The second part of the Medicare program is called Medicare Part B.
Medicare Part B Premiums
Most people have to pay a premium for Medicare Part B. The premium is usually deducted from a Social Security, Railroad Retirement or Civil Service Retirement check. The Medicare Part B premium can also be paid every quarter or through the electronic payment option. Medicare Premiums will be based on income beginning January of 2007.
What is Medicare Part B?
Medicare Part B is a medical insurance provided by the federal government to eligible beneficiaries. The coverage provided by Medicare Part B includes medically necessary doctor's services, outpatient care, and most other services that Medicare Part A does not cover.
What does Medicare Part B Cover?
Medicare Part B covers many services, tests, and preventive treatments that are common among health care patients. However Medicare Part B is still not a 100% insurance coverage plan. Medicare Part B helps cover only the medically necessary services including tests, labs, screenings, exams, lab tests, screening, bone mass measurement is covered every two years, lab Services such as blood tests or urinalysis,colorectal cancer screenings to find any pre-cancerous growths, annual fecal occult blood test, flexible sigmoidoscopy (every four years), screening colonoscopy (every ten years), or barium enema (every four years).
Diabetic screenings are covered by Medicare Part B if you have high blood pressure, dyslipidemia, obesity, or high blood sugar. Diabetic supplies covered include monitors, test strips, lancet devices, and therapeutic shoes. Diabetic self-management training is covered if prescribed by your doctor.
Cardiovascular screenings to help prevent heart attack or stroke are covered by Medicare Part B. A screening consists of testing your triglyceride, lipid, and cholesterol levels every five years.
Doctor, Hospital and Home Health Care
Home health services include only medically necessary part-time care and services such as skilled nursing care, physical or occupational therapy, home health aide service, speech language pathology, and medical social services. Medicare Part B also includes certain home use medical equipment such as wheelchairs, hospital beds, walkers, oxygen equipment, and other medical supplies.
Chiropractic services will be covered by Medicare Part B if it is to correct one or more of the bones that has moved out of place in your spine subluxation. Ambulance services are covered by Medicare Part B if any other form of transportation would endanger your health. Blood that you receive during an outpatient visit or another Part B covered service. Clinical trials may be covered by Medicare Part B if it will help to diagnose, prevent, or treat diseases.
Ambulatory surgery center fees are covered by Medicare Part B for approved services. Emergency room services for bad injuries, severe illness, or any time you believe your life is in danger. Doctor services do not include routine physical exams except the one time "Welcome to Medicare" exam.
Eyeglass coverage is limited to one pair of glasses and standard frames after cataract surgery.
Preventive Shots
Flu shots are covered by Medicare Part B one time per year during flu season.
Three hepatitis B shots are covered by Medicare Part B if you are at medium or high risk.
Additional services covered by Medicare Part B include hearing and balance exams,mammograms, dialysis, pap tests or pelvic exams, mental health care, medical nutrition therapy, hospital services, occupational therapy, outpatient surgery service and supplies, limited prescription drugs, practitioner services, physical therapy, prosthetic devices, and transplant services.
Sunday, September 27, 2009
Medicare Part A Explained
One part of the Medicare program is called Medicare Part A. Most people do not have to pay a premium for Medicare Part A because the individual paid Medicare taxes while working.
What is Medicare Part A?
Medicare Part A is a type of hospital insurance provided by Medicare. The coverage provided by Medicare Part A includes inpatient care in hospitals, nursing homes, skilled nursing facilities, and critical access hospitals. Medicare Part A does not include long-term or custodial care.
Private insurance companies handle the claims for the Medicare Part A plan that act as agents for the federal government in processing and paying Medicare claims.
What does Medicare Part A Cover?
Medicare does not cover everything, nor does it cover the total cost for many of the covered services or medical supplies. Coverage amounts are based on which Medicare plan you have. Medicare Part A helps cover only the medically necessary services below:
Blood Transfusions
This is blood that you receive during a covered stay in a hospital, critical access hospital, or a skilled nursing facility.
Hospital Stays
Medicare Part A covers hospital stays, which includes a semi-private room, meals, general nursing, and some hospital services and supplies. Inpatient care in critical access hospitals and mental health care are also covered. Hospital stays must be at least 3 days. The time begins the first midnight after admission and does not include any hours on the discharge date.
Nursing Home or Skilled Nursing Facility
Nursing home or skilled nursing facility stays must be related to diagnosis during a hospital stay. A nursing home or skilled nursing facility stay includes a semi-private room, meals, and rehabilitative and skilled nursing services and care.
The coverage is limited to a maximum of 100 days in a benefit period. The first 20 days are paid in full, and the remaining 80 days will require a co-payment. Medicare Part A will not cover long-term care, non-skilled, daily living, or custodial activities.
Home Health Services
Home health services include medically necessary part-time care and services including skilled nursing care, physical or occupational therapy, home health aide service, and medical social services. It also includes certain home-use medical equipment and other medical supplies.
Hospice Care
Hospice care is for the terminally ill who have six months or less to live. Coverage includes pain relief and symptom control drugs, medical and support services, grief counseling, and other services. Care is provided by a nearby, Medicare-approved Hospice caregiver who will visit you at your home. Medicare does not cover many of the services that are provided to patients who receive Hospice assistance.
Whatever health care and Medicare insurance coverage you choose, make sure you have a clear understanding of all the Medicare options, Medicare coverage and Medicare premiums.
What is Medicare Part A?
Medicare Part A is a type of hospital insurance provided by Medicare. The coverage provided by Medicare Part A includes inpatient care in hospitals, nursing homes, skilled nursing facilities, and critical access hospitals. Medicare Part A does not include long-term or custodial care.
Private insurance companies handle the claims for the Medicare Part A plan that act as agents for the federal government in processing and paying Medicare claims.
What does Medicare Part A Cover?
Medicare does not cover everything, nor does it cover the total cost for many of the covered services or medical supplies. Coverage amounts are based on which Medicare plan you have. Medicare Part A helps cover only the medically necessary services below:
Blood Transfusions
This is blood that you receive during a covered stay in a hospital, critical access hospital, or a skilled nursing facility.
Hospital Stays
Medicare Part A covers hospital stays, which includes a semi-private room, meals, general nursing, and some hospital services and supplies. Inpatient care in critical access hospitals and mental health care are also covered. Hospital stays must be at least 3 days. The time begins the first midnight after admission and does not include any hours on the discharge date.
Nursing Home or Skilled Nursing Facility
Nursing home or skilled nursing facility stays must be related to diagnosis during a hospital stay. A nursing home or skilled nursing facility stay includes a semi-private room, meals, and rehabilitative and skilled nursing services and care.
The coverage is limited to a maximum of 100 days in a benefit period. The first 20 days are paid in full, and the remaining 80 days will require a co-payment. Medicare Part A will not cover long-term care, non-skilled, daily living, or custodial activities.
Home Health Services
Home health services include medically necessary part-time care and services including skilled nursing care, physical or occupational therapy, home health aide service, and medical social services. It also includes certain home-use medical equipment and other medical supplies.
Hospice Care
Hospice care is for the terminally ill who have six months or less to live. Coverage includes pain relief and symptom control drugs, medical and support services, grief counseling, and other services. Care is provided by a nearby, Medicare-approved Hospice caregiver who will visit you at your home. Medicare does not cover many of the services that are provided to patients who receive Hospice assistance.
Whatever health care and Medicare insurance coverage you choose, make sure you have a clear understanding of all the Medicare options, Medicare coverage and Medicare premiums.
Saturday, September 26, 2009
7 Steps to Medicare Eligibility: Step 7 Get Ready
What should I do now to get ready?
1) Apply for supplemental Medicare insurance if you think you might qualify. If you make less than $16,245 ($21,855 for a couple), you should apply for extra help with costs.
2) Record the names and costs of your current drugs.
3) Talk with your doctor about your drugs. Ask which ones are on the Medicare plans’ drug lists, called formularies. If your drugs are not on the Medicare formularies, ask if the formulary has a drug you can take instead—and how you should switch over to this drug.
4) If you need help with Medicare, ask your family or friends to help you.
1) Apply for supplemental Medicare insurance if you think you might qualify. If you make less than $16,245 ($21,855 for a couple), you should apply for extra help with costs.
2) Record the names and costs of your current drugs.
3) Talk with your doctor about your drugs. Ask which ones are on the Medicare plans’ drug lists, called formularies. If your drugs are not on the Medicare formularies, ask if the formulary has a drug you can take instead—and how you should switch over to this drug.
4) If you need help with Medicare, ask your family or friends to help you.
7 Steps to Medicare Eligibility: Step 6 Joining
When can I join a Medicare Prescription Drug Plan?
1) For most people, the time to join (or switch) Medicare plans is November 15 to December 31 of each year.
2) If you turn 65 this year, you can join during the three months before the month you turn 65, your birthday month and the three months after.
3) If you qualify for extra help with your costs, you can join a Medicare drug plan anytime.
4) If you make less than $16,245 ($21,855 for a couple), you should apply for extra help with costs.
When will Medicare start covering my drugs?
If you join during open enrollment this fall between November 15 and December 31, your drug coverage would start on January 1, 2010.
If you qualify for extra help with costs, you can enroll anytime. Your Medicare coverage will start the first day of the month after the month you join. Example: If you join on November 2, your drug coverage would start on December 1.
Can I switch Medicare plans?
You can switch Medicare plans during the open period, November 15 - December 31 of each year. You may be able to switch to a different plan at other times of year under some circumstances.
Is there a penalty if I join Medicare now?
If you were eligible for Medicare Part A or B and you did not join a drug plan before May 15, 2006, you will probably pay a penalty. You will pay the penalty unless you qualify for the Extra Help or have other drug coverage that is as good as the Medicare Prescription Drug Coverage. The penalty is a 1% increase in your premium for each month after May 2006 that you were eligible for the Medicare plan and did not join it. You will pay these higher premiums for the rest of the time you have Medicare Prescription Drug Coverage. If you qualify for the Extra Help, you can join anytime, without paying a penalty.
1) For most people, the time to join (or switch) Medicare plans is November 15 to December 31 of each year.
2) If you turn 65 this year, you can join during the three months before the month you turn 65, your birthday month and the three months after.
3) If you qualify for extra help with your costs, you can join a Medicare drug plan anytime.
4) If you make less than $16,245 ($21,855 for a couple), you should apply for extra help with costs.
When will Medicare start covering my drugs?
If you join during open enrollment this fall between November 15 and December 31, your drug coverage would start on January 1, 2010.
If you qualify for extra help with costs, you can enroll anytime. Your Medicare coverage will start the first day of the month after the month you join. Example: If you join on November 2, your drug coverage would start on December 1.
Can I switch Medicare plans?
You can switch Medicare plans during the open period, November 15 - December 31 of each year. You may be able to switch to a different plan at other times of year under some circumstances.
Is there a penalty if I join Medicare now?
If you were eligible for Medicare Part A or B and you did not join a drug plan before May 15, 2006, you will probably pay a penalty. You will pay the penalty unless you qualify for the Extra Help or have other drug coverage that is as good as the Medicare Prescription Drug Coverage. The penalty is a 1% increase in your premium for each month after May 2006 that you were eligible for the Medicare plan and did not join it. You will pay these higher premiums for the rest of the time you have Medicare Prescription Drug Coverage. If you qualify for the Extra Help, you can join anytime, without paying a penalty.
7 Steps to Medicare Eligibility: Step 5
Step 5: Picking a Medicare plan
What types of Medicare plans will cover drugs?
If you want Medicare Prescription Drug Coverage, you will need to choose the type of Medicare plan you would like. There are two types to choose from:
1) Medicare Prescription Drug Plans, or PDPs
2) Medicare Prescription Drug Plans are separate, free-standing insurance plans that will cover prescription drugs only.
You would pick a Medicare Prescription Drug Plan if you have either:
- Original Medicare (Medicare Part A or B)
- A Medicare Cost Plan or one of the Private Fee-For-Service (PFFS) Plans that does not include drug coverage.
- Medicare Advantage plans with Prescription Drug coverage, or MA-PDs
- Medicare Advantage plans are health plans that cover both your medical care and prescription drugs.
The major types of Medicare Advantage plans are:
- Health Maintenance Organizations, or HMOs.
- Preferred Provider Organizations, or PPOs.
- Private Fee-for-Service plans, or PFFS.
- Special Needs Plans, or SNPs (which only serve certain groups of people with Medicare)
If you choose one of these plans, you will have to use hospitals and doctors in the Medicare Advantage plan’s network to save the most money. You will pay higher costs if you use providers outside the network.
There may be Medicare Advantage plans in your region that do not offer prescription drug coverage. Make sure you choose a Medicare plan with prescription drug coverage if you need it.
Most people will pick a plan based on:
- What drugs they use.
- What pharmacy they want to use.
- How much the plan costs.
Whether they want a Medicare plan that covers prescription drugs only (a standalone Medicare Prescription Drug Plan or PDP) or a Medicare Advantage plan with both medical benefits and prescription drug coverage (a Medicare Advantage Prescription Drug plan or MA-PD).
Choose two or three Medicare plans, then call each one for more information. Ask these questions:
1) Are there any limits for my drugs? For example, can I buy as much as I want at a time?
2) Can I buy the drug I want, or do I have to try another drug like it first?
3) Does the Medicare plan have to approve drugs before I buy them?
4) Can I buy my drugs through the mail? If so, how much will I save?
5) How can I get my drugs if I travel a lot?
6) What does it cost to use a drug store that is not in my Medicare network?
What types of Medicare plans will cover drugs?
If you want Medicare Prescription Drug Coverage, you will need to choose the type of Medicare plan you would like. There are two types to choose from:
1) Medicare Prescription Drug Plans, or PDPs
2) Medicare Prescription Drug Plans are separate, free-standing insurance plans that will cover prescription drugs only.
You would pick a Medicare Prescription Drug Plan if you have either:
- Original Medicare (Medicare Part A or B)
- A Medicare Cost Plan or one of the Private Fee-For-Service (PFFS) Plans that does not include drug coverage.
- Medicare Advantage plans with Prescription Drug coverage, or MA-PDs
- Medicare Advantage plans are health plans that cover both your medical care and prescription drugs.
The major types of Medicare Advantage plans are:
- Health Maintenance Organizations, or HMOs.
- Preferred Provider Organizations, or PPOs.
- Private Fee-for-Service plans, or PFFS.
- Special Needs Plans, or SNPs (which only serve certain groups of people with Medicare)
If you choose one of these plans, you will have to use hospitals and doctors in the Medicare Advantage plan’s network to save the most money. You will pay higher costs if you use providers outside the network.
There may be Medicare Advantage plans in your region that do not offer prescription drug coverage. Make sure you choose a Medicare plan with prescription drug coverage if you need it.
Most people will pick a plan based on:
- What drugs they use.
- What pharmacy they want to use.
- How much the plan costs.
Whether they want a Medicare plan that covers prescription drugs only (a standalone Medicare Prescription Drug Plan or PDP) or a Medicare Advantage plan with both medical benefits and prescription drug coverage (a Medicare Advantage Prescription Drug plan or MA-PD).
Choose two or three Medicare plans, then call each one for more information. Ask these questions:
1) Are there any limits for my drugs? For example, can I buy as much as I want at a time?
2) Can I buy the drug I want, or do I have to try another drug like it first?
3) Does the Medicare plan have to approve drugs before I buy them?
4) Can I buy my drugs through the mail? If so, how much will I save?
5) How can I get my drugs if I travel a lot?
6) What does it cost to use a drug store that is not in my Medicare network?
7 Steps to Medicare Eligibility: Step 4
Which drugs do the Medicare plans cover?
How do I find out which Medicare Prescription Drug Plans cover my drugs?
Each Medicare Prescription Drug Plan will have a list of drugs it covers, called the plan’s formulary. The formulary is important to you because it will tell you three things:
- The names of the drugs the plan covers.
- How much you would pay for each drug. How much you pay depends on what co-pay “tier” the drug is on – see the section on co-pay tiers below.
- If there are limits or restrictions on your ability to get a drug.
The Formulary – List of covered drugs
The drug lists will include both generic and brand name drugs. Some drugs are on every plan’s formulary because Medicare requires it. There are also other drugs that the Medicare law says the Medicare plans cannot cover. Medicare must review and approve each plan’s drug list.
If your drug is not on your Medicare plan’s list, you will either have to pay full price for the prescription, or switch to a similar drug that the Medicare plan does cover. Or you can apply to the plan for an exception to see if your Medicare plan will cover the drug.
Co-pay tiers
Each Medicare plan places the drugs it will pay for in different levels, called tiers. Each tier has its own co-pay or co-insurance amount. Your drugs may be included in all the Medicare plans in your area, but they could be listed on different tiers with different co-pay amounts.
Most Medicare drug plans will have three to five tiers.
How do I find out which Medicare Prescription Drug Plans cover my drugs?
Each Medicare Prescription Drug Plan will have a list of drugs it covers, called the plan’s formulary. The formulary is important to you because it will tell you three things:
- The names of the drugs the plan covers.
- How much you would pay for each drug. How much you pay depends on what co-pay “tier” the drug is on – see the section on co-pay tiers below.
- If there are limits or restrictions on your ability to get a drug.
The Formulary – List of covered drugs
The drug lists will include both generic and brand name drugs. Some drugs are on every plan’s formulary because Medicare requires it. There are also other drugs that the Medicare law says the Medicare plans cannot cover. Medicare must review and approve each plan’s drug list.
If your drug is not on your Medicare plan’s list, you will either have to pay full price for the prescription, or switch to a similar drug that the Medicare plan does cover. Or you can apply to the plan for an exception to see if your Medicare plan will cover the drug.
Co-pay tiers
Each Medicare plan places the drugs it will pay for in different levels, called tiers. Each tier has its own co-pay or co-insurance amount. Your drugs may be included in all the Medicare plans in your area, but they could be listed on different tiers with different co-pay amounts.
Most Medicare drug plans will have three to five tiers.
7 Steps to Medicare Eligibility: Step 3
What will the Medicare Prescription Drug Coverage cost me, and what will it pay for?
If you do not qualify for extra help with costs, you will pay:
- Medicare Monthly premiums
- Yearly Medicare deductible (if any)
- Co-pay or co-insurance for each prescription
If you do qualify for extra help with costs because of your limited income, you will pay:
- Low or no Medicare monthly premiums
- Low or no yearly Medicare deductible
- Low or no co-pay or co-insurance for each prescription
You can choose from many Medicare plans with different costs. In most cases, you should look for Medicare plans that have the lowest annual cost each year. Think about how much the drugs you take cost in each plan. Your overall annual cost includes your premiums, deductibles, co-payments or co-insurance for each prescription, and any drug costs you pay during the coverage gap.
What is the coverage gap, and what do I pay?
Medicare also cares about what they call your total drug costs. Your total drug cost is what you pay for the prescriptions on your plan’s drug list, plus what your plan pays for your prescriptions.
If your total drug costs (what you and the plan pay for your prescriptions on your plan's formulary) are greater than $2,700 in 2009, you will probably hit the “coverage gap,” sometimes called the donut hole. Then you will pay 100% of your drug costs until your out-of-pocket costs reach $4,350 (or your total drug costs hit $6,153.75). After that, you will pay either 5% of the costs of prescriptions on your Medicare plan's formulary (with your plan paying 95%) OR a co-pay of $2.40 for generic drugs and $6.00 for brand-name drugs on your plan’s formulary.
Some plans pay for drugs in the coverage gap. Those plans may pay for generic drugs, and they may even pay for some brand drugs. Premiums on these Medicare plans may be higher. Remember to choose the plan with the lowest annual costs per year.
If you qualify for extra help with costs, you will not have a coverage gap. You will continue to pay reduced or no co-pays or co-insurance for each prescription. Depending on how much income you have, your Medicare co-pays or Medicare co-insurance may get even lower when your total drug costs reach $6,153.75.
If you do not qualify for extra help with costs, you will pay:
- Medicare Monthly premiums
- Yearly Medicare deductible (if any)
- Co-pay or co-insurance for each prescription
If you do qualify for extra help with costs because of your limited income, you will pay:
- Low or no Medicare monthly premiums
- Low or no yearly Medicare deductible
- Low or no co-pay or co-insurance for each prescription
You can choose from many Medicare plans with different costs. In most cases, you should look for Medicare plans that have the lowest annual cost each year. Think about how much the drugs you take cost in each plan. Your overall annual cost includes your premiums, deductibles, co-payments or co-insurance for each prescription, and any drug costs you pay during the coverage gap.
What is the coverage gap, and what do I pay?
Medicare also cares about what they call your total drug costs. Your total drug cost is what you pay for the prescriptions on your plan’s drug list, plus what your plan pays for your prescriptions.
If your total drug costs (what you and the plan pay for your prescriptions on your plan's formulary) are greater than $2,700 in 2009, you will probably hit the “coverage gap,” sometimes called the donut hole. Then you will pay 100% of your drug costs until your out-of-pocket costs reach $4,350 (or your total drug costs hit $6,153.75). After that, you will pay either 5% of the costs of prescriptions on your Medicare plan's formulary (with your plan paying 95%) OR a co-pay of $2.40 for generic drugs and $6.00 for brand-name drugs on your plan’s formulary.
Some plans pay for drugs in the coverage gap. Those plans may pay for generic drugs, and they may even pay for some brand drugs. Premiums on these Medicare plans may be higher. Remember to choose the plan with the lowest annual costs per year.
If you qualify for extra help with costs, you will not have a coverage gap. You will continue to pay reduced or no co-pays or co-insurance for each prescription. Depending on how much income you have, your Medicare co-pays or Medicare co-insurance may get even lower when your total drug costs reach $6,153.75.
7 Steps to Medicare Eligibility: Step 2
Can't I just keep the drug coverage I have now?
In some cases, you may be able to keep your current prescription drug plan and not join a Medicare drug plan. In other cases, things will change, and you will have new options.
I do not take any drugs now, so why should I enroll now in Medicare drug coverage?
We all want to stay in good health, but no one can predict the future. These Medicare plans are insurance that covers the cost of prescription drugs. If your health changes and you need more medicines, this Medicare insurance will help pay for your drugs and protect you from very high drug costs.
If you enroll in Medicare later, you may have to pay higher monthly premiums for the rest of the time you have drug coverage from Medicare.
In some cases, you may be able to keep your current prescription drug plan and not join a Medicare drug plan. In other cases, things will change, and you will have new options.
I do not take any drugs now, so why should I enroll now in Medicare drug coverage?
We all want to stay in good health, but no one can predict the future. These Medicare plans are insurance that covers the cost of prescription drugs. If your health changes and you need more medicines, this Medicare insurance will help pay for your drugs and protect you from very high drug costs.
If you enroll in Medicare later, you may have to pay higher monthly premiums for the rest of the time you have drug coverage from Medicare.
7 Steps to Medicare Eligibility: Step 1
Am I eligible for the Medicare Prescription Drug Coverage?
If you have or are eligible for Medicare Part A or Part B, you are eligible for the new drug coverage.
There is no screening for pre-existing conditions or high drug costs. Medicare plans must take everyone who is eligible and enrolls.
What if I turn 65 soon?
You may join Medicare Part A, Part B and a drug plan during the three months before your birthday. You can also join Medicare for up to three months after your birthday. So if you turn 65 by July 1, 2009, you could join a Medicare drug plan starting April 1, 2009.
Why does it matter if I am eligible for Medicare drug coverage?
You do not have to join the Medicare Prescription Drug Coverage if you do not want to. But if you are eligible to enroll in this drug coverage and you do not, you will have to pay a penalty if you join later on, unless you are eligible for the extra help with costs.
If you have or are eligible for Medicare Part A or Part B, you are eligible for the new drug coverage.
There is no screening for pre-existing conditions or high drug costs. Medicare plans must take everyone who is eligible and enrolls.
What if I turn 65 soon?
You may join Medicare Part A, Part B and a drug plan during the three months before your birthday. You can also join Medicare for up to three months after your birthday. So if you turn 65 by July 1, 2009, you could join a Medicare drug plan starting April 1, 2009.
Why does it matter if I am eligible for Medicare drug coverage?
You do not have to join the Medicare Prescription Drug Coverage if you do not want to. But if you are eligible to enroll in this drug coverage and you do not, you will have to pay a penalty if you join later on, unless you are eligible for the extra help with costs.
House Votes to Prevent Medicare Premiums Increases
A bill passed by the house yesterday (Sept 25th, 2009) would prevent Medicare Part B medical insurance premiums from increasing next year. The legislation passed the house by a vote of 406 to 18.
Medicare Tied to Social Security
About 75 percent of seniors are already protected from Medicare Part B premium increases because of a law that prohibits premium hikes from being greater than the annual boost in Social Security payments. Social Security payouts are not expected to increase in 2010. But, without congressional action, Part B premiums could increase for approximately a quarter of Medicare beneficiaries from $96.40 monthly this year to $104.20 in 2010 and $120.20 in 2011.
Medicare Coverage for Income $85,000 or Higher
This increase in payments is steeper than usual because the costs are spread across a smaller share of beneficiaries. New Medicare enrollees and existing high income beneficiaries with a modified adjusted gross income above $85,000 ($170,000 for couples) are the individuals most likely to pay higher premiums next year if the bill does not become law. Medicaid would also have to absorb the larger Part B premiums for low-income seniors eligible for both government programs.
Medicare Tied to Social Security
About 75 percent of seniors are already protected from Medicare Part B premium increases because of a law that prohibits premium hikes from being greater than the annual boost in Social Security payments. Social Security payouts are not expected to increase in 2010. But, without congressional action, Part B premiums could increase for approximately a quarter of Medicare beneficiaries from $96.40 monthly this year to $104.20 in 2010 and $120.20 in 2011.
Medicare Coverage for Income $85,000 or Higher
This increase in payments is steeper than usual because the costs are spread across a smaller share of beneficiaries. New Medicare enrollees and existing high income beneficiaries with a modified adjusted gross income above $85,000 ($170,000 for couples) are the individuals most likely to pay higher premiums next year if the bill does not become law. Medicaid would also have to absorb the larger Part B premiums for low-income seniors eligible for both government programs.
Compare Medicare Plan Options
Original Medicare
This fee-for-service plan covers many health care services. You can go to any doctor or supplier that is enrolled and accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.
Medicare Health Plans (HMOs and PPOs)
These plans are approved by Medicare and run by private companies. When you join one of these plans, you are still in Medicare. They provide all of your Part A (hospital) and Part B (medical) coverage. They generally offer extra benefits, and many include prescription drug coverage. These Medicare plans often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered Medicare services. In many cases, your costs for services can be lower than in Original Medicare, but it is important to check with the plan because the costs for services will vary.
Medicare Prescription Drug Plans
These Medicare plans add prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans.
Medigap (Medicare Supplement Insurance) Policies
These policies help pay some of the health care costs that Original Medicare doesn’t cover. If you are in Original Medicare, you could get a Medigap policy to help cover the extra health care costs.
This fee-for-service plan covers many health care services. You can go to any doctor or supplier that is enrolled and accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.
Medicare Health Plans (HMOs and PPOs)
These plans are approved by Medicare and run by private companies. When you join one of these plans, you are still in Medicare. They provide all of your Part A (hospital) and Part B (medical) coverage. They generally offer extra benefits, and many include prescription drug coverage. These Medicare plans often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered Medicare services. In many cases, your costs for services can be lower than in Original Medicare, but it is important to check with the plan because the costs for services will vary.
Medicare Prescription Drug Plans
These Medicare plans add prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans.
Medigap (Medicare Supplement Insurance) Policies
These policies help pay some of the health care costs that Original Medicare doesn’t cover. If you are in Original Medicare, you could get a Medigap policy to help cover the extra health care costs.
Medicare.gov: Can I get Medicare if I am under age 65?
Traditional Medicare benefits are available to you within a 7 month period when you turn 65. Three months before and after your 65th birthday including the month of your birthday. Research your supplemental Medicare insurance options with your employer now. Your option to purchase supplement insurance may run out when you turn 65.
If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You do not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date.
You may refuse Part B coverage
However, if you decide to pick up Part B coverage at a later date, but before you turn 65, you may have to pay a 10% surcharge in addition to the Part B premium. Also, please be aware that you will automatically be re-enrolled in Part B when you turn 65, even if you previously refused Part B coverage. You may again refuse coverage, but if you keep it you will not have to pay a surcharge.
If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You do not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date.
You may refuse Part B coverage
However, if you decide to pick up Part B coverage at a later date, but before you turn 65, you may have to pay a 10% surcharge in addition to the Part B premium. Also, please be aware that you will automatically be re-enrolled in Part B when you turn 65, even if you previously refused Part B coverage. You may again refuse coverage, but if you keep it you will not have to pay a surcharge.
Medicare.gov: 2009 Medicare Premiums
Medicare Premiums for 2009 from Medicare.gov:
Part A: (Hospital Insurance) Premium
Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
The Part A premium is $244.00 per month for people having 30-39 quarters of Medicare-covered employment.
The Part A premium is $443.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Part B: (Medical Insurance) Premium
$96.40 per month*
Medicare Deductible and Coinsurance Amounts for 2009:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2009 = $1,068) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:
A total of $1,068 for a hospital stay of 1-60 days.
$267 per day for days 61-90 of a hospital stay.
$534 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
All costs for each day beyond 150 days
Skilled Nursing Facility Coinsurance
$133.50 per day for days 21 through 100 each benefit period.
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
$135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)
Part A: (Hospital Insurance) Premium
Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
The Part A premium is $244.00 per month for people having 30-39 quarters of Medicare-covered employment.
The Part A premium is $443.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Part B: (Medical Insurance) Premium
$96.40 per month*
Medicare Deductible and Coinsurance Amounts for 2009:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2009 = $1,068) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:
A total of $1,068 for a hospital stay of 1-60 days.
$267 per day for days 61-90 of a hospital stay.
$534 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
All costs for each day beyond 150 days
Skilled Nursing Facility Coinsurance
$133.50 per day for days 21 through 100 each benefit period.
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
$135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)
Medicare Annual Coordinated Election Period
Are you turning 65, looking to switch your Medicare provider, or caring for an elderly parent that is receiving Medicare? Here is a quick explanation of this period and how it affects you.
Medicare: Annual Coordinated Election Period (AEP)
The Annual Coordinated Election Period runs from November 15 through December 31, 2009. During this time beneficiaries may change prescription drug plans, change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time. Enrollment changes take effect on January 1.
With so many different Medicare Part D providers, it is important to do your research to get ready for November 15th and the Medicare AEP period.
Medicare: Annual Coordinated Election Period (AEP)
The Annual Coordinated Election Period runs from November 15 through December 31, 2009. During this time beneficiaries may change prescription drug plans, change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time. Enrollment changes take effect on January 1.
With so many different Medicare Part D providers, it is important to do your research to get ready for November 15th and the Medicare AEP period.
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