Medicare Health Plan Options

If you or someone you know is about to go on Medicare, you should know that you'll be able to choose how you receive your Medicare benefits including your prescription drug coverage. This brief article will explain some of the more popular options as well as give you specific phone numbers to call with you Medicare questions. Medicare health insurance is currently for people who are age 65 or older, under age 65 with certain disabilities, and at any age living with End-Stage Renal Disease (ESRD). ESRD is permanent kidney failure requiring dialysis or a kidney transplant.

While Medicare covers a lot of different health care services and supplies, it does not cover all of the costs associated with your health care. There are "gaps" associated with Medicare that require the beneficiary to pay out of their pocket. These Medicare costs include coinsurance, copayments and deductibles. Depending on the Medicare health plan you choose, you'll have varying degrees of costs.

Medicare Health Plan Options

Original Medicare is managed by the Federal Government and provides Part A and Part B health coverage. Original Medicare pays for many of the health care services and costs associated with normal services and supplies. Original Medicare does not pay for all of your health care costs. It is important that you understand your coinsurance, copayments and deductible. These are called out-of-pocket costs, or also known as cost-sharing.

Many Medicare beneficiaries choose to buy a Medicare Supplement policy (a.k.a. Medigap Policy) to help fill these out-of-pocket costs. Before you can buy a Medicare Supplement policy, you'll generally have to have both Part A and Part B. A Medicare Supplement policy can only generally help you if you have Original Medicare. If enrolled in Original Medicare and you would like to have prescription drug coverage, you'll need to buy a seperate policy to cover your prescription drugs. These are simply called Medicare Prescription Drug Plans.

Medicare Advantage Plans are known as Part C. They are health plans that are similar to traditional HMO or PPO insurance plans. These plans are another way to get your Medicare benefits. These are plans that are approved by Medicare, but run by private insurance companies. You'll find that your out-of-pocket costs may be different in a Medicare Advantage Plan. Check to find out what your coinsurance, copayments and deductibles will be for any Medicare Advantage Plan by using the online comparison tool found at Medicare.gov.

Medicare Prescription Drug Coverage is also called Part D. Prescription drug coverage is available for everyone with Medicare. These prescription drug plans are run by private insurance companies and approved by Medicare. There is a separate premium associated with Part D plans. You have to enroll in the plan and pay the premiums to get Part D prescription drug coverage.

In the next article we'll explore Medicare Supplement insurance policies. These plans are specifically designed to cover the gaps in Original Medicare.

Michael D Coday II is a licensed insurance agent in Texas. He offers free medicare supplement quotes for Texas residents at his website. Find him online now: http://www.medigapmedicareinsurance.com

Understanding Medicare - Comparing Medicare Part B and Part D

More than 40 million Americans are enrolled in the Medicare program, but not all of those Medicare beneficiaries have identical Medicare plans. Medicare programs can be designed to suit the particular needs of each Medicare beneficiary, which means that Medicare beneficiaries need to take time to understand the differences between major Medicare options so that they can ensure they select their best plans for their needs.

Medicare Part B and Medicare Part D are popular Medicare options that beneficiaries can select. However, unlike some other Medicare plans, Medicare Plan B and Plan D can be combined together. Here is a basic overview of the major differences between Medicare Plan B and Medicare Plan D that every Medicare beneficiary needs to be aware of:

Coverage differences

Medicare Part B is the Medical coverage plan. Part B will cover the cost of doctor visits, home health care, and lab tests. Additionally, some medications and medical equipment is covered under Medicare Part B, including items such as diabetic test strips and wheelchairs.

Medicare Part D is the medications coverage plan. Part D pays for many medications that a Medicare subscriber takes on a regular basis. These medications may include drugs for diabetes, heart disease, and asthma. Additionally, some short-term medications may also be taken, such as an antibiotic.

Types of medications generally covered by each plan

Medicare Part B and Part D cover different types of medications, in many cases. Part B may cover the following types of medications:

- Allergy injections

- Blood products, such as plasma protein

- Hemophilia drugs

- Flu vaccines (when the vaccine is provided according to state law)

- Intra-articular injections, which may include Orthovisc, Synvisc, and Carticel

- IV flushes, including Heparin and Saline solutions

- Pneumonia vaccines ordered by a doctor

Part B may also cover a vaccine if the vaccine is required as a result of an injury. For example, if a Medicare Part B subscriber steps on a nail, the subscriber may be covered for a tetanus shot. Part B will cover inhaled nebulizer medications for beneficiaries who are not in a long-term care facility.

Part B will also cover immunosuppressive medications after a transplant as well as oral anticancer medications, Hepatitis B vaccines for high-risk individuals, oral anti-emetic medications used to treat nausea within 48 hours of chemotherapy that is related to cancer chemotherapy, total parenteral nutrition medications used to treat permanent dysfunction of the digestive tract, injectable medications administered at home that require an infusion pump, and more.

Medicare Part D may cover the following types of medications:

- Any medicine regularly taken by a Medicare beneficiary for chronic conditions.

- Medications subscribed for short-term medical conditions

Medicare Part D may cover a vaccine if the vaccine is prescribed by a doctor for reasons unrelated to injury. Part D will cover inhaled nebulizer medications for beneficiaries who are in a long-term care facility.

Part D will also cover immunosuppressive medications after a transplant as well as oral anticancer medications required for reasons other than cancer treatment, Hepatitis B vaccines, oral anti-emetic medications used to treat nausea that is related to cancer chemotherapy - after 48 hours of the chemotherapy or for other reasons, total parenteral nutrition medications required for reasons other than permanent dysfunction of the digestive tract, injectable medications not administered at home that do not require an infusion pump, and more.

Medicare beneficiaries should speak with a healthcare advisor for more information about what specific medications and treatments are covered by Medicare Part B and Medicare Part D. In many cases, Medicare beneficiaries can save money and ensure greater coverage by enrolling in Medicare Supplemental insurance policies or by adjusting their current Medicare policies to better suit their specific healthcare needs and budgets.

By Wiley Long - President, MedigapAdvisors.com - The nation's leading independent agency specializing in Medigap coverage. Our professional medigap advisors will help you choose the best Medigap plan for your needs.

How to Select the Right Medicare Plan

Just deciding which way to go when choosing from the combination of different types of healthcare coverage is confusing for many people eligible for Medicare. For most people, having choices is a very good thing. But what about when you have thousands of plans to choose from?

When it comes to Medicare, you have nothing but choices. Depending upon your circumstances, you may want to stay with traditional Medicare, or Medicare Parts A and B. If you choose this path, you'll probably want to get a Medicare Part D (prescription drug) plan, too, to ensure your medications are covered. Or, you might be more interested in a Medicare Advantage plan, which can combine traditional Medicare with drug coverage and other benefits. You also may be interested in even more coverage, such as that offered through a Medigap (supplemental) plan.

Fortunately, help is available. A Medicare advisor offers education on available Medicare programs, answers questions, and offers detailed plans of action to get the most out of your insurance choices. You also should know the basics beforehand.

Traditional Medicare

Medicare Parts A and B, also known as traditional or original Medicare, have been around since 1965. Medicare Part A is free to most people who've worked and paid Medicare taxes for at least 10 years and provides people with inpatient hospital coverage. Medicare Part B, which costs most people $96.40 in 2009, covers outpatient medical expenses.

People who have traditional Medicare can see any doctor they want in any facility they want without a referral, as long as that doctor or facility accepts Medicare patients. But traditional Medicare's benefits are limited.

Not only does traditional Medicare not cover most outpatient prescription drugs, if a beneficiary uses their coverage frequently enough, it can get very costly. That's why we also have Medicare Advantage and Medicare Part D plans available.

Medicare Advantage Plans

Medicare Advantage, also known as Medicare Part C, combines Medicare Parts A and B in one plan so you can get your Medicare Part A and Part B coverage in the same place. Medicare Advantage plans also often include prescription drug coverage and other benefits not commonly found under traditional Medicare, such as vision and dental services.

This program works just like private insurance - you have different types of plans to choose from depending upon what type of provider access you want (for example, health management organizations (HMO), preferred provider organizations (PPO) and more) and what health conditions or prescription drugs you take. You also can choose from a number of different levels of coverage. All Medicare Advantage plans must offer at least as much coverage as that offered under traditional Medicare. If they offer prescription drug coverage, that coverage must meet minimum Medicare Part D standards as well.

Medicare Part D

Medicare Part D is prescription drug coverage. Like Medicare Advantage, Part D is offered by private companies who are reimbursed for providing healthcare coverage. Also like Medicare Advantage, a minimum amount of coverage is required for a plan to qualify as a Part D plan and many different plans, some with different levels of coverage, are offered throughout the United States. Part D plans are best for people who use prescriptions, but don't need to see their doctors often.

Medigap Medigap, or Medicare supplemental plans, is sold by private companies to fill the "gaps" in traditional Medicare. This includes the cost of deductibles, co-payments and coinsurance. It also may cover other services that Medicare does not insure. In 2009, there are 12 Medigap plans - A through L.

Although Medigap may offer some additional coverage if an individual chooses to keep traditional Medicare, you can't buy a Medigap plan if you have Medicare Advantage. Because most Medicare Advantage plans offer better coverage and frequently more benefits than Medigap, having both is usually unnecessary. You can have both Medigap and Medicare Part D, but it may be more expensive to do this than simply purchasing a Medicare Advantage plan instead.

Comparing And Contrasting

It's no wonder that people are confused. There are thousands of plans available throughout the United States, and an average of 40 Medicare Advantage and Medicare Part D plans in any given area.

This is where a Medicare advisor can come in handy. With so many options in just one area, choosing a plan might feel like throwing darts at a board. Using a Medicare advisor can help you narrow down your choices so you know which combination of Medicare coverage will work best for you and which plans will give you the best and most affordable coverage for your needs.

Jim Allsup writes for Allsup, a provider of Social Security disability, Medicare and workers' compensation services, including Allsup Medicare Advisor, Medicare assistance services for people with disabilities and seniors.

Medicare Part D Prescription Drug Plans

Medicare Part D: What is it?

Medicare's prescription drug program was created as a result of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Although the Act was written into law in 2003, Medicare eligible individuals did not start enrollment into these plans until January 1, 2006. This plan is commonly referred as PDP (Prescription Drug Plan) or simply Part D.

Part D is available to everyone who has Medicare regardless of income or health history. Private insurance companies provide the coverage. The enrollees select a plan from those available in their geographic region and pay the insurer a monthly premium for the coverage. Even though enrollment is voluntary there is a penalty for late enrollment which will be discussed a bit later in this article.

You can elect to enroll in a Medicare Prescription Drug plan in one of two ways:

(1) Stand along prescription drug plans (PDP); or

(2) Medicare Advantage Prescription plans (MA-PD).

The first type of plan covers prescription drug benefits only. These plans were designed for people who choose to stay with traditional fee for service Medicare and need the prescription drug coverage along with a Medicare supplement to round out their medical coverage. Most States have several carriers who offer this coverage on a free standing basis. The plans do vary in areas of monthly premiums, deductibles, copays, formularies, and other cost sharing arrangements.

Medicare Advantage plans, the second broad category of prescription drug plans, not only cover medications but also Medicare approved medical services. These plans are available through private insurers and include HMO, PPO, and Private-Fee-for-Service programs. In the case of Medicare Advantage Plans, the Medicare beneficiary has actually "traded" their traditional Medicare benefits for a Medicare Advantage program. Medicare Advantage plans sometimes provide enrollees wish additional benefits. However, there are frequently restrictions on the doctors and hospitals that they may use for covered medical services.

Enrolling in a Plan

Generally speaking, an individual may enroll in a Prescription Drug Plan during their initial open enrollment period when they first qualify for Medicare Part B. For someone turning age 65, this would be the three months prior to their birthday month, the month of their birthday, and the three months following their birthday month. After, their initial enrollment period (IEP), there is an annual open enrollment period (AEP) when they can change plans. Historically, the annual open enrollment period commences on November 15th and closes on December 31st with enrollments effective the following January 1st. There are other special enrollment periods available to medicare beneficiaries such as when they relocate or leave employer sponsored plans.

For the 2011 plan year, the annual open enrollment period will commence a bit earlier and end prior to the holidays to avoid confusion over deadlines in past years.

The "Standard" Prescription Drug Plan

All of the insurers that participate in the PDP program must offer at least the Standard plan of coverage. Monthly premiums will vary from State to State. However, the average premium for 2010 is expected to be $46.58. The plan deductible for 2010 is $310.

After you pay the yearly deductible, you pay the following amounts for the remainder of 2010,

- 25% of the cost of drugs after the $310 annual deductible until total charges reach $2830

(the plan pays the other 75% of charges); then

- 100% of the next $3610 in total drug charges (often called the donut hole or coverage

gap); then

- 5% of your drug charges or a copay of $2.50 for generic medications or $6.30 whichever is lesser; for the rest of the calendar year after you have spent a total of $4550 out of pocket.

Even though, at a minimum, an insurer must provide a Standard plan, they are permitted to offer plans that do differ in benefits. These other plans usually do away with the deductibles and impose fixed dollar copays for covered medications instead percentage copays. Some of these other plans even cover generic mediations in the "donut hole."

The Late Enrollment Penalty

If you do not have "creditable coverage" from another source, such as an employer plan or the Veterans Administration, and do not sign up for a Medicare prescription drug plan when first eligible, you will, in all likelihood, be charged a penalty for late enrollment. The penalty is based on the number of months that have elapsed since you were first eligible to enroll and when you finally do enroll. A penalty of 1% per month will be levied and that penalty will last for as long as your remain enrolled in a plan. The penalty is based on the average cost of a plan in the year that you finally enroll. For example, if 50 months have elapsed since you were eligible to enroll and the national average cost for a plan in that year was $50, the cost for your plan would be $75- (1.50 times $50). Again, this penalty would be assessed each year into the future for as long as you remain enrolled in a plan.

Financial Help for Those of Modest Means

The Social Security Administration has a program available for those with qualifying incomes called Extra Help. Extra Help can save qualifying individuals as much as $3900 per year. Extra Help can assist with premiums, paying deductibles and copays associated with a Medicare prescription drug plan. To qualify for Extra Help, an individual must be enrolled in a Part D prescription drug plan and for 2010; resouces must be limited to $12,510 for an individual or $25,010 for a married couple. Resources would include things like bank accounts, stocks, bonds, and mutual funds. Houses, cars, life insurance cash values, and money received from relatives or others to pay household expenses do not count as resources. Some individuals with higher annual income may qualify for the Extra Help program. To inquire if you qualify, you can contact the Social Security Administration at 800-772-1213 or visit your local Social Security office.

Using Information Sources To Choose a Plan

There are a number of useful sources to help you learn about the PDP plans available to and help you compare so that you can select the plan that works best for you.

Medicare's Medicare & You 2010 Handbook available at http://www.medicare.gov is an excellent source of information. The handbook lists plans in your area and basic information about cost and plans benefits.

State Health Insurance Assistance Programs and Community Organizations quite are excellent places to find help.

Also, do not forgot your local Medicare certified health insurance agent. Should you or your parents need assistance in selecting a Medicare prescription drug plan, please feel free to contact us at 818-597-2890.

Edward Walden, CLU, RHU, REBC

Discover the 8 Critical Questions to Ask When Selecting a Medicare Supplement Plan

Once you qualify for Medicare, there are many options for a Medigap, or supplemental coverage plan. All the information out there can make the process confusing, however use this guide to help help ask the right questions so you can understand the differences.

The 8 Critical Questions YOU MUST Ask When Picking a Medicare Plan

1.  Do I retain my rights to Medicare Part A & B?

The reason you want to ask this question  is because even though you have your rights to Medicare Part A and B, your choices on where you use your benefits may be limited.  For example, Most Medicare Advantage plans have a network which you must use to get your benefits, if you go out of the network you may pay a much higher portion of the bill or not even covered at all unless it is an emergency situation.


2.  Will I be able to see the same doctor or visit the same hospital?

Just as in the question above, if your favorite doctor or hospital is not in the Medicare Advantage network, then you will have to make a choice on whether the plan is worth it.  On the other hand a Medicare Supplement plan along with Original Medicare will not restrict you to a network, as long as the doctor or facility accepts Medicare then they will accept your Medicare Supplement as well.


3.  Is there a co pay-and if so, how much?

Currently the Medicare Supplement plans do not have a copay option, however some of the plans to require you to take care of your Part B deductible.  Depending on the plan, this might still be a good option depending on what your monthly premium is.  There are some supplement plans that take care of both your Part A & B deductible for you.
Medicare Advantage programs typically have a co-pay, deductible and an out of pocket maximum that you are responsible for each year.  Be careful, these plans also change each year as well, so your co-pays and deductibles could increase from year to year.


4.  Is there an out of pocket maximum?

Medicare Advantage plans do have an out of pocket maximum, which is the portion you are required to pay above and beyond your deductibles and co-insurance.  Medicare Supplement plans typically have a deductible you have to meet if there is one and that is it, once you meet your deductible the plan takes care of the rest.


5.  What happens if I travel to Florida or outside of my normal area -am I still covered?

With Medicare Supplement plans, the only requirement is that the provider accepts medicare, then your benefits will take care of the rest up to your plan limits.  With a Medicare Advantage plan, you may only be covered in emergency situations or if there happens to be coverage you are typically exposed for much much more of the expenses incurred.  Make sure you look at your plan benefits summary to see what your true financial exposure is.


6.  Does it cover prescriptions? Glasses? Dental?

Medicare Supplement plans do not cover prescriptions glasses or dental, you will have to obtain a separate policy for these coverages.  Medicare advantage programs are not required to offer all of these benefits but you may find some plans that incorporate some of these benefits within your plan. 
There are some Medicare Advantage plans that do have prescription coverage included, however the included prescription plan may not be the best option for you.  Make sure you look at all options before you choose a plan.


7.  What does the coverage cost, and will my rates go up?

Typically the Medicare Advantage have a lower monthly premium when compared to a Medicare Supplement program, however your potential total expenses each year may be 2x, 3x, maybe even 5 times the amount you would spend on a Medicare Supplement plan.  Don't just look at the monthly, also factor in your doctors co-pays, deductibles, and out of pocket expenses you would be responsible for during the year.
As for rates going up, just as with any other type of insurance program, rates do change from time to time because they have to compensate for their actual expenses. How much do Medicare Supplement policies cost? More information on premiums can be found here.
Medicare Advantage programs on the other hand also have one other factor you may want to consider, the current administration has made many statements and started to take action towards reducing the funding for the Medicare Advantage programs, because of the fact that it costs Medicare more than Original Medicare benefits.  Which as an agent concerns me as to what will happen to the benefits of those programs over the long haul.


8.  As my agent, how much commission will you make?

Each company sets a commission amount that they are willing to pay an agent or advisor to recommend their product.  The companies pay the agents directly so you should never have to pay an agent for their services.  The other thought process is that you are paying that agent for their services by being their client, so are they thinking about more than what they are going to make for each sale.  Medicare Advantage commissions are approved by Medicare and released by the private companies,  depending on the situation there may be more of a financial incentive for an agent to place you in on product instead of the product that is best for you.   Do not be afraid to ask your potential agent how they will be compensated for that product they recommend, compared to other potential products.

SSDI & Medicare - A Beginner's Guide

Figuring out how the Social Security Disability Insurance (SSDI) and Medicare programs are related can be confusing to anyone who isn't currently enrolled in these programs. This article provides basic information on SSDI and Medicare eligibility and benefits. In addition, this guide will show you how to apply for and receive the right benefits for your situation.

Defining the Programs

SSDI is a payroll tax-funded, federal insurance program that was established in 1954. A portion of the FICA taxes taken out of your paycheck are set aside for this disability insurance program, which provides monthly income to people who are unable to work due to a severe disability.

Medicare is another federal insurance program, but is health insurance instead of disability insurance. It is available to all individuals age 65 and older as well as those who have been receiving SSDI cash benefits for 24 months. The program is made up of many parts - Medicare Part A consists of hospital benefits; Medicare Part B is medical benefits; Medicare Part C (Medicare Advantage) provides extra coverage and is provided by private insurance companies; and Medicare Part D is voluntary prescription drug coverage.

Determining Eligibility - How to See if You Are Entitled to Benefits

Eligibility for each program depends on several factors. For SSDI, there are three general qualifying criteria: 1) you must have worked and paid into the program (through your payroll taxes) for five of the last 10 years, 2) you also must have been disabled before reaching the full retirement age of 65-67, and 3) you must meet Social Security's definition of "disability." The Social Security Administration (SSA) has a process to determine who's eligible for benefits. By evaluating your income, limits of your disability, past job history and more, the SSA determines whether or not you're qualified to receive disability insurance.

There are several ways people can become eligible for Medicare. Anyone who turns 65 is automatically eligible for benefits. If you get Social Security retirement benefits or receive benefits from the Railroad Retirement Board (RRB), you will be considered eligible as well. Additionally, if you're awarded SSDI benefits for something other than Lou Gehrig's disease (ALS), you will become eligible for coverage 24 months after the date of entitlement to cash benefits. If you are awarded SSDI and have ALS, you will automatically be eligible for Medicare once you begin receiving SSDI benefits, and if you have kidney failure, you'll be able to enroll in Medicare three months after starting dialysis.

Specific Benefits You Can Receive

Social Security Disability Insurance allows you to receive a regular monthly income, results in eligibility for Medicare benefits (as explained earlier), and allows possible extension of your COBRA benefits, protects your retirement and long-term disability benefits, plus allows for dependent benefits and return-to-work incentives.

Medicare has many parts to cover specific healthcare costs. Medicare Part A covers inpatient care in hospitals and provides patients with a stay in a semi-private room, complete with meals, general nursing, and drugs. Part A also covers the cost of a blood transfusion if the hospital must purchase blood for you, up to 100 days per each benefit period in a skilled nursing facility, and hospice care for those with a life expectancy of six months or less due to a terminal illness. Part A coverage costs nothing, except for your deductibles or copayments, and coverage gaps must be paid by you or covered by other insurance.

Medicare Part B covers doctors' visits and services, outpatient care, rehabilitative care under a physical therapist, occupational therapist, or speech-language pathologist, and some preventative services like flu shots and mammograms. The monthly cost (or premium) for Part B coverage is tied to your annual income and adjusted each year. Most will pay the standard Part B premium of $96.40 per month in 2009 (if your annual income is not more than $85,000 as a single taxpayer or $170,000 if filing a joint tax return).

Medicare Advantage (Part C) plans at a minimum cover everything offered by traditional Medicare (Parts A and B). They also may offer additional benefits not covered by traditional Medicare like dental care, vision screening, prescription drugs and other services that would otherwise need to be provided under a supplemental insurance policy (Medigap).

Your out-of-pocket costs are likely to be less with a Medicare Advantage plan than if you use traditional Medicare and a Medigap policy. Everyone in a Medicare Advantage plan pays at least the same monthly premium as those enrolled in Medicare Part B. Your premiums may cost more depending on the benefits provided by the plan.

Medicare Part D (prescription drug coverage) provides brand-name and generic prescription drug coverage. These plans are provided by private companies that are approved by Medicare. Part D coverage is optional and available to those enrolled in traditional Medicare (Parts A and B) or Medicare Advantage plans that don't offer prescription drug coverage. Costs, extra benefits and details vary by plan.

Work With a SSDI & Medicare Advisor Service to Maximize Your Benefits

Don't stay confused trying to figure out the complex rules of these programs on your own - let those who understand it best help you maximize your benefits. Medicare & SSDI programs can be confusing with all of the different program requirements and eligibility criterion. Working with an SSDI expert and Medicare Advisor Service can help you determine the best coverage for your specific needs to ensure you get all of the benefits you are entitled to receive.

Jim Allsup writes for Allsup, a nationwide provider of Social Security Disability, Medicare and workers' compensation services for individuals, employers and insurance carriers. Allsup provides a Medicare Advisor service to help you select the Medicare plans that are right for you.

Understanding Medicare

What Is Medicare?

Medicare is a national, tax-supported health insurance program for people 65 and over and some persons with disabilities. If you or your spouse have worked full time for 10 or more years over a lifetime, you are probably eligible to receive Medicare Part A (Hospital Insurance) for free. Medicare Part B (Medical Insurance) is available at a monthly rate set annually by Congress ($110.50 in 2010 for incomes $85000.00 or less for an individual). Some seniors are eligible to receive the medical insurance portion (Part B) free as well, depending on their income and asset levels. For more information, inquire about the Qualified Medicare Beneficiary (QMB), Special Low Income Medicare Beneficiary (SLMB), and Qualifying Individual programs through your county social services office.

How Does Medicare Work?

Medicare is actually two separate types of insurance--hospital and medical. It is not intended to cover all your medical expenses. Hospital insurance (Part A of Medicare) covers medical treatment and surgical procedures performed in a hospital. It also covers hospice, home health, and limited skilled nursing care. Medical insurance (Part B of Medicare) covers part of the cost of doctor bills, outpatient care, medical equipment, and lab and diagnostic tests. With the Medicare modernization act of 2003, Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Coverage), also became available, through private insurance companies.

How Do I Get Medicare?

If you are receiving Social Security benefits prior to turning 65, you should automatically receive notification of your enrollment in Medicare shortly before your 65th birthday. Other individuals must apply by calling or visiting their Social Security office to receive Medicare. If you are not yet receiving Social Security or if you have not received a Medicare enrollment notice, you should contact the nearest Social Security office for information. Applications for Medicare can be made during a seven-month period beginning three months prior to the month of your 65th birthday. IT IS BEST TO APPLY DURING THE THREE MONTHS PRIOR TO THE MONTH OF YOUR 65TH BIRTHDAY. If an application is made during that time, coverage will begin on the first day of your birth month. Applying later will delay the start of your benefits. You can also apply for Medicare from January 1 through March 31 every year after your 65th birthday. Your coverage then starts July 1 of the year you signed up and you will pay a 10 percent surcharge on the Part B premium for each 12 months you were eligible but not enrolled.

What If I Am Still Working? If you continue to work after age 65 or your spouse is working and you are covered by an employer group health plan (EGHP), you may want to delay enrollment in Part B of Medicare. Enrolling in Medicare Part B will trigger your open enrollment for Medicare supplement insurance at a time when you do not need supplemental coverage. The penalty for late enrollment in Part B does not apply if you are covered by an EGHP because of your or your spouse's current employment. If you do work after age 65, you may apply for Medicare Part B at any time prior to retirement, but you must apply no later than eight months after your formal retirement in order to avoid paying a premium penalty. Even if your employer offers a retirement health plan, you will want to sign up for Medicare Part A and probably for Medicare Part B when you retire. Most retirement plans assume you are covered under Medicare and will not pay for services that Medicare would have covered. Veterans may be eligible for special medical programs. However, eligibility and benefits are very restrictive and are subject to change. The Department of Veterans Affairs advises veterans to apply for both Parts A and B of Medicare to ensure adequate medical coverage.

What About Costs Medicare Does Not Cover? Medicare pays for only a portion of hospital and medical bills. As with many private insurance plans, the government expects beneficiaries to pay a share of their bills. Medicare Parts A and B both have deductible and coinsurance requirements. The deductibles for 2010 are $1100.00 per Benefit Period, for Part A. The Part B deductible is $155.00 per year. Private insurance is available to cover all or some of these out-of-pocket costs. These insurance plans are called Medicare supplements (also called Med Sup or Medigap plans).

Medicare Supplement Insurance

Medicare Supplements are standardized by the Federal Government. They are lettered A, B, C, D, F, G, K, L, M & N. Each standardized Medigap policy must offer the same basic benefits no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies. Plan A pays the Medicare hospital and physician coinsurance, the first three pints of blood, and 365 days of hospitalization beyond Medicare. Plans B through N provide these benefits and add further benefits such as coverage for Medicare deductibles, excess charges and limited preventive care, and foreign travel. ONLY ONE MED SUP PLAN IS NECESSARY. You should only buy one Med Sup plan. No one should try to sell you an additional Med Sup plan unless you decide you need to switch policies.

Open Enrollment in Medicare Supplement Insurance At age 65, all consumers - including those already receiving Medicare due to disability - have a six-month "open enrollment" period. For six months beginning when you are both age 65 or older and enrolled in Medicare Part B, companies must sell you any Medicare supplement plan they offer. After this limited open enrollment period, companies can pick and choose whom they will cover. Other Options If you have an individual or "bank group" insurance policy, becoming Medicare eligible does not require you to cancel it and purchase a Medicare supplement. Doing so may save premium costs but it is important to compare benefits before deciding what will work best. If you are eligible for employer retirement insurance, review the plan carefully to understand what benefits are available and how it works with Medicare. Be aware that employer plans are not standardized and are not subject to the requirements governing standardized Medicare supplement policies. Some Texas residents are eligible to enroll in approved Medicare Advantage plans. These plans are offered by private insurance companies. Each year Medicare Advantage companies decide where they will offer their plans, what benefits will be offered, and what the premiums will be. There are several Medicare Advantage plans available in several counties in East Texas. Depending on plan choice, a member may be responsible for paying co-payments for certain covered services.

Should I Purchase Long-Term Care Insurance?

In the past, families often stepped in to help when older family members were no longer able to care for themselves. Today, with older people living longer, families often living long distances apart and more women working outside the home, fewer families are able to provide this care. A wide range of long-term care services is now available--day care, respite care, home care, and nursing care. These services are expensive and often exceed a person's ability to pay. People often mistakenly assume that Medicare will cover their long-term care costs. MEDICARE ONLY COVERS LONG-TERM CARE UNDER VERY, VERY LIMITED CIRCUMSTANCES.

Many Texas residents are eligible for Medicaid payment of their long-term care bills. Medicaid is a medical assistance program for people with limited income and assets. Eligibility is determined by the local county social services office. Private long-term care insurance is an option for people to consider, particularly if they have assets they wish to protect. You should not buy this type of insurance unless you can afford to pay the premiums every year. Remember, long-term care insurance premiums can and often do go up. Long-term care plans are not standardized like Med Sup plans. Therefore, it is very important to shop around and compare benefit options and cost.

David Hecker is a Licensed Insurance Agent based in Longview TX. He specializes in Medicare Products. He is licensed in Texas, Louisiana and Arkansas. He can be reached at (903) 918-9091. E-mail: dhecker@cablelynx.com or on the web at: http://www.tx-medicaresupplement.com To receive your "Free" e-mail newsletter about Medicare Supplements, send an e-mail request to: dhecker@tx-medicaresupplement.com Not connected with or endorsed by the United States government or the federal Medicare program.

Medicare Coverage For Home Care and Skilled Nursing Care

One of the biggest myths about Medicare is that it pays for long-term care. It doesn't. Medicare covers only limited periods of inpatient care in a skilled nursing facility, and skilled nursing care and therapy at home, under strict guidelines. Still, Medicare's coverage of these services can be vital if the person you're caring for has just been hospitalized or has otherwise suffered a serious medical event. Medicare can pay for costly short-term, intensive rehabilitation, which in turn can give you a chance to arrange for longer-term care if it's needed.Medicare coverage of inpatient care in a skilled nursing facility is a standard part of Medicare Part A. Someone already enrolled in Part A doesn't have to do any special paperwork to receive nursing-facility coverage.Skilled care at home can be covered by either Medicare Part A or Medicare Part B, under slightly different rules. Persons enrolled in either Part A or Part B can receive coverage for skilled home care without any additional Medicare enrollment.

"Nursing home" or "nursing facility" can refer to different levels of inpatient care in different types of places, including rest homes, nursing homes, board-and-care homes, assisted-living facilities, congregate living homes, and sheltered care homes. All of these provide what is called custodial care, which is long-term residence and nonmedical assistance with the activities of daily living -- such as bathing, eating, walking, and dressing -- for people who don't have acute medical conditions but who are no longer able to care for themselves completely. This type of custodial long-term care is not covered by Medicare.At the other end of the spectrum is a much higher level of inpatient medical care, referred to as skilled nursing or rehabilitation care. Under certain circumstances, Medicare Part A covers this skilled care for a limited time while a patient is recovering from a serious illness, condition, or injury. This care is usually provided in the nursing-facility wing of a hospital, in a separate skilled nursing facility, or in the skilled nursing part of a "multilevel" nursing or rehabilitation facility.

In order for someone to receive Medicare Part A coverage for inpatient nursing-facility care, a number of different conditions have to be met:

Prior hospital stay: A patient's stay in a nursing or rehabilitation facility has to begin within 30 days of an inpatient hospital stay of at least three days.


Need for daily skilled nursing or rehabilitation: Medicare covers an inpatient nursing-facility stay only if the person needs, and his or her physician prescribes, daily skilled nursing care or physical rehabilitation. For someone who needs skilled care but doesn't need it every day, Medicare will not cover an inpatient stay; instead, Medicare might cover home care.

Medicare-approved facility: For Medicare to cover inpatient skilled nursing or rehabilitation care, the care must be received in a facility that Medicare has certified for that purpose.

Improving condition: Medicare covers inpatient skilled nursing care only as long as the patient's condition is improving. Once Medicare, the patient's doctor, and the facility have determined that his or her condition has stabilized, Medicare will no longer cover inpatient care.

If, and as long as, a patient meets the qualifying conditions described above, Medicare will pay a limited amount for inpatient nursing-facility care.For the first 20 days in the facility, Medicare pays all covered charges -- excluding only items like a telephone or television or a private room if not medically necessary.For days 21 to 100 in a nursing facility during any one benefit period, Medicare no longer pays any of the cost.

If a patient needs skilled nursing or rehabilitation care at home, either Medicare Part A (following a minimum three-day hospital stay) or Part B (no hospital-stay requirement) can cover it. The care may be provided in the patient's home or anywhere else he or she stays. If a patient meets the requirements to qualify for home care (see "How does someone qualify for Medicare coverage of at-home care?" below), Medicare can cover skilled nursing care and physical and speech therapy as needed while the patient recovers from an illness, condition, or injury. Medicare also covers needed medical supplies and equipment.Medicare doesn't generally cover nonmedical at-home care and assistance, including meals and housekeeping. However, if a patient is getting Medicare coverage for skilled nursing or therapy at home, Medicare generallys pays for limited visits by an aide from a home care agency to help him or her with personal care. If Medicare covers skilled care for the patient, it can also cover the services of an occupational therapist to help him or her relearn how to accomplish daily personal care and household tasks safely.

For Medicare Part A or Part B to cover a patient's at-home care, several conditions have to be met:

Need for part-time skilled care: The patient must have a medical need for, and his or her doctor must prescribe, skilled nursing care or rehabilitative physical or speech therapy. The care must be needed part-time only, to help recover from a specific illness, injury, or acute condition. If, instead, the patient needs care because of a long-term condition or general frailty, Medicare will not cover it. Nor will Medicare cover full-time or daily care.

Confinement to home: Medicare covers at-home care only if and for as long as the patient is "confined to home." This means that he or she is unable to leave home without difficulty and with the assistance of another person or a medical device such as a wheelchair. However, it doesn't necessarily mean bedridden.

Recovery period: At-home care is covered only while the patient is actively recovering, which means while his or her condition is improving. Once a patient's condition has stabilized, as determined by his or her physician, the home care agency, and Medicare, coverage ends.

Medicare-approved agency: Medicare only covers home care provided by a Medicare-certified home healthcare agency. Unfortunately, this leaves out registry nurses, private therapists, and independent caregivers.

If a patient qualifies for coverage of at-home care, Medicare pays the full amount of the home care agency's charges, except for the rental cost of durable medical equipment such as a wheelchair or hospital bed (for which Medicare pays 80 percent). Sometimes, a patient's medigap insurance policy will pick up this extra 20 percent; otherwise, patients have to pay for it personally. The home care agency is not allowed to bill patients for any amount above the Medicare-approved charges.Medicare doesn't put any specific limit on the number of home care visits it will cover, nor on the total number of days patients can be served by the home healthcare agency. But coverage will continue only as long as they meet all of the qualifying conditions for coverage. A patient's condition and needs are regularly evaluated by the agency and by Medicare itself to determine how long the agency's care is medically needed and thus how long Medicare will keep paying.

If the person you're caring for is in the hospital and you're looking for answers about follow-up nursing-facility or home care, contact the hospital's discharge planner, who arranges both of these types of care, or the hospital ombudsman, who is trained in Medicare issues and helps patients understand them.Even if he or she isn't currently in the hospital, you can get information about nursing-facility and home care coverage directly from Medicare's website or by calling (800) 633-4227. If he or she has been referred to a particular nursing facility or home care agency, the intake administrator for that service can also help with Medicare-related questions or problems.

http://www.caring.com/articles/medicare-home-care

[http://www.caring.com/articles/medicare-coverage-for-skilled-nursing]

Information on Medicare

At initial glimpse it may seem incredibly bewildering to figure out the differences among a number of Medicare plans and firms. There will in addition be differences in what is on offer in assorted counties in California. For you to make the appropriate decision then you must study as much info as you can on Medicare in California, only then will you be able to find the scheme that most suits your wishes. It is not the case that you must be over sixty five to meet the criteria for a Medicare plan, if you are under sixty five and regarded as permanently disabled then you are in addition qualified to go in for a scheme.

The coverage and costs vary with distinct sorts of schemes. Moreover reflect on that fees possibly will grow yearly, and advantages can be added or withdrawn. This is why it is important to keep in the know with the latest information on health insurance in California.

There are 4 aspects to Medicare and it is prudent to know the details of every one prior to enrolling.

Part A is referred to as hospital cover. It will insure the receiver for the bulk of in-patient hospital treatment, together with some forms of in patient home care and plus hospice treatment. To be entitled to this assistance devoid of footing a monthly fee, you will require to be holding 40 or more quarters of Social Security credits. If you possess less than this total, though more than thirty, then you can acquire Medicare Part A for a monthly fee of around $250.00. Individuals with lesser than thirty Social Security credits would have to pay $461.00 each month in 2010.

Medicare Part B includes health insurance relating to out patient costs. This contains doctor's fees, laboratory tests, out patients hospital care, speech and physical therapy, ambulance transport, and certain medical equipment. This segment of the Medicare plan is optional. It is repeatedly the case that if you are still in employment then you may possibly by now have comparable schemes by way of a employer medical program so it may well not be considered necessary to sign up until you leave.

The rate of this premium is $110 in 2010, however in the order of 73 percent of Medicare holders will continue to pay the 2009 fee of ninety six dollars. This is for the reason that the individuals will not obtain a cost of living change in their 2010 Social Security benefits. Those who are new to Medicare will need to pay the complete 2010 amount as will persons who have a larger take-home pay.

It is important to realize that Medicare does not promise a wholly inclusive cover for all your medical connected circumstances. There will commonly be various reasonably substantial fees to pay beside deductibles and the expenditure of special services and objects. These include eyeglasses, hearing aids, dental care, as well as any form of long-term care be it in a private home or nursing home.

Medicare Part C is also referred to as Medicare Advantage. This is an choice to the original cost for service form of Medicare. The Medicare program will pay for Medicare Advantage plans and will pay private medical cover firms to provide health cover to the beneficiaries of the schemes. To be qualified for a Medicare Advantage plan, you should be signed-up for both Part A and Part B of the Medicare plan. By choosing to register yourself for Medicare Part C you will still be entitled to all the benefits that are included in the complete Medicare scheme.

You will be offered the Medicare benefits through a certain private plan. These may possibly additionally incorporate insurance for the expenditure for prescribed medications, this will be referred to as a MA-PD program. If this isn't the case then the plan would be deemed MA-only. The majority of Medicare Advantage plans will have amplified advantages over the first set up.

If you are opting for such a scheme then you need to examine the costs with care as lots may be more pricey for certain aspects. And numerous Medicare Advantage plans insist that you to only visit doctors or visit hospitals that are associated with their system. There are 5 separate Medicare Advantage plans: Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medical Savings Accounts.

Part D of Medicare in California is what's more referred to as the MMA (Medicare Prescription Drug, Improvement, and Modernization Act). This is a form of prescribed drug coverage in which all Medicare receivers are qualified no importance what their fitness position or income. To be eligible for this kind of Medicare, the person should sign up for a medication plan and contribute to the premiums and deductibles.

Medicare in California

New Medicare Supplement Plans M and N Offer New Lower Premiums For Medicare Recipients

Due to the 2010 Medigap Modernization act which goes into effect on June 1st. 2010, there will be some changes regarding the current standardized Medicare Supplement Plans. These changes will not affect those who are already enrolled in a Medigap Plan prior to this date, and only applies to people enrolling on June 1st or after.

Medigap Plans E, H, I, and J are being eliminated by Medicare, however those who are currently enrolled in these plans will be allowed to remain in them with no changes. Two benefits that are also being eliminated are the At-Home Recovery benefit, as well as the Preventative Care benefit, as these were determined by Medicare to be completely underused by beneficiaries. Those who are enrolled in plans prior to June 1st. 2010 that contain either of these benefits will be allowed to continue using them.Other important changes include the addition of the Hospice benefit to all Medicare Supplement Plans, as it will now be a core benefit of all Medigap Plans.

The new Modernized Medicare Supplement Plans will also include two new plan letters that will likely be very attractive to those currently on a Medicare Advantage Plan. Those two plans are Medicare Supplement Plan M, and Medicare Supplement Plan N. Due to the rising costs of Medicare Advantage Plan premiums, and the growing number of physicians choosing to not participate in them, Medigap Plans M and N offer various cost sharing features that help in offering lower premiums for both compared to Plans such as Medicare Supplement Plan F or Plan G.

Medicare's new Plan M offers unique cost sharing options that are particularly attractive to Medicare beneficiaries who are relatively healthy. Plan M offers to pay 50% of the Medicare Part A deductible, which is $1100 per benefit period in 2010. For example, if you are admitted to the hospital and you have a Medigap Plan M, you would need to pay half of the $1100 deductible, or $550. The current rules still apply to the Medicare Part A deductible, in that if you are admitted and leave for 60 days or more, and then need to return within the calendar year, you must pay this deductible again.

With a Medicare Supplement Plan M, you are also responsible for paying the Medicare Part B deductible, which is $155 for 2010. Beyond this deductible there are no doctor's office co-pays and the 20% coinsurance will be paid by the plan.

Another new plan being introduced on June 1st. 2010 is Plan N. This plan also offers cost-sharing options to the beneficiary much like Medicare Supplement Plan M, however with Plan N they are in the form of co-pays.

If you are admitted to the hospital and have a Medicare Supplement Plan N, you are required to pay a $50 co-pay. For doctors visits there is a co-pay of up to $20 per visit, after you meet the Medicare Part B annual deductible ($155 in 2010). These co-pays allow for the premiums of Medigap Plan N to be lower than the current Medicare Supplement Plans available, also making it an outstanding choice for those who are coming off of a Medicare Advantage Plan (Whether the plan is leaving your area, or you are in the enrollment period and wish to make a change).

With lower premiums and cost sharing options such as co-pays and deductibles, Medicare Supplement Plans M and N should be an excellent option for people on Medicare, particularly those who do not mind paying portions of deductibles or co-pays.

Russell Noga is the owner of http://www.Medisupps.com an online independent agency and Information Center people can visit to learn about Medicare Supplement Plans and Rates in their area.

An Overview of Medicare Supplement Plans A Through L

You'll find twelve Medicare supplement policies that handle expenses not covered by regular Medicare program. Each of these policies is required to pay for particular fundamental items.

The policies are identified as Plan A through Plan L. Each one provides a different set of benefits targeted at filling "gaps" in Medicare insurance coverage. They're each listed consequently. Plans K and L are similar in benefits to Plans A and J, but are less costly every month yet have higher limits.

If you are looking for a high allowable choice, Plans F and J have a $2000 deductible limit. This insurance plan allowable must be paid before the plan insures any expenses whatsoever. The amount of the insurance deductible on these plans aren't fixed and, consequently, may increase annually. Your premium itself is lower, although your out-of-pocket fee will be much higher.

Please be aware: Medicare SELECT is really a Medicare medigap health care insurance policy offered in addition to the twelve common A-L plans. SELECT usually costs less than the standard A-L plans. The downside to Medicare SELECT is the fact that you will have limits on which health professionals and hospitals you'll be able to decide on. If you wish to learn more about which Medicare SELECT plans can be obtained in your area, speak to your state insurance plan department.

Are you presently in a Medicare Advantage Program? (Medicare Health Maintenance Organization HMO is a Medicare Advantage Plan.) If you are, you no longer require a Medigap coverage plan.

People of Massachusetts, Minnesota, and Wisconsin have different normal Medigap plans from which to pick.

Simple Benefits:

Paid for by Plans A-J:

? Medicare Part A copayments along with insurance coverage for 365 more days after Medicare benefits end

? Medicare Part B copayments (typically 20 % of Medicare-approved expenses), or copayments for hospital services

? Initial 3 pints of blood annually

Paid for by Plan K:

Medicare Part A copayments plus coverage for 365 more days after Medicare benefits expire

? 50 % of hospice cost-sharing

? 50 percent for the initial three pints of blood every year

? 50 % Medicare Part B copayments, except 100 % copayments for Part B preventive services

Covered by Plan L:

Medicare Part A coinsurance plus insurance coverage for 365 additional days after Medicare benefits end

? 75 percent of hospice cost-sharing

? 75 % for the first three pints of blood on a yearly basis

? 75 % Medicare Part B coinsurance, except 100 % coinsurance for Part B preventive services

Medicare Part A Hospital Insurance deductible

Dealt with by Plans B-J:

$1,068 in 2009 for each benefit period for hospital services

Paid for by Plan K:

50 percent of the $1,068 Part A hospital insurance deductible

Covered by Medigap Plan L:

75 % of the $1,068 Part A hospital insurance deductible

Skilled Nursing-Home Costs

Dealt with by Medigap Plan C-J:

Your cost ($133.50 in 2009) for the days 21 through 100 in a skilled nursing home

Dealt with by Medigap Plan K:

50 % of $133.50 for days 21 through 100 in a skilled nursing home

Insured by Plan L:

75 percent of $133.50 for days 21 through 100 in a skilled nursing home

Medicare Part B Deductible

Covered by Medigap Plans C, F, J:

Yearly insurance deductible for doctor services ($135 in 2009)

Medicare Part B Excess Charges

Insured by Medigap Plan F (100 percent), G (80 %), I (100 percent), J (100 percent):

If your doctor doesn't accept assignment, the difference between what your medical professional bills and the Medicare-agreed upon amount.

Foreign Travel Emergency

Paid for by Plan C-J:

? Outside the United States: 80 percent of the expense of emergency care

? Up to $50,000 in your lifetime

? Yearly deductible of $250

At-Home Recovery

Paid for by Plans D, G, I, J:

? If already receiving skilled home care dealt with by Medical insurance Help, assistance with daily living activities, such as bathing and getting dressed.

? After you no longer must have skilled care, assistance for up to eight weeks

? Will pay up to $40 a visit, seven visits each week, or a total of $1,600 each year

Non-Medicare-Covered Preventive Services

Paid for by Medigap Plans E, J:

Up to $120 annually for non-Medicare-covered preventive services ordered by your general practitioner

To learn the main features of every single Medigap Insurance plan alternative, visit the Medicare Supplemental Insurance (Medigap) Reference at http://medicaresupplementalinsurances.com now!

Paying For Home Health Care - What Do Medicare and Medigap Cover?

Prescribed only by a physician, home health care is skilled nursing care that aids in the recovery from illness, injury, or surgery in the patient's home. And fortunately for many seniors who are now opting for care at home, Medicare insurance covers most costs related to home health care.

The government, however, has set some limitations on payouts - you are only eligible if you need intermittent care (usually defined as seven days a week or less than eight hours a day over 21 days or less) (1), physical/occupational therapy or speech language pathology; you are homebound; and the home health care agency providing care is approved by your Medicare insurance program.

In addition to medication administration, general supervision, and therapy services, the Medicare home health benefit covers a number of other necessities, including medical aids and supplies to aid in recuperation. On the occasion, though, you may be required to cover some of the costs associated with home health care. But what can you expect to pay out-of-pocket that's not covered by Medicare dollars?

Medicare Insurance: Part A and Part B

Hospital Insurance (Medicare Part A) helps cover the costs of your inpatient care at hospitals, skilled nursing facilities, or religious non-medical health care establishments. Part A can also help cover hospice and home health care services. Individuals aged 65 and older are usually automatically enrolled in Medicare Part A and do not have to pay a monthly premium if Medicare taxes were paid while working. If you did not pay taxes, you are still eligible, but you will be required to pay a monthly premium.

Medical Insurance (Medicare Part B) helps cover services such as those offered by your physician and outpatient care. Many seniors maintain their enrollment in Part A, but elect not to use Part B, which requires a monthly premium that is dependent upon income, the requirements of which change yearly. Unfortunately, if you didn't sign up for Part B when you were first eligible for insurance, your premium may be slightly higher (2).

For questions on your Medicare insurance benefits, you should contact 1-800-MEDICARE or read the handbook mailed to you each year entitled "Medicare and You."

What's Covered and What's Not

Medicare insurance pays for physical and occupational therapy and speech language pathology services, counseling, some medical supplies, durable medical equipment (which must meet coverage criteria), as well as general assistance with daily activities which include dressing, bathing, eating, and toileting. For most other medical equipment, Medicare insurance will cover 80% of its cost (3).

However, Medicare will not cover twenty-four hour care at home, meals delivered to your home, and services unrelated to your care such as housekeeping. Of course, as mentioned above, you will be required to pay 20% for medical equipment not fully covered by Medicare insurance such as wheelchairs, walkers, and oxygen tanks (4).

In some cases, your home health care agency may present you with a Home Health Advance Beneficiary Notice (HHABN), which, simply put, means if your agency is ceasing your care services, you will be presented with a written statement outlining the supplies and services the agency believes your Medicare insurance benefits will not cover as well as a detailed explanation of why. Should this situation arise, you do have recourse - the HHABN lists directions on acquiring the final decision on payment issues or filing an appeal if Medicare refuses to cover costs for home health care. In the meantime, you should continue receiving home health care services, but keep in mind that you will be paying for these services out-of-pocket until Medicare accepts your claims and remits past expenses.

Medigap and Other Out-of-Pocket Expenses

Medigap, a supplemental insurance policy, is sold privately and covers the services and supplies not paid for by Medicare insurance. When used in conjunction, Medigap and Medicare can often cover a large majority of the costs of your home health care. Insurance companies offer a variety of different Medigap policies (A through L), but since each one comes with specific benefits, you'll need to compare the highlights closely. Medigap policies vary by cost, and many insurance companies require you to have both Medicare Parts A and B in order to purchase a supplemental plan (5).

For seniors with both Part A and Part B Medicare, your home health care situation is usually covered, save for the 20% out-of-pocket expenses for medical equipment. Just remember to keep track of your Medicare insurance benefits (and Medigap if applicable) by verifying with your physician, home health care agency, and insurance representative. Paying for home health care does not have to cost you an arm and a leg, but do be prepared for the occasional (but necessary) out-of-pocket medical expenses.

Sources

1. Centers for Medicare and Medicaid Services, Medicare and Home Health Care, page 6

2. Medicare website: "Your Medicare Benefits."

3. Ibid.

4. Ibid.

5. Medicare website: "Medigap (Supplemental Insurance) Policies."

Jill Gilbert is the President and CEO of Gilbert Guide, a comprehensive website helping seniors and their loved ones find a senior care provider along with extensive tools and resources to solve the challenges of aging. She is the author of "Leading by Example," a monthly column in McKnight's Long-Term Care News, the chief industry publication for long-term care providers. Jill has been interviewed for a CBS News special, was a key presenter at the Pennsylvania Assisted Living Association's annual conference, and was recently interviewed on San Francisco TalkBack.

Gilbert Guide was founded on the concept that quality matters, and its primary goal is to educate consumers on a breadth of senior care issues. Visit http://www.GilbertGuide.com for a comprehensive provider database, expert advice, and quality assessment tools that help consumers conduct their own "expert" evaluations of providers.

Medicare Supplement Insurance Helps to Make Sense of Medicare

Many of those over 65 who saved for retirement have retained greater economic flexibility than those hit by layoffs while still trying to amass savings. That makes seniors a very desirable market for several industries. In fact, senior marketing is the fastest growing marketing segment today.

In sharp contrast, one of the biggest marketing failures that can have seriously harmful complications for those over 65 surrounds Medicare. With multiple parts, two deductibles, partial coverage (only 80 percent) for doctors' services, no coverage at times (such as when you travel outside of the U.S.) and no reconciliation when doctors charge above what Medicare will pay, Medicare is a maze of contradictions. How do seniors calculate and plan for their health care costs?

In truth, both people under and over age 65 find Medicare often to be obscure and some simply give up in confusion. It's a sad comment on the "information age" that we haven't explained Medicare's coverage in a way that allows many seniors to estimate their expected health care costs and plan accordingly.

Medicare Supplement Plans Help to Translate Medicare's Coverage

Private insurers marketing Medigap insurance must explain Medicare, at least in part, to show the need for their plans to protect seniors from all the health care charges that Medicare won't cover. For many, private insurance companies discuss Medicare in ways that are more direct and more comprehensible to give seniors a better overall understanding of where the holes in Medicare's coverage put them at risk. The risk is real because hefty doctor and hospital bills far too often devour retirement savings forcing seniors to reduce their standard of living. Health care costs may be the single biggest concern for many seniors because their need for health care grows as they age and because health care prices are spiraling out of control.

A Medicare Supplement Can Cut Seniors' Medical Bills down to Size

With existing Medicare benefits in jeopardy (Medicare was extended beyond it's predicted bust in just eight years), baby boomers and seniors are exploring alternatives, such as Medicare Advantage plans and Medicare Supplement plans.

In the face of the new health care laws, Advantage plans are beginning to lose their subsidies. It's expected that these plans will become increasingly expensive with the decline of government subsidies. Medigap insurance, often called Medicare supplement insurance, is a viable alternative. With 10 different plans, each one fills the gaps in Medicare in a slightly different way so seniors are free to choose only the benefits they need without paying for any extras. Medigap plans cover Medicare's Part A and Part B deductibles to make seeing the doctor and going to the hospital when you need more affordable. These plans can also cover Medicare's co-pays and co-insurance charges, and certain plans expand Medicare's coverage to services beyond Original Medicare, such as emergency medical care when you're out of the country.

Confusion over Medicare Has Left Seniors Unprepared for Health Care Debt

Although millions are now enrolled in Medicare in order to pay for their health care needs, many remain unprotected simply due to a lack of understanding about the intricacies of the Medicare system. One of the biggest misunderstandings involves the Medicare "pre-approved" amount. Medicare only pays for 80 percent of a standardized amount for procedures. That doesn't stop doctors from charging more; it just shifts the burden of payment onto the patient. Doctors can continue to charge their regular fee, Medicare can continue to pay its standard payment and it's up to you to make those ends meet. Getting the right information is crucial to getting the most out of Medicare, and Medicare supplement insurance is one key to bridging the gaps in Medicare coverage.

By Wiley Long - President, MedigapAdvisors.com - The nation's leading independent agency specializing in Medicare Supplemental Insurance. Our professional MediGap advisors look forward to the opportunity to help you get the best insurance for your Medicare needs.

The Medicare System and Senior Citizens

Medicare benefits are, inevitably, something we must all become familiar with as we get closer to retirement age. However, what exactly is medicare? When did it begin? And what is its purpose? Here is a brief outline of the federal government's medicare program, including its history and the rationale for its existence.

Medicare came into existence in 1965. It was created as one of the component parts of then-President Lyndon B. Johnson's "Great Society" initiative. The principal purpose of medicare was to provide a system of healthcare for elderly U.S. citizens, i.e. individuals who were sixty-five years of age or older.

However, medicare benefits are not simply for the elderly. Medicare is also availabe to individuals who are younger than sixty-five and who are disabled.

Qualifying for medicaid benefits on the basis of disability status, of course, requires that a person file an application, or initial claim, for title II benefits with the social security administration. Title II benefits are mandated under title 2 of the social security act and title II benefits are commonly referred to as social security disability benefits, or SSD.

Individuals who are approved for social security disability benefits are eligible to receive medicare benefits two years after their date of entitlement has been established and, no doubt, this provides for a healthcare safety net for disabled citizens who must subsist on a relatively small monthly disability benefit.

Who is eligible for medicare? Fortunately, unlike supplemental security income and medicaid benefits, medicare is not considered a needs-based program. In other words, younger individuals who are disabled and individuals who are of retirement-age may be eligible without regard to their income.

Until recently, medicare benefit coverage was thought of primarily in terms of hospital insurance and medical insurance. Medicare part A covers hospital visits and nursing home stays, while medicare part B pays for outpatient care and services, including doctor's visits, xrays, and lab reports. However, the medicare program was recently restructured to include a prescription drug benefit. This is known as medicare part D.

Medicare part D went into effect on January 1st, 2006, as part of the Medicare, Prescription Drug Improvement and Modernization Act. Medicare Part D is available to any individual who is eligible to receive medicare part A and medicare part B benefits. The intent of medicare part D is to guarantee prescription drug coverage for medicare beneficiaries. However, the federal government does not actually provide this coverage. Prescription drug coverage under medicare part D is provided by independent drug plans that are actually operated by private health insurers, though, legally, such plans are regulated by the federal government, i.e. the medicare program.

Are medicare benefits free? No, medicare part B requires the payment of a monthly premium which, for 2006, was $88.50. However, for those individuals who might have difficulty paying this premium, an assistance program is available to qualified individuals to pay part B premiums. This program is known as MQB, or medicaid for qualified (medicare) beneficiaries. Like other types of medicaid, this particular medicaid program is needs-based and serves no other purpose than to pay a medicare recipient's monthly medicare insurance premium.

The Medicare program may well be the most transformational program to arise as a result of Lyndon Johnson's Great Society initiative, and its effect, in many ways, may be as profound as the creation of the social security program under President Franklin D. Roosevelt. Recent estimates hold that medicare accounts for more than a tenth of all federal spending and approximately one-third of healthcare spending.

The author of this article is Tim Moore, who, in addition to being a former food stamp caseworker, medicaid caseworker and AFDC caseworker, is a former disability claims examiner. He publishes a blog on the disability process which is titled the Social Security Disability and SSI blog

New Medicare Supplement Plans Are Available Now

Medicare does not cover all health costs. There are gaps in the coverage. Some or all of these gaps can be filled by additional insurance purchased from private insurance companies. These plans are known as Medicare Supplement Insurance Plans or Medigap Plans. There are currently twelve plans available, identified by letters A through L.

Since Medicare Supplements are standardized by government regulations, all Medicare Supplement insurance companies are regulated as to what provisions and what policies they can offer. That does nott mean the prices are the same. There can be a big difference in premium costs for the same plan, depending on which insurance company you choose.

First, a little background information:

The Medicare Prescription Drug Improvement and Modernization Act of 2003 (also called the Medicare Modernization Act) was signed into law In December of 2003. Prior to this Act, Medicare did not provide for outpatient prescription drug benefits. This Act created Medicare Part D, to give access to prescription drug insurance coverage for those eligible for Medicare Part A or who were enrolled in Medicare Part B. This coverage began on January 1, 2006 and is administered by private health plans.

The Medicare Modernization Act (MMA) also encouraged the National Association of Insurance Commissioners (NAIC) to modernize the Medicare supplemental insurance marketplace. NAIC developed a revised Medigap Plan model.

On July 15, 2008, Congress enacted the Medicare Improvements for Patients and Providers Act (MIPPA) that authorized the states to put the NAIC's changes into effect. Congress felt that Medigap insurance had not kept up with some of the changes in Medicare, so the 2010 Medicare Supplement changes are, in effect, an effort to modernize the Medigap Insurance market by dropping some coverage options and adding others.

Summary of changes for 2010 Medigap plans purchased on or after June 1, 2010:

? Preventative Care will be dropped from all 2010 Medicare Supplement plans

? At-Home Recovery benefit will be dropped from all 2010 Medicare Supplement plans

? Medigap Plans E, H, I and J will no longer be available for new sales

? Two new Medigap Plans -Supplement Plan M and Supplement Plan N will be available in June 2010

? Plan G will be modified to increase excess charges from 80% to 100%

? A New Hospice Benefit will be added to all plans

? Insurance carriers will be allowed to offer plans that include New or Innovative Benefits, such as hearing aid benefits or eye wear. They may not include outpatient prescription drug benefits.

Current underwriting guidelines for these new 2010 Modernized Plans allow the application dates to be written 60 days prior to the effective date of coverage. This means that the new Plan M and Plan N can be acquired now.

The new Medicare Supplement Plan M will be standardized as is all the current plans available.

This plan uses what is known in the insurance industry as cost-sharing in an effort to reduce monthly premium costs. You would see a slightly lowered premium, but would split the cost of Medicare Part A deductible ($1,100 in 2010) with the insurance company. This means that your Part A deductible would be $550.

Medicare Supplement Plan M does not cover any of the Medicare Part B deductible. Once you meet this Part B deductible ($155 in 2010) you would not have any co-pay for doctor visits. We think this will in effect reduce this plans monthly premiums by 15% compared to the popular existing Medicare supplement Plan F premiums.

Medicare Supplement Plan M does cover the basic Core Benefits including full coverage for the Part A daily inpatient hospital coinsurance charges, all costs of hospital care after the Medicare benefit is used up, Part B coinsurance charges, the first three pints of blood, and now the Part A hospice coinsurance charges for palliative drugs and has the foreign travel emergency benefits. Hospice care is included (as it is in all Medicare Supplement Plans for 2010).

Take a close look at Plan N. From what I have learned so far, it looks to become one of the most popular plans because of its affordability. Plan N also uses cost-sharing in an effort to reduce monthly premium costs. In order to lower the monthly premium costs, unlike Plan M, Supplement Plan N uses co-pays. Co-payments for doctor visits are $20 and $50 for emergency visits. Currently the co-pay system is set to go into effect after the Medicare Part B deductible is met.

Look for Plan N as a cost effective alternative to Medicare Advantage Plans. It offers a better solution than Medicare Advantage because Plan N has no network restrictions and much lower out-of-pocket liabilities to the client.

Medicare Supplement Plan N has 100% coverage for the Part A inpatient deductible. It does not cover the Part B deductible. Insurance companies are estimating this will in effect reduce this plans monthly premiums by 30% - 35% compared to the popular existing Medicare supplement Plan F premiums.

Medicare Supplement Plan N does cover the basic Core Benefits including full coverage for the Part A daily inpatient hospital coinsurance charges, all costs of hospital care after the Medicare benefit is used up, Part B coinsurance charges, the first three pints of blood, and now the Part A hospice coinsurance charges for palliative drugs and has the foreign travel emergency benefits. Hospice care is included (as it is in all Medicare Supplement Plans for 2010).

It's almost impossible to call all the insurance companies that offer Medicare Supplement Plans in your state to find the best prices on premiums. Your best bet is to contact a company that can find the best prices among all the insurance companies that service your area. One such source would be http://www.medigap4seniors.com

Medicare and Medicare Insurance - A Beginner's Guide to Understanding the Parts of Medicare

Turning 65 or going on Medicare for the first time can be an overwhelming experience in one's life. Coupled with that, most make an attempt, sometimes futile, to understand the complex world of Medicare and Medicare insurance. This article is to serve as a primer of the "parts" of Medicare, of which there are currently four, and what they do.

Part A

Part A is the part of Medicare that everyone gets from paying into the social security system during their working life (as long as they meet the minimum work amount requirements). The primary thing that it covers as inpatient hospital care, and you will sometimes here it referred to as the "hospital" part of Medicare. However, it does also cover skilled nursing facility care, home health care and hospice facility care.

Part B

Medicare Part B is optional - most people who have employer coverage that works with Medicare coverage do not necessarily need Part B until or unless their employer coverage ends. Medicare Part B has a monthly premium associated with it, that is typically paid out of one's social security check.

Part B covers "services" primarily, and it is sometimes called the "doctor's office" part of Medicare. Some of the primary things that it covers include doctor's services, diagnostic tests, outpatient services and physical therapy and some preventive-type screenings.

Part C

Part C is the portion of Medicare that was created in the last 10 years. It is sometimes referred to as "privatized Medicare", but is primarily known as Medicare Advantage. In Part C, a private insurer that has a contract with the government takes over management of all of your Medicare benefits. Your benefits are all provided through this private insurer - you pay premiums directly to this company and they pay claims on your behalf.

This is an optional part of Medicare. You still have to pay the Part B premium and you do not altogether "lose" Part A and Part B, but Part C does provide your benefits in place of A & B. Also, you can not have (or do not need) a Medicare Supplement plan and Part C - most elect to either have one or the other. Supplements pay AFTER Medicare pays; Medicare Advantage pays INSTEAD of Medicare.

Part D

Part D is the part of Medicare that you may hear about the most. This is the portion of the Medicare program that covers prescription drugs. It is offered through private companies, which must be certified and approved by the Centers for Medicare & Medicaid Services on an annual basis to offer this prescription coverage (Part D).

You pay premiums directly to the private companies, although most offer the ability to deduct it automatically from your Social Security check. This is an optional part of Medicare - not everyone signs up for it when they are first eligible or at all.

Secure Medicare Solutions is a leading, independent resource for South Carolina Medicare Supplement insurance and South Carolina Medicare Insurance. Our web site contains a bevy of resources for those Turning 65, including information about South Carolina Medicare Supplements.

Medicare Complete - Is it a Medicare Supplement Or Medicare Advantage Plan?

If you watch TV, you probably have seen one or more advertisements for Medicare plans. Many of these plans are offered by United Health Care. They offer Medicare supplements, also known as Medigap, and Medicare Advantage Plans. But which type of plan is Medicare Complete?

Many people refer to all Medicare plans offered by private insurance companies as supplements. But this is not the case. Medicare supplements and Medicare Advantage Plans are two distinct types of plans. This misunderstanding leaves people confused about Medicare Complete. Before we unravel the mystery of Medicare Complete, let's take a look at the difference between a supplement and an Advantage plan.

Medicare supplement - A supplement or Medigap insurance is an insurance policy that is offered by a private insurance company to fill the gaps left by Medicare. When Medicare was enacted in 1966, it was not meant to be totally comprehensive coverage. The beneficiary is responsible for a certain level of cost sharing. In general terms, the beneficiary is responsible for a hospital deductible, co-pays after extended hospital stays and 20% of outpatient expenses.

Medicare Advantage Plan - An Advantage Plan is also offered by a private insurance company, but instead of filling the gaps left by Medicare, the Advantage Plan is another way to receive your Medicare benefits. Insurance companies contract with and are approved by CMS (Centers for Medicare and Medicaid Services) to administer your Medicare. Plans are required to meet certain criteria, and in many cases offer benefits beyond conventional Medicare. You may still have cost sharing, but it is in the form of deductibles, co-pays and co-insurance. Plans typically include a maximum out-of-pocket expense. Advantage Plans often include Part D prescription drug coverage.

Setting the record straight. Medicare Complete is a Medicare Advantage Plan. Offered in some service areas as a PPO and offered in others as a HMO, Medicare Complete does not fill the gaps left by Medicare, but rather is an Advantage Plan with predetermined out-of-pockets costs. Unlike a standardized supplement, Medicare Complete may have varying levels of coverage and benefits depending on the plan's service area. You may have a regional PPO plan available in your County, while someone in a neighboring County may have Medicare Complete available as a HMO plan.

If you are looking for a plan that includes Part D drug coverage and a low monthly cost, then you may want to take a look at Medicare Complete when you are comparing Medicare Advantage Plans. If on the other hand, you don't mind a higher monthly premium and are looking for a plan that will fill the gaps left by Medicare, you may want to consider a Medicare supplement.

Determining if Medicare Complete is right for you.

Here are some things to consider when determining whether Medicare Complete is the best plan for your needs.

Is the plan affordable? This means affordable, not only as far as any premium that may be required (there may not be one!), but also the amount of cost sharing that may be required to use the plan.
Do you feel comfortable with the plan's provider network? In many service areas Medicare Complete has a strong network, but you need to investigate this for yourself.
Does the plan offer as many extra benefits as other Advantage Plans that may be available to you? Many plans offer dental, vision, hearing and in many cases the Silver Sneakers program.
Do you feel that the maximum amount out-of-pocket that you could incur is reasonable compared to paying a higher monthly premium for a supplement? If the maximum annual amount is high and you have several costly health conditions, you may want to consider whether a supplement would be a better option.

Choosing a Medicare Advantage Plan is an important decision, but armed with the right information, it does not need to be overwhelming. Now that you know that Medicare Complete is an Advantage Plan, it is up to you to do your homework and determine if the plan is right for you.

David Forbes is President of Alliance Marketing Associates, Inc. David offers helpful advice on topics related to insurance for seniors, including finding an affordable Medicare Plan.

Sign up for your Free Mini-Course on Medicare Plans at http://www.affordablemedicareplan.com/

Prescription Drug Coverage With Supplemental Medicare Insurance and Medicare Advantage Plans

If you are about to turn 65, you have probably been studying up on how Medicare works and the various plans it offers. Because some of the plans are similar, the differences between them are often blurred, leaving potential beneficiaries confused about what plan is right for them.

Medicare Part C, known as a Medicare Advantage Plan, is one of the four basic parts of the Medicare system. It allows users of the original Medicare Parts A and B to get coverage from a government approved private insurance company of their choice. Medicare Advantage Plans include plans like Health Maintenance Organization Plans (HMO) and Preferred Provider Organization Plans (PPO). The biggest weakness the original Medicare plans have is that they do not cover the cost of prescription drugs. If you want additional coverage, you have a few options.

Medicare Part D is available to anyone with original Medicare (Parts A and B), and can help cover the costs of prescription drugs. You must get this coverage through a private insurance company approved by Medicare. If you have a Medigap policy, the same as supplemental Medicare insurance, it may already cover the costs of drugs. But if it does not, you are allowed to get a Medicare Prescription Drug Plan as part of Medicare Part D, but must alert your insurance company if you do so. Not all supplemental Medicare plans will cover drug costs, so it is important to make sure the plan you choose offers this benefit. If it does not, just remember that you can still get drug coverage through a Medicare Plan.

If you are not going to utilize Medicare Part D, or get supplemental Medicare insurance, consider Medicare Part C - the Medicare Advantage Plan. These plans, provided by private insurance companies, may offer prescription drug coverage at an additional cost. If you have one of these plans, you will not need supplemental Medicare insurance at all; it is simply an alternative. Make sure to check your coverage history from past employers; you might have additional coverage choices if your former or current employer provided you with prescription coverage.

Make sure not to buy a supplemental Medicare plan if you already have a Medicare Advantage Plan. Doing this is illegal, unless you are completely dropping your Medigap plan and returning to original Medicare. Be very careful before ever dropping your supplemental Medicare insurance, because it is possible that you may not be able get it back in the future. Discuss the issue with your State Health Insurance Assistance Program and your insurance company before ever making a decision that could affect your long-term health coverage.

Getting prescription drug coverage is an important element in any health coverage plan, and only gets more important as you get older. You should seriously consider getting a plan that helps cover the costs of prescriptions, as you never know what types of health issues you may have in the future. Whether you choose to get supplemental Medicare insurance or a Medicare Advantage Plan, having some kind of drug coverage will have you prepared for any twists or turns life may bring.

Richardt Insurance has over 35 years of experience helping seniors find the best supplemental Medicare insurance and prescription drug coverage that is available in their state.

Medicare Open Enrollment is Coming So Get Ready!

Are You Ready For Medicare Open Enrollment?

When Medicare Open Enrollment rolls around, it is time to consider your health and prescription plans for next year. According to the US Center for Medicare and Medicaid, Medicare Open Enrollment is from November 15th to December 31 this year. Even if you are content with your current Medicare health and prescription benefits, you want to make sure that the plan will be very similar next year. Because plans do change, and the period after Medicare Open Enrollment is when those changes will show up.

How To Prepare For Medicare Open Enrollment

The Medicare websites gives some great tips to evaluate your current Medicare health and prescription plans, and they are pretty simple.

Gather Information About Your Health Needs. This includes your current prescription list, your medical providers, and any notices you have received from Medicare, Social Security, and any private health or prescription insurance companies about changes to your plan.
Compare plans in your local area for cost, coverage, and customer service. You can do research by using the Medicare website, contacting a local insurance agent who is a specialist on various Medicare Health and Prescription Plans, and also by asking people you know and trust about their experiences.
Decide if you would like to keep your current coverage or make a change.
If you decide to consult an insurance agent, look for a Medicare specialist who is appointed and certified with multiple area plans. If you find an agent who only represents one company they may be less motivated to give you a balanced view. Of course, you may end up purchasing from one company, but it would be best to do your shopping with a consultant who is not motivated to only push one plan.

Understand the differences between Medicare Advantage Plans and Medicare Supplements. This subject still causes confusion. And no, there is no one right answer for everybody. Some people feel as if Medicare Advantage plans are only for seniors with moderate to low incomes, but some individuals with very high incomes are very satisfied with Medicare Advantage. On the other hand, some people, especially those who do not live where a doctor network is convenient, may be happier with a very flexible plan like some Medicare Supplements, even though they cost more. Of course, on still another hand, some Medicare Advantage plans will work with any doctor who accepts the plan, so they can be very flexible too!

I do not mean to be confusing here, but I do mean to illustrate that the variety of Medicare Health and Prescription plan choices makes choice complex. If you have questions, do not hesitate to consult Medicare or a private Medicare Specialist. An insurance agent who specializes in Medicare health plans should not charge you anything. They earn a living with commissions from the various companies when they do sell a plan. If you can find an agent who is appointed and certified with all, or most, of the local plans, they will not be motivated by that commission to select one plan over another. They should be motivated to find the best plan for you, and keep you as a valuable client!

Do you need to find a Medicare Health Plan?

It only takes a moment to Compare Medicare Health Plans. Our forms are simple and free, and they will show you the options in your local area.

http://www.noMedical.net