Medicare

Medicare

Medicare
Medicare is the federal health insurance plan for people over age 65 or who are long-term disabled. Eligibility and enrollment is through the Social Security Administration. Medicare has changed over the years, offering additional options for healthcare insurance. Traditional Medicare includes Part A for hospital insurance and Part B for medical coverage, meaning it covers doctor visits and other medical bills. Part C, also called Medicare Advantage, allows private health insurance companies to provide Medicare benefits. Part D is a prescription drug plan. It's important to carefully assess your healthcare needs and which plan is right for you. Learn more about Medicare benefits with expert advice from Sharecare.

Recently Answered

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    People with higher incomes (generally above $85,000 for an individual, or $170,000 for a couple) do pay higher Part B premiums. However, due to provisions in the new health care law, the costs of annual wellness visits and many preventive screenings are now covered in full.

    For people with low incomes, the Medicaid program can act as a Medigap plan to absorb the costs Medicare doesn’t cover. 
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    Medicare and/or your insurer or benefits manager at your employer or union can answer your questions — and it doesn’t hurt to confirm answers by speaking with a second source. Never drop your private coverage without fully understanding the consequences. You may not be able to get it back! 
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    A , Internal Medicine, answered

    You don’t have to do anything (well, except maybe breathe). Enrolling in a Medicare drug plan is optional. If you elect not to enroll, you will pay for your prescription drugs on your own. Here’s the tricky part. While you can choose not to enroll in a drug plan right away, if you decide later on that you do want a plan because your doc just prescribed a ton of meds for you, you have to wait until the open enrollment period (mid-October to early December), and you will pay a penalty and a higher premium.

    So enrolling in a drug plan when you are first eligible may be beneficial even if you don’t take a lot of prescription medications, especially because as you age, you may require more medication to stay healthy. If you are still working after age 65, and your employer offers health insurance, check with that employer, as enrolling in the drug benefit option of Medicare may make you ineligible for your employer’s drug benefit plan. But do enroll in Medicare within three months of your 65th birthday because your Social Security benefits may be tied to just enrolling.

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    If you have Medicare or are eligible for Medicare, you can contact the following federal government Web site:

    Centers for Medicare and Medicaid Services
    Web site: www.medicare.gov
    Toll-free number: 1-800-MEDICARE (1-800-633-4227) (English- and Spanish-speaking staff are available at this number 24 hours a day, 7 days a week.)

    The federal government Centers for Medicare and Medicaid Services Web site can help you pick the right Medicare-approved prescription drug plan (Part D) based on where you live, your income, and the drugs you take. You can join a Medicare prescription drug (Part D) plan if you have Medicare Part A and/or Part B.

    You may qualify for "Extra Help" if you have very limited income and assets but don't get Medicaid. If you qualify for Extra Help, you may not have to pay a premium, deductible, or co-payments for Medicare Part D. You can apply or get more information about this by calling Social Security. (If you already have Medicaid, you automatically get Extra Help and do not need to apply.)

    If you're enrolled in a state pharmacy assistance program, including Medicaid, you can still get a Medicare Part D card. If you have prescription drug coverage through your current health insurance or you get discounts on your prescriptions through other programs, you should review your coverage closely to see if the Medicare drug plan will save you more money on your prescriptions.

    Medicare Access for Patients Rx

    Web site: www.maprx.info

    Medicare Access for Patients Rx (MAPRx) links you to information about Medicare Part D, also called the Medicare Prescription Drug Program. It answers common questions about Medicare Part D, and has a state-by-state listing of other possible resources and programs.

    Although MAPRx does not directly serve Medicare recipients, it is a good source of information from the Centers for Medicare and Medicaid Services, Medicare Rights Center, Center for Medicare Advocacy, and many other organizations and agencies. Free fact sheets can be downloaded from the Web site or from related Web site links.

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    After a kidney transplant Medicare Part D can help you pay for your prescribed drugs that are not covered by Part A or Part B.

    Medicare coverage for immunosuppressive drugs is often confusing because it is determined by a number of factors, including the transplant recipient’s Medicare eligibility at the time of transplant, disability status, whether the recipient received dialysis treatment, the type of organ being transplanted, and whether the transplant was performed in a Medicare-approved facility. Adding to the confusion is the Medicare Part D drug benefit, which provides additional drug coverage to many Medicare beneficiaries.

    For Medicare beneficiaries who receive immunosuppressive coverage under Medicare Part B, non-immunosuppressive drug coverage can be accessible through enrollment in Medicare Part D.
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    For transplant recipients the reality of utilizing Medicare Part D to maximize benefits is not simple, but rather complicated. The intricacies of Medicare Part D involve not only understanding premium costs and benefit stages, but formularies, and particularly for people having transplants, deciphering how Medicare Part B immunosuppressant coverage influences Part D coverage.

    Medicare Part D plans are voluntary prescription drug coverage options offered by private insurance companies who meet standards established by Medicare. Everyone entitled to Medicare Part A (which covers inpatient care in hospitals, skilled nursing facilities, hospice care and some home health care) or enrolled in Medicare Part B (recipients pay a monthly premium for Part B, which helps cover doctor and specified outpatient care and some outpatient medications such as immunosuppressants for qualifying people) qualifies to enroll in a Part D plan.

    Most Medicare recipients will pay a premium to participate in Part D, with premiums varying from plan to plan in each state. Part D plans’ monthly premiums range from less than $20 to greater than $60; however average premiums range from $32.20 to $37 for the average standard plan (Medicare defines standard plan as the minimum coverage that a drug plan most provide).

    If you did not have Medicare Part A when you got your transplant or if you did not have your transplant in a Medicare approved transplant program, your anti-rejection drugs have not been covered by Part B, but may be covered under Part D. 
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    Transplant recipients not eligible for Medicare Part B will have access to immunosuppressive and non-immunosuppressive drugs through the Medicare Part D program (if a plan in your region has a drug formulary that includes immunosuppressive drugs). In the event that a plan in your region has a drug formulary that includes immunosuppressive drugs, transplant recipients will still incur monthly premiums, a yearly deductible, as well as significant coverage limits.
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    Listed below are two types of plans offering Medicare prescription drug coverage after a kidney transplant:
    • Medicare Prescription Drug Plans: These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-For-Service (PFFS) Plans and Medicare Medical Savings Account (MSA) Plans.
    • Medicare Advantage Plans (like an HMO or PPO) are other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.”
    Prior to choosing a Medicare plan, make a list of all the medications you take, the doses and the pharmacy you use. Choose a plan that covers all or most drugs that you take now or you may need to take later. A plan’s list of covered drugs is called a “formulary.” Standard plans don’t cover everything, including over-the­counter medications and most vitamins and herbal supplements. Each plan has its own formulary and they can change. 
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    A , Geriatric Medicine, 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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    Medicare Part C plans, also known as Medicare Advantage plans, are Medicare-approved plans offered by private insurance companies. Part C plans are an alternative to Original Medicare. Along with covering doctors and hospitals, they often cover prescription drugs, too.

    Part D plans are Medicare-approved private plans that help people who have Parts A and B to pay for prescription drugs.