A recent Wall Street Journal article, “Dodging a Medicare Mishap,” warns Medicare beneficiaries and their families to take special care when it comes to outpatient and prescription drug coverage. The main reason is that the rules are more complicated than most people realize. What makes matters worse is that things are expected to be even worse next year.
“As unfortunate as this may be, sometimes seniors leave important decisions to chance,” says Alan Weinstock, insurance broker at http://www.MedicareSupplementPlans.com, “especially when it comes to complex programs such as Medicare.”
Medicare Beneficiaries and Their Families Leave Medicare to Chance
Sometimes people who are accustomed to having employer benefits and, therefore, don’t realize their responsibility in transitioning to Medicare, believe that because Medicare is a Federal program they will be contacted by the government and guided on what to do. Nothing could be further from the truth.
Waiting for someone else to inform you about Medicare Parts A through D and to help you decide what is right for you can place you or your family members in a precarious situation. There are specific guidelines with regard to enrollment obligations and deadlines.
What Medicare Beneficiaries and Their Families Need to Know
First, there are four parts to Medicare: Parts A, B, C and D. Medicare Part A covers hospitalization and inpatient care. It is generally free for people who are age 65 or older if they (or their spouse) have worked for at least 10 years. Part B covers doctor’s visits and outpatient treatment. The cost of Medicare Part B depends on your annual income.
For most current Medicare beneficiaries already on the plan and with annual earnings under ,000 the monthly rate is .40. For those who are new to Medicare in 2010, the new higher rate is 0.50 per month. However, for those whose earnings exceed ,000 per year for individuals and 0,000 per year for couples, the cost of Medicare Part B is higher. Check with Medicare to find out your cost.
Many Medicare beneficiaries, who sign up for Medicare Parts A and B, also chose to sign up for Medicare Part D, the prescription drug coverage plan. They may also choose to add a Medicare supplement insurance or Medigap plan as well.
It’s important to note that Medicare Part D coverage is tied to the area where the beneficiary lives. So if you move or are temporarily staying outside your coverage area, make sure your Part D plan understands you are not moving permanently or you may be dis-enrolled.
Finally, Medicare Part C is an alternative to Medicare Parts A, B and D. It is Medicare Advantage which is an all-inclusive package that covers supplemental expenses and prescription drugs, but only if Medicare beneficiaries are treated by providers within a specified network.
Here are two additional rules to keep in mind regarding Medicare coverage. If you don’t sign up for Medicare at age 65, special-enrollment-rules may apply. Know how they will affect you. And if you choose a Medicare Advantage plan, your opportunity to switch plans later on are more limited.
Starting in 2011, the annual enrollment period shrinks to Jan. 1 through Feb. 14 – instead of until March 31. And now instead of being able to switch to a different Medicare Advantage plan, you will be limited to dis-enrolling from your Medicare Advantage plan altogether and enrolling in traditional Medicare instead.
It’s important to understand how Medicare coverage affects your or your loved ones to ensure that you don’t miss out on important coverage. For more information on Medicare coverage, check with your Senior Health Insurance Program, a free statewide health insurance counseling service for Medicare beneficiaries and their caregivers.
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Question by Julie6962: What is the difference between Railroad Medicare and regular Medicare?
Why do people have Railroad Medicare? Why don’t they just have regular Medicare? Is there something special/better/differe about Railroad Medicare compared to regular Medicare?
Best answer:
Answer by J Somethingorother
same coverage exactly…different agency handles it is all. Railroad employees made their own retirement system and their system processes their medicare too.
This document was created to empower people with a better understanding of the Medicare system. A better understanding will help you make an informed decision, instead of being sold by a smooth talking salesman….. Yes I am an insurance professional, but I am a Christian first and abhor salesman that push products. I believe in educating consumers about all of their options. Once properly informed they will make the correct decision for themselves.
Medicare is a GREAT health insurance program!! The problem is most people feel intimidated by it. They are overwhelmed by the choices and get frustrated and ultimately turned off by the whole system. That is unfortunate, but hopefully this article will clear up some of these issues.
Medicare is a health insurance program designed for seniors (people 65 & older) and people with certain disabilities. It covers Hospitalization costs (Medicare Part A) and doctors or outpatient services (Medicare Part B). It was signed into law in 1965 by Lyndon B. Johnson. It has gone through many changes over the years and now there is also Medicare Part C (also called Medicare Advantage) and Medicare Part D (prescription Drug coverage).
Who is eligible for Medicare?
People age 65 & older People under age 65 with certain disabilities People of all ages with end-stage renal disease
How to start Medicare
Medicare will start automatically for people turning 65. Medicare will send out information to you a few months prior to your 65th birthday. You will get a Medicare welcome package, which includes a Medicare & You book (filled with everything you could possibly want to know about Medicare), and your Medicare ID card. This will have your Medicare Claim # as well as your Part A & Part B effective dates of coverage. The Part A & Part B effective dates of coverage should be the 1st day of your birthday month. So if you were born on July 17th, your Part A & Part B effective dates of coverage would be July 1.
How much does Medicare cost?
For most Americans Medicare Part A is free. Medicare Part B costs for most people .40 / month. This is for people with individual income levels up to ,000 or jointly 4,000 a year. The monthly premium will be higher for people with higher income levels.
What does it cover?
Medicare Part A
Helps cover your inpatient care in hospitals. Part A also helps cover skilled nursing facility, hospice, and home health care if you meet certain conditions.
Blood
All costs for the first 3 pints of blood you get as an inpatient, then Medicare approved amount for additional pints of blood (unless you or someone else donate to replace what’s used).
Home Health Care
for Home Health Care services. 20% of the Medicare approved amount for durable equipment.
Hospice Care
Copayment of up to per prescription for outpatient prescription drugs and 5% of the Medicare approved amount for inpatient respite care (short term care given by another caregiver, so the usual caregiver can rest). You may have to pay room and board if you get hospice care in a facility other than short term general in-patient care or respite care.
Hospital Stay
,024 Deductible and no co-insurance for days 1-60 each benefit period 6 per day for days 61-90 each benefit period 2 per “lifetime reserve day” after day 90 each benefit period (up to 60 days over your lifetime)
Skilled Nursing Facility Stay
for the first 20 days each benefit period 8 per day for days 21-100 each benefit period All costs for each day after day 100 in the benefit period
Medicare Part B
Helps cover medically-necessary services like doctors’ services and outpatient care. Part B also helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse.
Clinical Laboratory Services
for Medicare covered services
Home Health Care
for Home Health Care services. 20% of the Medicare approved amount for durable equipment.
Medical & other services
20% of the Medicare approved amount for most doctor services, outpatient therapy, most preventive services, and durable medical equipment
Mental Health Services
50% for most outpatient Mental Health Care
Other Covered Services
Copayment or Coinsurance amounts
Outpatient Hospital Services
Coinsurance or copayment amount that varies by service
Part B Deductible
The first 5 yearly for Part B covered services or items
Medicare Part C
Another way to get your Medicare benefits. It combines Part A, Part B, and, sometimes, Part D (prescription drug) coverage. Medicare Advantage Plans are managed by private insurance companies approved by Medicare. These plans must cover medically-necessary services. However, plans can charge different copayments, coinsurance, or deductibles for these services.
Medicare Part D
Helps cover prescription drugs. This coverage may help lower your prescription drug costs and help protect against higher costs in the future.
What is not covered by Medicare Part A or Part B
Items and services that Medicare doesn’t cover include, but aren’t limited to, the following:
Acupuncture Chiropractic services Cosmetic surgery Custodial care (like help with bathing or using the bathroom), except when you also get skilled nursing care in a skilled nursing facility, at home, or in a hospice Deductibles, coinsurance, or copayments when you get certain health care services. People with limited income and resources may get help paying these costs. Dental care and dentures (with only a few exceptions) Eye care (routine exam), eye refractions (exam that measures your ability to see at specific distances), and most eyeglasses Foot care (routine), like cutting corns or calluses (with few exceptions) Hearing aids and exams for the purpose of fitting a hearing aid Hearing tests that haven’t been ordered by your doctor Most Laboratory tests for screening purposes Long-term care, for example, if you only need custodial care in a nursing home Orthopedic shoes (with few exceptions) Physical exams (routine or yearly). Medicare will cover a one-time physical exam within the first 6 months of enrolling in Part B (coinsurance and Part B deductible applies) Prescription drugs. Most prescription drugs aren’t covered by Part A or Part B Shots to prevent illness Syringes or insulin, unless the insulin is used with an insulin pump, but it may be covered by Medicare prescription drug coverage (Part D) Travel (Most health care while you’re traveling outside the United States)
Medicare Coverage Options
Medicare Supplement Insurance
Health insurance policies sold by private insurance companies to fill “gaps” in Original Medicare Plan coverage that assist in paying for some of the health care costs that the Original Medicare Plan doesn’t cover, plus benefits not covered by Original Medicare, like emergency health care outside the United States (subject to plan purchased).
You pay a monthly premium to the private health insurance company that sells you the policy. Medicare and the Medicare Supplement policy both pay their shares of covered health care costs.
Medicare Advantage Plans
Health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program, and sometimes called “Part C.” When you join a Medicare Advantage Plan, you are still in Medicare. Some of the plans require referrals to see specialists.
In many cases, the premium can be lower than they are in the Original Medicare Plan or the Original Medicare Plan with a Medicare Supplement policy. Medicare Health Plans charge different premiums and have different costs of services, so it is important to check with the plan before you join.
They generally offer extra benefits, and many include prescription drug coverage.
In many cases, your costs for prescription drug coverage can be lower than in the stand-alone Medicare Prescription Drug Plans.
Some of the plans coordinate your care, using networks and referrals, more than others. This can help manage your overall care and can also result in savings to you.
You don’t need to buy a Medicare Supplement policy, if you purchase a Medicare Advantage Plan
Medicare is a government program whose intended recipients include people 65 years or older, or people in the retirement community. Discover how people under 65 can qualify for Medicare if they have total disability, or a disability that makes it impossible to function in society, withhelp from a financial services specialist in this free video on Medicare. Expert: William Rae Contact: www.hbwfl.com Bio: William Rae has been licensed in the insurance and financial fields for over 30 years. Filmmaker: Christopher Rokosz Video Rating: 5 / 5
Question by Suzi P: Medicare…?
okay..
my parents are with medicare, and like… they say that they don’t cover braces, but the girls at my school say that they do.
i think my parents are lying to me.
i already have orthodontic plates, but i’ve had them for 4 years and worn them every day, but they haven’t done much.
i really NEED braces….
really really
does anyone know
a) how i can convince them to let me
b) does medicare cover the cost, if so how much of the cost?
thank you all !!
Best answer:
Answer by diggitystud m Your parents are right. Medicare is a government program that entitles people 65 and older to certain health care like hospital bills, drugs, and so on.
So unless you are 65 or older you are not elligable for medicare.
You and your friends could be confusing medicare with medical insurance which is a totally different matter.
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Despite recent economic strain, US citizens on the cusp of senior status are still springing into action when it comes to purchasing Medicare supplement plans in anticipation of upcoming healthcare needs. With inflation rates and projected healthcare costs continually escalating, it seems as though many emerging senior citizens may need to take extra precautions, in terms of both personal savings and Medicare supplement selection.
A recent study performed by the Employee Benefits Research Institute (EBRI) describes the degree of savings needed to obtain a quality medicare supplement plan:
“…a man retiring this year at age 65 will likely need between ,000 to 8,000 in savings to cover insurance premiums and out-of-pocket expenses during retirement. The differences in dollar amounts are based on the statistical chances of an individual having enough money. In other words, it one wants to be 90% sure of having enough in savings, he would need the higher amount; for a 50% chance he would need at least the lower amount.”
The EBRI study also described the divergence between supplement plans for men and women.
“Because women live longer, they need even more money. A women retiring at age 65 in 2009 will need from ,000 to 2,000 in savings to cover insurance premiums and out-of-pocket expenses in retirement for a 50/50 chance of having enough money, and 4,000 to 0,000 for a 90% chance, said the report’s author, Paul Fronstin, an EBRI researcher.”
Due to these striking figures and countless others, many soon-to-be retirees are reconsidering their options. Instead of shifting directly into a life of leisure, many current 50-somethings are beginning to save their money more scrupulously. This shift in priorities has been understandably upsetting to many, but imperative nonetheless.
The current state of Medicare and the overall healthcare system has made selecting the right Medicare supplement plan more important than ever, and by working with the experts at MedicareSupplementShop.com, you can rest assured that you have gotten the best possible value for your healthcare dollar.
What is Medicare? How and when will I use it? Watch this short and easy to understand video about Medicare Part A, B, C and D. -Stay Smart Stay Healthy See more videos at: www.youtube.com Video Rating: 4 / 5
Question by Melissa: medicare???
on my pay stub, it says “medicare employee” as a tax. does that mean i have health insurance or is that something they just take out of everyones paycheck??
Best answer:
Answer by Asystole Its the medicare tax – it’s taken out of everyones check
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