would be sent to the White House for the president’s approval before being brought before Congress. This legislation, if enacted will go into effect after Obama’s first term as president on September 15, 2014.

Other proposals are also being given consideration with respect to Medicare. In particular, the Obama administration wants to give the Medicare Payment Advisory Commission (MedPAC) the authority to determine cuts and makes other changes to Medicare.

Category: Medicare News, Original Medicare | Tags: , , ,
Annie Finneran | 03/25/2009
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Choose the Medicare plan that’s right for you

When your Original Medicare Plan kicks in, it’s time to make some other decisions relative to your health. Being informed about your options can help you make a better decision. Medicare is a national health insurance program for individuals ages 65 or older, individuals under the age of 65 who have been declared disabled, or individuals with end-stage renal disease (ESRD). There are approximately 43 million elderly and disabled Medicare-eligible beneficiaries in the U.S. today.

Medicare is broken down into 4 parts: Medicare Part A, Medicare Part B, Medicare Part C or Medicare Advantage, and Medicare Part D.

Medicare Part A is the Original Medicare. You are automatically enrolled in the Original Medicare Plan which is managed by the federal government. Medicare Part A is the hospital insurance. It covers inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care. You don’t usually have to pay a premium for Part A because the individual paid Medicare taxes while working.

Medicare Part B is a medical insurance offered by the federal government to eligible beneficiaries. Medicare Part B covers physician services, non-physician services, diagnostic tests, lab services, and ambulance transportation. Preventative care is also covered by Part B. Most people have to pay a premium for Part B.

Medicare Part C, or Medicare Advantage is a combination of Part A and Part B. Medicare Advantage plans are private health plans provided by private insurance companies. Part C is an alternative to Original Medicare and offers extra benefits. Part C plans include Medicare Health Maintenance Organization (HMO), Medicare Preferred Provider Organization (PPO), Medicare Private Fee for Service (PFFS), and Medicare Medical Savings Account (MSA).

Medicare Part D is a prescription drug coverage that helps pay for outpatient prescriptions drugs. You can either add Part D to your Original Medicare Plan or join an HMO or PPO that includes Part D coverage.

Just like choosing health insurance, Medicare insurance should be tailored to your needs. You can choose a plan based on premiums and out of pocket costs, additional benefits, whether referrals are needed, and whether the doctor you currently have is in network or out of network. After you have researched and gathered all the information necessary to make an informed decision, it is then time to choose from a variety of plans that suit your needs.

Category: Medicare Advantage, Medicare Tips, Original Medicare, Prescription Drug Coverage | Tags: , , , , , ,
Annie Finneran | 02/11/2009
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Do you have Medicare Supplemental Insurance?

Medicare is a federally funded health insurance plan that is available for those who are 65 or older and Medicare eligible. Original Medicare coverage is divided into two parts. Part A is hospital insurance and for those who are eligible and covered by Social Security can enroll without a charge. However if you are not covered by Social Security, you must pay part of the premium. When you apply for Social security, you automatically apply for Medicare. Medicare Part A helps cover inpatient care in hospitals and skilled nursing facility, hospice, and home health care. Medicare Part B is a medical insurance program covering physician and specialist charges. It also helps to cover some preventive services to help maintain your health and to keep certain illnesses from getting worse. Part B is optional if you are eligible for Part A but in order to take advantage of Part B, you must pay a monthly premium.

Unfortunately Original Medicare does not usually provide adequate coverage for all. The expenses that are not covered by Medicare can be covered by a Medicare Supplemental Plan, or Medigap. Medicare Supplemental Plans are designed to supplement Original Medicare and are provided by private health insurance carriers and can help to cover expenses such as coinsurance, copayments, and deductibles.

You may be able to choose from up to 12 different standardized Medigap policies. Medigap policies must follow Federal and State laws. Each plan, A through L, has a different set of basic and extra benefits depending on your health care needs but each policy must offer the same basic benefits no matter which insurance company sells it. However, Medigap policies do not cover long-term care, vision or dental care, hearing aids, eyeglasses, and private-duty nursing.

What you need to know to buy a Medigap policy

  • You must have Medicare Part A and Part B
  • You pay a premium for your policy to the private insurance carrier

- As long as you pay the premium, your insurance company can’t cancel your Medigap policy.

Category: Original Medicare, Supplement Medigap | Tags: , , ,
Annie Finneran | 01/16/2009
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Medicare Buzz Words Everyone Should Know

Medicare, like standard health insurance can be very confusing, especially if you don’t know what half the words mean.

  • Part A: Hospital insurance- helps pay for hospice care, inpatient hospital care, and skilled nursing facility care. Individuals are entitled to Part A if they contributed payroll taxes for 10 years or more while they worked.
  • Part B: Supplementary Medical Insurance- helps pay for physician services, outpatient care, preventive services, x-rays, diagnostic tests, and mental health services. It is funded primarily by premiums.
  • Part C: Medicare Advantage- provides care through managed care plans. Plan C provides Parts A, B, and D benefits.
  • Part D: Prescription drug plan- enrollment is voluntary and is provided by private prescription drug plans or Medicare Advantage prescription drug plans.
  • Medigap- refers to private supplemental health insurance plans sold to Medicare beneficiaries. It covers medical expenses that may not be covered by the Original Medicare plan.
  • Original Medicare- a fee-for-service plan that covers many health care services and drugs but doesn’t pay for all health care costs. There are costs such as coinsurance, copayments, and deductibles that you must pay. It includes Medicare Part A and Medicare Part B.
  • Monthly premium- a monthly payment to Medicare, an insurance company, health care plan or drug plan for health coverage.
  • Annual deductible- The amount you pay for medical services and prescriptions before your health insurance plan or Medicare plan kicks in and begins to pay.
  • Coinsurance- The amount you may be required to pay for services after you pay any deductibles.
  • Copayment- an amount you pay for services such as a doctor’s visit or specialist visits regardless of whether you have fully paid your deductible.

These are just some of the terms you should be familiar with when you are dealing with your Medicare plan or when you are choosing a Supplemental Medicare plan. They can help you to better understand the process and make an informed decision about the right plan to choose. Other ways to stay informed is to talk to your health insurance representative or carrier and stay current with insurance news.

Category: Medicare Tips | Tags: , , , , , ,