Medicare

Medicare

With eligibility determined by the Social Security Administration, Medicare is the health plan for people over age 65 or who are long term disabled. Medicare was traditionally broken into two parts, Part A for Hospital Coverage and Part B for Medical (doctor's) coverage. Part B, also called Supplemental insurance has a premium that may come out of a Social Security check. In recent years drug covered was added, Part D, and a specially regulated private component, Medicare Plus, also known as Part C, may be offered as an enhanced layer of coverage.

Recently Answered

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    AUnitedHealthcare answered
    Generally, the best time to sign up for a Medicare supplement plan is during your six-month open enrollment period that starts the first month in which you are age 65 and enrolled in Part B (except in the states of Massachusetts, Minnesota, New York and Vermont, where open enrollment is ongoing). Some states have additional open enrollment periods, including those for people under age 65. There may be other situations in which your acceptance may be guaranteed.  

    Enrolling during this period gives you a guaranteed right to buy any Medicare supplement plan sold in your state, regardless of any medical conditions you may have.

    If you delayed enrollment in Medicare Part B beyond your open enrollment period, you may still apply for a Medicare supplement plan as long as you're enrolled in Medicare and don't already have health insurance coverage.
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    Every year, even before the healthcare law, insurance companies that offered Medicare Advantage plans made decisions about what they would cover and what they would charge. Each insurance company will continue to make a business decision whether to change your benefit package and costs.

    As in previous years, you will receive a notice from your Medicare Advantage plan in the fall. It will tell you what changes, if any, will take place in your plan for the upcoming year. This is the time for you to review your options carefully and make the best choice to fit your needs.

    If you have questions about the notice, you can contact your Medicare Advantage plan directly. You can also call 1-800-Medicare (1-800-633-4227) to speak with a representative about your options.

    You can also compare your options at Medicare Plan Finder: www.medicare.gov/find-a-plan. This site shows which Medicare Advantage plans are offered in your area.

    If your plan is changed or dropped, you can switch to another available Medicare Advantage plan or to Original Medicare during Medicare’s open enrollment period.
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    You should use Medicare’s open enrollment as an opportunity to review all your Medicare choices to select a plan that works best for you. Open enrollment is available each year between October 15 and December 7.

    When evaluating different plans, remember to consider:
    • Cost: What are the monthly premiums, the annual deductible and copays?
    • Coverage: What services are covered?
    • Quality: How does the plan rate on providing quality care?
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    Medicare now pays for an annual wellness visit and a personalized prevention plan. You will be able to work with your doctor to create a personalized prevention plan to keep you as healthy as possible. The wellness visit may include the following:
    • An assessment of your health risks
    • Your updated medical history
    • A list of your current healthcare providers
    • A list of your current prescription and over-the-counter medications
    • Your height, weight, and blood pressure measurements
    • A screening schedule for appropriate preventive services for you to follow over the next five to 10 years
    • A list of your health risk factors along with treatment options
    Medicare continues to cover a one-time Welcome to Medicare physical exam for people who are new to the Medicare program. The Welcome to Medicare exam is free, with no deductibles and copayments. This exam is available only once during the first 12 months of enrollment into the Medicare program.

    Those who are new to Medicare cannot get both the Welcome to Medicare exam and the annual wellness visit during their first 12 months of enrollment. The annual wellness visit takes place each year after that.
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    AThinh Tran, MD, Internal Medicine, answered on behalf of Baptist Health South Florida

    Medicare “Part A” is hospital insurance; “Part B” covers fees from physicians and other health   providers. Traditional Medicare offers Part A and Part B coverage. Medicare  Advantage plans, which replace Part A and Part B coverage, are called “Part C” and include private hospital and medical insurance programs that are health maintenance organization, Preferred Provider Organization or Private Fee for Service plans. “Part D” refers to prescription drug plans, which are offered by private companies approved by Medicare. Some Medicare Advantage plans offer Part D drug coverage.

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    AAnne Fabiny, MD, Gerontology, answered
    Here are some factors to consider when choosing a Medicare health plan. Be aware that plan costs can change yearly:
    • Premium. Monthly premiums charged by each plan can be paid directly to the company responsible for the drug plan or deducted from a Social Security check. Some plans don't charge any premium at all.
    • Deductible. Each calendar year, coverage starts only after fulfillment of a deductible, which varied from none at all to $310.
    • Coverage. Once the deductible is met, the participant is responsible for a copayment or coinsurance amount, which varies by plan. In some plans, the copayment or coinsurance is always the same (for example, $10 per prescription or 25% of the drug's cost) and the plan pays the remainder. In other plans, common medications are placed in different tiers, each with different copayments. For example, the copayment might be $10 for drugs in Tier 1 and $60 for drugs in Tier 3.
    • Coverage gap. Many Medicare drug plans used to have a gap in their coverage for prescription drugs, sometimes referred to as a "donut hole." However, a health care reform legislation passed gradually fills that hole. Prior to reform, Medicare stopped paying after the beneficiary and the plan had spent $2,830 for prescription drugs and would only start paying again after the person's out-of-pocket spending hit $4,550. The health care reform bill provides a one-time $250 payment to people who hit the gap, and over the following 10 years, the gap will gradually disappear, so you will no longer have a period when you have to pay 100% of your drug costs.
    • Catastrophic coverage. This starts automatically when the individual has paid the out-of-pocket maximum ($4,550). Then, through the end of the calendar year, the plan pays up to 95% of the cost of the covered drugs.
    • Penalty. A premium penalty of 1% per month may apply to anyone who fails to enroll in Medicare D once eligible and chooses to enroll later. The penalty doesn't apply to anyone who currently has drug coverage through other benefits, but begins if a person loses those benefits and fails to apply for Medicare Part D promptly. The penalty may also be waived for low-income people.
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    AAnne Fabiny, MD, Gerontology, answered
    Following these tips may help you avoid pitfalls and resolve any problems that crop up in a Medicare Part D prescription drug plan:
    • Read the fine print. Sometimes hurdles exist even for covered drugs. A plan may request a statement from your loved one's doctor for particular covered drugs, or it may require a trial of a generic drug first before paying for a brand-name drug. Sometimes plans drop drugs from their list of approved medications (called a formulary), so it's best to double-check with a phone call before enrolling, even after doing an online search. Make sure any quantity limits on particular drugs fit your loved one's needs.
    • Cut cost. As many as one in three people on Medicare has sufficiently low income to qualify for assistance through Social Security, which may exempt him or her from paying premiums and deductibles and keeps copayments very low. If the person you are caring for reaches the gap, you can stretch out coverage and cut costs by opting for generic drugs or less costly prescription drugs and by purchasing drugs through mail-order discount pharmacies and stores that sell some generic drugs inexpensively. The Website www.medicare.gov offers lists of state and national pharmaceutical assistance programs, which can also be a great help.
    • Keep records. Keep an annual file with copies of your family member's Medicare card and plan card, health plan phone number, and explanation of benefits. Save receipts for covered drugs, so you can request reimbursement, if necessary, and have a record of payments made after reaching the coverage gap. Plans automatically record this information when the subscriber buys covered drugs within their networks, but they usually require receipts for any bought elsewhere.
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    AAnne Fabiny, MD, Gerontology, answered
    Depending on where you live, Medicare options may be overwhelming or relatively few. Before researching them, list all the prescription drugs on your Medicare card. Typically, plans will not cover every drug. Investigate options carefully. Also check to see if the pharmacies in the plan are convenient for you. The American Association of Retired Persons (AARP) recommends choosing a single permanent mailing address if the Medicare recipient spends significant time in more than one place.
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    AAnne Fabiny, MD, Gerontology, answered
    Care related to the admitting illness is the responsibility of the hospice provider. Hospice jargon for a patient's terminal illness is "the admitting illness," and the hospice provider must cover the costs of any care related to that illness. For conditions not related to the admitting illness, regular Medicare coverage kicks back in. Doctors and patients often think that choosing hospice means opting out of conventional Medicare coverage entirely, and that's not the case.
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    ABetty Long, RN, MHA, Nursing, answered

    Typically, Medicare insurance covers:

    • Up to 90 days of inpatient hospital services in each benefit period
    • An additional 60 lifetime reserve days
    A benefit period begins when you are admitted to the hospital and ends when you have been out of the hospital for 60 days, or have not received Medicare-covered care in a skilled nursing facility (SNF) or hospital for 60 consecutive days from your day of discharge.

    If you continue to be hospitalized past 90 days, Medicare provides 60 lifetime reserve days of inpatient hospital coverage. These lifetime reserve days can only be used once — if you use them, Medicare will not renew them.

    If someone has been hospitalized past 90 days, the healthcare facility must notify the patient (or family) in writing that they are planning to 'tap into' the lifetime reserve days.