Panel Gets Earful Of Advice On Taming The Federal Deficit

Among the messages to the super committee?members: caution. Meanwhile, Democratic governors expressed?fears about deep cuts in federal aid to their states,?especially regarding Medicaid and other entitlement programs. Hospital advocacy groups also carried a similar message about treading lightly in regard to trimming Medicaid funding.

The Associated Press: Lawmakers Advise Super Committee To Be Cautious
Congress flooded its super committee with a jumble of advice Thursday about taming the government’s out-of-control debt, with top agriculture lawmakers readying a bipartisan plan to pare food and farm aid while others urged an aggressive hunt for savings coupled with warnings against cutting cherished programs. Most of the suggestions came from Democrats on 16 Republican-run House committees who sent letters to the special debt-cutting panel. Generally, their advice was to create jobs, raise revenue and avoid damaging cuts to public works, health care and other programs they said are crucial to an economic recovery (Fram, 10/13).

USA Today: Congress Funnels Deficit-Cutting Ideas To Super Committee
When it set up a super committee to find $1.5 trillion in deficit reduction, Congress also asked other committees to weigh in with advice about what spending to cut. Today is the deadline for those recommendations. And much of the advice so far is about what not to cut (Korte, 10/14).

Politico: Dem Govs Lobby Super Committee
Fearing deep cuts in federal support to their states, several Democratic governors set up a series of meetings Thursday to lobby super committee members and White House officials. Maryland Gov. Martin O’Malley, the chairman of the Democratic Governors Association, and Govs. Mark Dayton of Minnesota and Christine Gregoire of Washington met separately with the Senate Democratic super committee members and the House Democratic super committee members in the Capitol. Gov. Deval Patrick of Massachusetts, a close ally of President Barack Obama, was expected to join the calls by telephone. Later in the day, the governors had scheduled a meeting with White House Chief of Staff Bill Daley (Allen, 10/13).

The Washington Post: Dem Governors Huddle With Debt Super Committee Members
A quartet of Democratic governors is huddling Thursday with members of Congress’s debt-reduction super committee on Capitol Hill, urging lawmakers on the panel to focus on job creation and avoid making cuts or changes to entitlement programs that would result in a greater burden on the states. … In a letter to the super committee’s members, O’Malley, who last December was elected to head the DGA, backed the White House’s call for a debt-reduction package including both cuts and revenue increases. He also urged the panel’s members not to avoid changes to Medicaid that would increase the burden on state governments (Sonmez, 10/13).

National Journal: Democratic Governors Ask Committee Not To Pass Medicaid Costs To States
Two Democratic governors met privately on Thursday with Democratic members of the deficit-reduction super committee, urging against any effort to shift Medicaid-related costs and other expenses to the states. In attendance was Maryland Gov. Martin O’Malley, chairman of the Democratic Governors’ Association, and Minnesota Gov. Mark Dayton. Massachusetts Gov. Deval Patrick joined by telephone. Washington Gov. Chris Gregoire was slated to join the meeting, which was organized by House Minority Leader Nancy Pelosi, D-Calif., who attended, but couldn’t make it. The governors’ main message to the Democratic members of the deficit panel was about Medicaid-related costs and who is responsible for them, but they also pressed job creation in general and aspects of Obama’s defeated jobs bill (House, 10/13).

Modern Healthcare: Deficit-Reduction Panel Urged to Spare Medicaid
Leading hospital advocacy groups urged the deficit-reduction super committee to omit Medicaid cuts from any final proposal for at least $1.2 trillion in savings over 10 years. Specifically criticized were proposals to switch the various state Medicaid federal medical assistance percentages into a single “blended rate” and another to limit states’ use of provider taxes. Both approaches would effectively shift more of the financial burden for the state-federal insurance program for low-income beneficiaries onto the states, according to the Oct. 12 letter to the panel from the hospital advocacy groups. Such existing proposals that have received budget savings estimates from federal scorekeeping entities are expected to receive the most serious consideration by the deficit panel, according to other members of Congress and outside observers (Daly, 10/13).

Original post:
Panel Gets Earful Of Advice On Taming The Federal Deficit

Tags: deficit, democratic, government, house, ideas, news, obama, panel, states, super-committee, usa, white

Supplement For Medicare

Health care reform has sparked heavy debate regarding the appropriate supplement for Medicare. It is widely known that seniors ages 65 and above are eligible for government medical aid (Medicare) to assist in healthcare cost. Medicare covers a portion of senior’s medical cost. Although government assistance is available, many seniors still lack ample funds to cover the holes in Medicare. Thus, seniors are left to decide whether to adopt a Medicare advantage plan or to simply adopt a supplement for Medicare.

Though this segment is dedicated to the appropriate supplement for Medicare it is prudent to explain differences in what Medicare advantage plans would provide as well. As stated above traditional Medicare covers certain medical needs for seniors. The government covers (by paying doctors and hospitals) certain senior medical needs based on a fee for service schedule. There are options for seniors to be covered by an advantage plan with 0 out of pocket monthly. It goes without saying that where one medical plan may be ideal for an individual; the same medical plan may fall short of covering another individual’s needs. Advantage plans are plans in which the government pays insurers a specific amount monthly for every Medicare member that they enroll (the plans cover hospitals and doctors as well). Individuals covered under advantage plans are able to choose HMO plans which require advantage recipients to choose from a network of health care providers as well as PPO plans which allow for in network providers as well as out of network providers. It should be noted that individuals going outside of the network would likely have to pay additional fees. All advantage plans offer the same benefits (regardless of the insurer). However, the benefit to the Medicare Advantage plans is that they cover things such as hearing, vision and dental care whereas traditional Medicare plans do not. Medicare Advantage has become increasingly popular due to the advantages provided over and above traditional Medicare. However, that is precisely the issue that critics raise. Advantage plans are said to “pay out” more than traditional Medicare plans. The congressional budget office has estimated that over 150 billion additional dollars has been spent in the last 10 years on advantage plans (that would not have been spent with standard Medicare). Ultimately, the additional expenditures mean more money spent by taxpayers. Which is why Medicare Advantage plans have been targeted by government and health care reform.

With Medicare Advantage plans being heavily scrutinized and funding likely to be cut at least to some extent, supplements are becoming more appealing. Where advantage plans offer 0 out of pocket, a supplement for Medicare would require some payment by the senior. Where advantage plans replace traditional Medicare, a supplement for Medicare is literally that…a supplement that covers certain holes left by traditional Medicare. Therefore, Medicare is considered the primary plan and a supplement for Medicare is considered secondary to the plan. Medigap plans are also offered through private insurers at specific cost. Medicare supplement plans are also considered medigap plans as they fill the gaps left by Medicare. Gaps such as Deductibles, Coinsurance and Co-pays can be filled with an appropriate supplement for Medicare. Any doctor that accepts Medicare should accept a supplement for Medicare. Medicare participants must be enrolled in Medicare part b in order to be eligible to buy a Medigap plan. Medicare part b covers things like doctor services, outpatient care, home health services as well as some preventative services. There are several Medigap plans available and participants typically need not go through underwriting if they will attain the age of 65 within the next 6 months(and two months following their 65th birthday). Open enrollment occurs from November 15th through December 31st and this is the time that changes may be made by existing supplement users. Medigap options vary and are labeled A through L. Each plan offers different options to fill the holes left by traditional Medicare plans. Core benefits include hospital coverage for specific periods during Medicare benefit period, approved hospital cost for co-payments during specific periods, skilled nursing coinsurance, doctor deductibles, foreign travel emergency coverage, at home recovery, drug benefit as well as preventative care. Benefits vary from plan to plan and may be viewed in the Medicare handbook. You may also view supplement for Medicare options by searching Medicare resources at the Texas low cost health insurance site.

http://www.texaslowcosthealthinsurance.com, Medicare resources

View the original article here

Deficit Panel Moves Deliberations Behind Closed Doors

The 12-member ‘super committee’ held a private meeting Thursday and emerged with few details, though a co-chair acknowledged that their work won’t be easy. Meanwhile, President Barack Obama and House Speaker John Boehner, R-Ohio, are signaling the different courses they want to see the panel follow.?Also, congressional Democrats are getting increasingly worried about what might become of Medicare and Medicaid.

ABC News: Deficit Super Committee Breakfast Club
For its third meeting, the 12-member, deficit-reduction committee gathered in the U.S. Capitol today for an early, closed-door breakfast over orange juice, coffee, pastries and bacon to talk about how it can achieve a plan for deficit reduction by Thanksgiving. After emerging from the meeting, the co-chairs of the debt committee were scant on details about what nitty-gritty was discussed. Rather, they seemed to use this morning’s breakfast as more of a getting-to-know-you meeting, even as all the members have called for quick work with a November deadline and the threat of the trigger options looming (Miller, 6/15).

The Associated Press/MSNBC: Super Committee Meets In Private To Talk Deficit Reduction
Members of Congress’ debt reduction super committee said Thursday that their assignment of finding ways to reduce government red ink won’t be simple. Emerging from a private breakfast meeting among the panel’s members, Rep. Jeb Hensarling, R-Texas, told reporters: “We know that it will not be fun. We know it will not be easy, it will not be popular with any current political constituency” (9/15).

Politico Pro: Dems Worry Over How, Not How Much In Cuts
Democrats say they are resigned to the fact that Medicare and Medicaid won’t go completely unscathed as part of Congress’s latest effort to cut federal spending. Their question is not how much, but simply how, the programs get squeezed. “I don’t think the number is important,” Rep. Bill Pascrell of New Jersey said, reacting to reports that President Barack?Obama will seek at least $340 billion in savings from the two programs. But where he gets the money and who it affects is very significant. The comments come just days before the president will take another swing at lopping trillions of dollars off the national deficit over the next decade. Details remain scarce, but administration officials this week said his proposal could include $340 billion in health care savings in 10 years (Dobias, 9/15).

CNN Money: Boehner: No Tax Hikes For Super Committee
House Speaker John Boehner drew a line in the sand on taxes on Thursday, saying that a special debt committee tasked with cutting at least $1.2 trillion from federal deficits shouldn’t consider tax hikes. “Tax increases, I think, are off the table,” Boehner said in a speech to the Economic Club of Washington, D.C. “It’s a very simple equation. Tax increases destroy jobs. And the Joint Committee is a jobs committee. Its mission is to reduce the deficit that is threatening job creation in our country.” The only things the 12-person super committee should tackle are spending cuts and entitlement reform, he said (Liberto, 9/15).

The Washington Post: Boehner Says No New Taxes For Debt Panel
House Speaker John A. Boehner (R-Ohio) on Thursday reaffirmed GOP opposition to any tax increases to solve the nation’s deficit problem, signaling a swift return to the trench warfare that characterized the debt and spending debate of early summer. Boehner said that the special committee seeking long-term debt reduction should achieve its mandated $1.5 trillion in savings entirely by cutting federal agency spending and shrinking entitlement programs (Kane and Helderman, 9/15).

The Wall Street Journal: Boehner Pushes Tax Overhaul
The Boehner speech came as the White House was preparing to present its own deficit-reduction recommendations next week to the super committee. The Wall Street Journal reported the president has decided against including proposals to slow the growth of Social Security spending. But many Democrats remain concerned that the package will revive proposals to pare entitlements such as Medicare and Medicaid and that the deficit debate will distract from Mr. Obama’s jobs proposal. “The president should continue to talk about jobs,” said Rep. George Miller (D., Calif.) (Hook, 9/16).

Politico: Obama To Shield Social Security In Deficit-Reduction
The shift away from Social Security will allow him to avoid a clash with his Democratic base over the popular retirement program at a time when he needs its support more than ever, both to push for his $447 billion jobs program and to buck up his lagging poll numbers. Medicare could be a different story, though, as the White House revisits some unpopular ideas from the talks with Boehner (Budoff Brown, 9/15).

Reuters/MSNBC: Obama To Exclude Social Security From Deficits Plan
President Barack Obama will not include reforms to the Social Security retirement program in his deficits proposals to Congress next week, the White House said Thursday. … Obama also expressed a willingness in the summer debt talks with House of Representatives Speaker John Boehner, a Republican, to raise the eligibility age for Medicare health benefits to 67 from 65. But The Wall Street Journal said Thursday the White House was now looking at cuts to providers and increased premiums for wealthier recipients of Medicare, the health care program for the elderly (MacInnis, 9/15).

Politico: Obama Jobs Plan: Raise Taxes On Health Care
The White House wants another shot at requiring some Americans to pay more for their employer-backed health coverage, despite a previously tepid response from the very same lawmakers needed to advance the proposal (Dobias, 9/15).

Excerpt from:
Deficit Panel Moves Deliberations Behind Closed Doors

Tags: boehner, health, house, money, obama, package, president, security, social, street, summer, taxes, white, white-house, work

The twelve different types of Medicare Supplement policies

There are certain Medicare supplement policies, commonly referred to as Medigap, which are sold to Medicare beneficiaries who are already enrolled in Medicare or Medicare Advantage plans. These Medicare supplement plans help cover the "gap" or pay for expenses that Medicare does not include. Medicare supplement policies are private insurance plans that help pay expenses, such as deductibles, co-payments, or prescription drug costs.

Medicare beneficiaries can purchase Medigap, or Medicare supplement policies, on the open health insurance market. At this time, many seniors do not purchase Medicare supplement plans and only rely on Medicare or Medicare Advantage plans. The premium costs for Medicare supplement policies vary based on geography, type of plan, age and health condition. Therefore, purchasing Medicare supplement plan right when you turn 65 is probably a good idea, because th at is when you are the healthiest and youngest and eligible for Medigap coverage. If you purchase a Medicare supplement policy later on, you may have to pay a really high premium.

There are standardized Medicare supplement policies, which are government-regulated to include specific benefits so that individuals can compare the policies easily. However, each health insurance provider can set their own prices for their Medicare supplement policies. That is why it is important to do some comparison shopping between insurance providers.
At this time, there are twelve different standardized Medigap or Medicare supplement policies. They are identified by the letters A through L. The federal and state government both regulates these Medicare supplement policies, in order to protect seniors. The first mandate is that all Medigap policies be clearly identified as "Medicare Supplement Insurance". The twelve different types of Medicare Supplement policies have a different set of basic benefits, plus possibly more additional benefits. In the next year or two, some additional Medicare supplement policies will be added. These will also be identified by letters.

In order to buy a Medicare supplement policy, you must already have Medicare Part A and Part B. You will continue to pay your premium for Part B, and then an additional premium for the Medicare supplement policy. Part A, as you are probably aware of, does not require an additional premium, as long as you paid into Medicare ta xes throughout your career life. Unlike traditional health insurance, each spouse must purchase their own Medicare supplement policy. One Medigap plan will not cover married spouses.

If you enroll in a Medicare Advantage plan, rather than the traditional Medicare, you are not eligible to also buy a Medigap policy. This is because the Medicare Advantage plans already have additional benefits, in addition to standard Medicare, and therefore a Medicare supplement insurance policy would be considered double benefits. You can get a lot of information about Medicare, Medicare Advantage plans, and Medicare Supplement insurance plans on the government's web site at Medicare.gov.

Remember that you can purchase Medigap or Medicare supplement insurance plans from the private health insurance market, and through a licensed insurance broker. A broker can help you find the right Medicare supplement insurance, and explain to you the difference between the twelve different Medigap policies available.

Medicare Frequently Asked Questions

Straight talk. Answers to 3 FAQ's about Medicare and Medicare Supplement Insurance. You don't need to be a Medicare expert or devote hours reading info and researching online to understand your Medicare and Medicare Supplement options.

Q: What is the difference between Original Medicare and Medicare Advantage (MA) Plans?

A: There are several key differences between Original Medicare and Medicare Advantage Plans. Original Medicare is your government Medicare. Medicare Advantage is private Medicare that takes the place of your government Medicare. You will have similar out-of-pocket expenses with an MA plan as you would with Original Medicare alone.

It is important to understand that in general an MA plan is the same coverage as Original Medicare. You may get some extra benefits such as dental or eyeglasses, and some of the plans include drug coverage as well, but the base coverage will be the same as original Medicare.It is not the same as Medicare plus a Medigap or Supplement Plan. You can not get a supplement plan to cover your out-of-pocket expenses when you are enrolled in an MA plan.

Q: What are my potential out-of-pocket expenses with my Medicare coverage?

A: Medicare itself is great coverage but there are some gaps in the coverage that many beneficiaries fill with a Medicare Supplement policy.

Medicare Part A covers hospital room and board, short-term skilled nursing care and hospice care.

There is a deductible for Part A. Currently the deductible is $1132.00. This means that you will pay the first $1132.00 before Medicare benefits are paid. This is not an annual deductible. It is a benefit period deductible. A benefit period starts the day you are admitted to the hospital and ends 60 days after you are released. It is possible that you could encounter the Part A deductible more than once in a year. After the deductible is met Medicare covers 100% semi-private room and board for 60 days. From day 61-90 the is a daily co-insurance of $283 per day. After 90 days Medicare provides coverage for an additional 60 lifetime reserve days with you paying a daily co-pay of $566.

Skilled nursing facility following a hospital stay of at least 3 days is covered by Medicare at 100% for the first 20 days. Days 21-100 have a $141.50 co-pay per day.

Hospice is covered by Medicare with very limited co-pays.

The deductibles and co-insurances increase from year to year.

Your exposure on the A side of Medicare are your deductible, and the various co-insurances mentioned above.In addition, Medicare doesn't cover the first 3 pints of blood.

Medicare Part B covers medical expenses in or out of the hospital such as doctor visits, inpatient and outpatient medical and surgical services and supplies.Diagnostic testing, speech and physical therapy, and durable medical equipment are Part B expenses.

There is a calendar year deductible for Part B. This year the deductible is $162.00. After you have met your deductible medicare covers 80% of approved amounts for covered services.

Your exposure on the B side of Medicare includes the deductible and 20% of approved amounts for covered services and any Part B excess charges. Part B excess charges are charges for covered services that exceed Medicare approved amounts.

Q: How can I limit my exposure and cover the gaps in my Medicare coverage.

A: You can supplement your Medicare coverage with a Medigap insurance policy.

There are 10 Medicare supplement policies that are approved by Medicare. All of the supplements have the same basic benefits.

Medicare supplement basic benefits for Medicare Part A cover all of your hospital co-insurances and will extend your covered days beyond Medicare coverage for and additional 365 days. The Part A deductible and skilled nursing co-insurance coverage are optional benefits.

Your supplement will automatically adjust to the changes in Medicare deductibles and co-pays from year to year.

Under Medicare Part B, Medicare Supplement basic benefits will cover your 20% co-insurance.

You can choose a supplement plan that includes optional benefits such as Part B deductible, Part B excess, and foreign travel emergency coverage.

Seek the guidance of a broker who specializes in Medicare to help you determine which of the 10 Medicare Supplement Plans best suits your needs.

Stephanie Coutavas is an Insurance Professional specializing in Senior Insurance Solutions and Medicare Insurance. Co- founder and Senior Broker at MedicareQuote4U.com-Common Sense Insurance Solutions Group. Stephanie decided to specialize in Medicare because, "I saw the effects of the confusion and misinformation in the senior market. I really feel that with the proper,correct information, presented in an understandable way that our Seniors can position themselves for the future and achieve the peace of mind and security that they deserve at this exciting stage of life. We strive one client at a time to make sure that we address the individual and that they are better for having met us, regardless of whether they choose us as their broker."

Whether you are receiving Medicare Benefits before age 65, helping a parent or loved one or just not sure if there might be a better value for your health care $$$, we can help. Call us at 1-888-347-5552 to speak with a licensed Medicare Supplement Specialist or visit us at http://www.medicarequote4u.com. We are your Medicare Supplement experts and we are standing by to help.

Supplement For Medicare

Health care reform has sparked heavy debate regarding the appropriate supplement for Medicare. It is widely known that seniors ages 65 and above are eligible for government medical aid (Medicare) to assist in healthcare cost. Medicare covers a portion of senior's medical cost. Although government assistance is available, many seniors still lack ample funds to cover the holes in Medicare. Thus, seniors are left to decide whether to adopt a Medicare advantage plan or to simply adopt a supplement for Medicare.

Though this segment is dedicated to the appropriate supplement for Medicare it is prudent to explain differences in what Medicare advantage plans would provide as well. As stated above traditional Medicare covers certain medical needs for seniors. The government covers (by paying doctors and hospitals) certain senior medical needs based on a fee for service schedule. There are options for seniors to be covered by an advantage plan with 0 out of pocket monthly. It goes without saying that where one medical plan may be ideal for an individual; the same medical plan may fall short of covering another individual's needs. Advantage plans are plans in which the government pays insurers a specific amount monthly for every Medicare member that they enroll (the plans cover hospitals and doctors as well). Individuals covered under advantage plans are able to choose HMO plans which require advantage recipients to choose from a network of health care providers as well as PPO plans which allow for in network providers as well as out of network providers. It should be noted that individuals going outside of the network would likely have to pay additional fees. All advantage plans offer the same benefits (regardless of the insurer). However, the benefit to the Medicare Advantage plans is that they cover things such as hearing, vision and dental care whereas traditional Medicare plans do not. Medicare Advantage has become increasingly popular due to the advantages provided over and above traditional Medicare. However, that is precisely the issue that critics raise. Advantage plans are said to "pay out" more than traditional Medicare plans. The congressional budget office has estimated that over 150 billion additional dollars has been spent in the last 10 years on advantage plans (that would not have been spent with standard Medicare). Ultimately, the additional expenditures mean more money spent by taxpayers. Which is why Medicare Advantage plans have been targeted by government and health care reform.

With Medicare Advantage plans being heavily scrutinized and funding likely to be cut at least to some extent, supplements are becoming more appealing. Where advantage plans offer 0 out of pocket, a supplement for Medicare would require some payment by the senior. Where advantage plans replace traditional Medicare, a supplement for Medicare is literally that...a supplement that covers certain holes left by traditional Medicare. Therefore, Medicare is considered the primary plan and a supplement for Medicare is considered secondary to the plan. Medigap plans are also offered through private insurers at specific cost. Medicare supplement plans are also considered medigap plans as they fill the gaps left by Medicare. Gaps such as Deductibles, Coinsurance and Co-pays can be filled with an appropriate supplement for Medicare. Any doctor that accepts Medicare should accept a supplement for Medicare. Medicare participants must be enrolled in Medicare part b in order to be eligible to buy a Medigap plan. Medicare part b covers things like doctor services, outpatient care, home health services as well as some preventative services. There are several Medigap plans available and participants typically need not go through underwriting if they will attain the age of 65 within the next 6 months(and two months following their 65th birthday). Open enrollment occurs from November 15th through December 31st and this is the time that changes may be made by existing supplement users. Medigap options vary and are labeled A through L. Each plan offers different options to fill the holes left by traditional Medicare plans. Core benefits include hospital coverage for specific periods during Medicare benefit period, approved hospital cost for co-payments during specific periods, skilled nursing coinsurance, doctor deductibles, foreign travel emergency coverage, at home recovery, drug benefit as well as preventative care. Benefits vary from plan to plan and may be viewed in the Medicare handbook. You may also view supplement for Medicare options by searching Medicare resources at the Texas low cost health insurance site.

http://www.texaslowcosthealthinsurance.com, Medicare resources

Medicare and Medicare Advantage Update 2010

Q. What are the changes to Medicare in 2010?

A. Medicare is made up of three parts: Hospital Insurance (Part A), Medical Insurance (Part B), and Drug (RX) Insurance (Part D). Part A Deductible for 2010 is $1,100 for a hospital stay of 1 - 60 days, $275 per day for 61-90 days, and $550 day for 91-150 days of a hospital stay (lifetime reserve days). After 150 days, you pay all costs for the hospital. Part A also includes Skilled nursing facility and some home health care but not long term care. Skilled nursing facilities is subject to a $137.50 per day co-insurance for days 21-100. Part B covers Medicare eligible physician services, outpatient hospital services and certain home health services and durable medical equipment. You pay 20% of the Medicare-approved amount after you meet the $155 deductible.

Part D coverage is for both short and long-term prescription needs not given in the hospital, coverage for both brand name and generic drugs and can differ dramatically from one company to the other. Part D is not deducted from your Social Security check.

Q. Can you explain the difference between a Deductible, co-pay(ment) and out of pocket.

A. The deductible is the amount you must pay for health care before Medicare begins to pay. These amounts can change every year. A co-payment is a partial cost you will spend to see the doctor. These can be zero or more. These are out of pocket which are costs that you must pay on your own because they are not covered by Medicare.

Q. What are the differences in HMO, PPO, PFFS, SNP and MSA plans?

A. Health Maintenance Organizations (HMO)- Just like the private sector, HMO is a group of doctors, hospitals and other care providers that agree to give health care to Medicare beneficiaries for a set amount of money from Medicare every month. You get your care from the provider in the plan.

Preferred Provider Organization (PPO)- Doctors, hospitals and providers that belong to the network and with most PPO plans, you can use doctors, hospitals and providers outside the network for an additional cost.

Private Fee for Service (PFFS)- These are sometimes referred to as regional PFFS since the doctor or hospital accepts payments from the insurance plan rather than Medicare. The Insurance plan decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare covered benefits.

Special Needs Plan (SNP) - A type of plan for people with chronic illnesses or conditions with special needs.

Medical Savings Plans (MSA) - A type of savings plan for those people who do not go to the doctor often but need a savings plan to pay some of the costs of the deductibles and co-payments.

Q. My Doctor takes Blue Cross but he does not take Medicare Advantage Blue Cross. What does that mean?

A. Medicare Advantage plans are a hybrid of coverage offered from an insurance company. When you are eligible for Medicare at age 65, you select Part C--Medical Insurance offered by a company. You still pay your premiums out of your social security check for Part B but the government pays the insurance company to administrate the benefits. These Medicare Advantage Plans appear to have many benefits and include Drug coverage (Part D). Medicare Advantage plans are the best of both worlds but they have some drawbacks. If your doctor is not a Medicare Advantage plan doctor, you will pay additional costs to see him/her but with most plans you can see another doctor (usually not available with HMO plan). You will be subject to separate deductibles and separate co-payments and often need a referral for approval before you can get care from the specialist. If you do not get a referral, the plan may not pay for your care.

Q. Since Medicare Advantage provides all Medicare health care through that plan, what if I don't like it? I have heard Doctors payments will be cut and the company I sign up with may stop insuring them. What protection do I have?

A. Since Medicare is a government provided plan for those 65 and older, you have many options for coverage. Every November 15 through December 31 you can switch from one Medicare Option to another--you can enroll in any Medicare Advantage or Part D at this time. This is called the Annual Enrollment Period. (AEP) Your new coverage would begin on January 1. From January 1 to March 31 Medicare members can make ONE plan change to a like kind. For example, you can change to another MA plan. The member CANNOT change Part D coverage during this time unless they have it with the plan they are leaving. This is called Open Enrollment Period (OEP). During Special Enrollment Period (SEP), members must enroll within 63 days of a special event. This is if you move outside the service area, move into or out of a long term care facility, loose credible prescription drug coverage, return to the US from another country or get assistance from the state in which you live, loose coverage under an employer or union either voluntarily or involuntarily.

Q. What other benefits do I get with a Medicare Advantage Plan?

A. You may get extra benefits by selecting a Medicare Advantage Plan. These may include vision, hearing, dental and/or health and wellness program including membership to a specific gym. Because you do not need to buy a Medigap or Medicare Supplement policy, the premium are supplemented by the government and are less expensive than a traditional supplemental plan.

Q. I hear there are many gaps in the Part D (Drug) coverage and I take 5 prescriptions a day. How do I get most of my drugs covered?

A. Every insurance company that offers Part D coverage has a written list of drugs. These include generic and brand name drugs. (Check the web sites or ask your agent for a printed formulary drug book.) Your plan may have several tiers and your co-payment amount depends on which "TIER" your drug is listed. Not all brand names will be covered and these can be very expensive if you have a high copayment or it is not listed. Always ask your doctor whether the drugs prescribed are available as generic. Be sure to ask your doctor whether you can split a high-dose version of the prescribed drugs as

they are often the same price as low-dose version or go to http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/MPDPFIntro.asp?version=default&browser=IE%7C7%7CWinXP&language=English&defaultstatus=0&pagelist=Home&ViewType=Public&PDPYear=2010&MAPDYear=2010&MPDPF%5FMPPF%5FIntegrate=N to compare drug plans in California.

Q. I like what I see--a policy issued by a leading insurance company that does not cost me the same as a Medigap or Medicare Supplement. Why should I buy a Medicare Supplement instead of a Medicare Advantage Policy?

A. That is a good question. If you can afford the individual premiums for a Medicare Supplement with a separate part D, you should do that. You can choose you own doctor as long as that doctor takes Medicare patients. Today many plans are a hybrid and some cost ZERO monthly premium and include a RX plans are also a PPO so people have the freedom of a PPO. As Seniors age, options and benefits become very important and we are here to help you decide which plan is best for you. Be confident in your Medicare Choices.

For the past 30 years, Karen Adams has been an independent insurance agent working primarily in Southern California. She has help hundreds of clients find the right insurance program to meet their needs. Rapidly approaching age 65, she decided to become as knowledgeable as possible about Medicare solutions. "I have written articles about Medicare Supplements and have insured clients who have reached Medicare age. Most Medicare Supplements (MS) are about the same and as long as a doctor takes Medicare he/she must accept the supplement their patient uses (not an HMO plan). Therefore, the advantage from one company over another is how easy they make their payment process, how patient orientated the company is, how large their network of Doctors and the premium they charge for the plan," says Karen. "Then came highly government regulated Medicare Advantage (MA) plans and the ball game changed. Now there is ZERO premiums with Drug coverage. What cost from $200 to $300 a month in premium in a supplement with a prescription drug card now appears to be free. What's that all about? Karen can help you untangle the web of MEDICARE insurance. Call her today or go to http://adamsinsuranceagency.com/ for your personalized quote.

The Medicare Factor in Long Term Care Planning

Medicare and Health Insurance History in the United States With a vision to provide a universal health plan, such as Medicare, the United States does not truly have a national health care plan. Even though universal health care, another name for national health care plans, has its conception in the 20th century, the United States has shied away from its inception. In fact, the United States is one of the few industrialized countries that do not offer true, government provided universal health care.

The first private health insurance programs created nation wide was the Blue Cross plans. Originally paid by individuals on prepaid bases for certain hospitals, this was later changed to include any sponsored hospital. The individual would provide a monthly payment that ensured he was cared for a specified number of days.

The Blue Shield plan was another plan created during the 1940s. It allowed the prepayment for doctor services. The plan’s creation provided an alternative to a national health care plan. The Blue Shield and Blue Cross plans eventually merged, forming what we call today Blue Cross Blue Shield.

There are varying reasons that a national health care insurance plan has not taken hold in the United States. As the American Medical Association has opposed the establishment of a national plan, the employer sponsored insurance plan has added the catalyst to not create a national plan. Since the employers can write off the plans provided to their employees, Congress has not received any push to change the concept of employer-sponsored plans.

The closest conception of universal health care the United States institutionalized is Medicare. Medicare was created in 1965.

Then Came Medicare

So how did Medicare take hold? Though it is not a true national health care plan for everyone, only for those over 65, it is because of President Lyndon B. Johnson and a majority of Democrats in both houses of Congress that the plan came into existence.

Attempting to provide a plan comparable to the private sector, the creation of Medicare part A came about. By mimicking the current plans, Medicare part A provided a determined amount of hospital care. Any more care beyond what the plan stated was to be paid by the patient.

The disadvantage to a plan such as this is the increasing expense of hospital care. The costs paid by the insured are now at a level to completely destroy financially that individual. In other words, as expenses have increased with hospital care, Medicare Part A has not kept pace. Therefore, any difference in cost is paid for by the patient.

This realization gave way to catastrophic plans. These plans allow the insured to pay for some of the upfront costs up to a predetermined out-of-pocket limit. Once that is reached, the insurance pays 100% of the cost. Unfortunately, Medicare has not evolved into this type of arrangement.

As such, we are beginning to see the bankruptcy of the plan, as well as the bankruptcy of the insured attempting to cover their part of the insurance plan.

Medicare part B evolved into a plan to encourage doctors to be paid by the federal government with the attempt to not institute price controls by the same. Under the original intent, Medicare part B paid for 80% of a doctor’s services while the patient paid the other 20%, and any fees above the reasonable costs.

However, the plan has degenerated into a government price control plan, where the government dictates to doctors what they will be paid for services the doctors provide.

Medicare Eligibility

Medicare enrollment takes place only one time during the year. The time frame usually is between October and December of the year prior to its activation for an individual. To learn more of the enrollment process for Medicare, read this publication: http://www.medicare.gov/Default.asp .

Most individuals understand that to enroll one must be age 65 years or older. However, most may not know that they also must be eligible for receiving Social Security or Railroad retirement. Furthermore, the individual does not need to be receiving either one of the retirement payouts, but one must be eligible to receive them.

In short, you can receive Medicare without receiving Social Security or Railroad Retirement income. You probably know someone who has decided to continue working. As such, they have delayed their receipt of government retirement payouts. However, to ensure a medical benefits plan, they have signed up for Medicare.

When you sign up for Social Security or Railroad retirement at age 65, or decide to receive payments at 65, you are automatically enrolled in Medicare Part A and Part B.

If an individual under 65 is disabled, and has applied for and receives Social Security disability for two years will receive Medicare. Furthermore, if a person of any age with end-stage renal disease may also receive Medicare.

Anyone born after 1938 will not receive their full retirement benefits from Social Security until the age of 67. Due to this, most individuals may decide to continue working. As such they will not apply for Social Security at the age of 65, thus not automatically receiving Medicare Part A.

Or, if the person is under a group plan, he or she may be forced into enrollment in Medicare at the age of 65. The person will not lose their group coverage, but it will be shared with Medicare.

I Have A Group Plan

Returning to the previous situation where an individual continues to work, or not retire, and not having a group plan, he or she may not receive a reminder to sign up for Medicare Part A. Fortunately, there will not be any penalties. However, he or she will only be allowed to sign up during a specified period during the year.

As for Medicare Part B, there is a penalty. You must sign up for Medicare Part B either three months before or after your 65th birthday. Otherwise, a penalty will be assessed against the premiums. However, if a person is covered under equivalent group coverage or is on Medicaid, the penalty is waived.

Though Medicare Part A is paid via payroll deductions and there is not cost when implemented, this is not the case with Medicare Part B. Medicare Part B is a cost-sharing plan.

The premiums for Medicare Part B are $88.50 (for year 2006). However, these premiums increase every year as the cost of medical services increase. Beginning in 2007, for those individuals in high-income brackets, they will pay a higher premium as a percentage for Medicare Part B.

The increases are phased in over a five-year period. The increases are scheduled as such:

income of: $80,000 -$100,000: 65% subsidy
income of: $100,000-$150,000: 50% subsidy
income of: $150,000-$200,000: 35% subsidy
income above: $200,000: 20% subsidy
If you are married, the incomes are twice what are depicted. However, for both individuals and married couples, the income ranges increase annually based on the Consumer Price Index (CPI).

I’m Not Eligible for Social Security

What about those individuals who are not eligible for Social Security and their spouse is not eligible either? That person can still get Medicare but will pay a premium, which may be equivalent to the Medicare Part A premium.

Eligibility for Social Security requires at least 10 years, or 40 quarters, under the system or paying into the system.

You do not have to participate in the Medicare program. However, if a person does not participate in Part A, they are not allowed to participate in Part B. If the person, though, must pay premiums for Part A, they can elect not to, and instead purchase Part B. It also works the other way. If you do not desire to participate in Part B, you do not have to.

To sign up for Part B, it must be done so during the first three months before the month of an individual’s 65th birthday, or three months after. This equates to seven months to sign up (3 months before and after, and the individual’s birthday month).

If an individual does not sign up for Medicare Part B during the initial period, they are penalized. The penalty is 10% for each full 12-month period the individual does not sign up. A person can sign up for Part B between January 1 and March 31 if they do not sign up during their initial enrollment period – the seven months mentioned earlier.

Can I Afford Not To Have Medicare Part B?

But what of the individual who cannot afford the premiums for Medicare Part B? Most individuals who are affected in this manner may be able to receive assistance through Medicaid or a state’s Medicare Savings Program. Normally, someone must meet the state’s requirement of limited income and resources. The plan will pay for Medicare premiums and possibly Medicare deductibles and coinsurance.

A situation which may help with understanding may include a person who receives Medicare Part A (which the Medicare Savings Program might pay the premium) and

He or she has resources equal to or less than $4,000; a couple would be $6,000. The resources may include monies in checking or savings account, stocks or bonds.

He or she has a monthly income of less than $1,068; a couple would be $1,426 (as of 2005; Alaska and Hawaii have higher limits).

If you are an individual that is 65 or older and still working with a group insurance plan, there are solutions to Medicare Part B. Most individuals under this scenario will continue with their group plan and use Medicare Part A as their secondary, or supplemental, insurance. However, they may not need the Part B.

But what if they do need Part B? As mentioned earlier, would they not be penalized if they signed up later? There are special rules for someone under a group insurance plan that allows them to sign up for Part B without a penalty.

If an individual is retired but has continued with a group plan under an agreement with the company, there are waivers to allow for coverage of Part B. However, the waiver only takes effect if the person loses their group coverage in the future.

If you are one of the aforementioned individuals who need to take advantage of these waivers for Medicare Part B, then you will need to apply during the Special Enrollment Period.

Study Up So You Don’t Have To Pay Up

Make sure you go to the Medicare link (http://www.medicare.gov/Default.asp) and read what you are entitled to. I don’t like that word, entitlement, but you have paid for Medicare so use it. Just don’t abuse it. Make it part of your Long Term Care Planning so you can make it through your golden years.

T. Sydney Shinn Home Health Care Solutions [http://www.home-health-care-solutions.com]

A developer of technical health care solutions, a Crown Ministries budget counselor, and a family man, Mr. Shinn understands the challenges of today's families. After taking care of his own father for five years, he created Home Health Care Solutions to to provide the material that families need to make informed decisions on home care options.

Wonder if a loved one will be able to continue to live in their home as they mature? Discover information for families and seniors about in home care giving, in home care services, mental and hospice care, legal and financial planning to ensure that the elder family member is able to live in their home forever. The site provides guidance in preparing the retiree, family, caregiver and senior family member.

Supplement For Medicare

Health care reform has sparked heavy debate regarding the appropriate supplement for Medicare. It is widely known that seniors ages 65 and above are eligible for government medical aid (Medicare) to assist in healthcare cost. Medicare covers a portion of senior's medical cost. Although government assistance is available, many seniors still lack ample funds to cover the holes in Medicare. Thus, seniors are left to decide whether to adopt a Medicare advantage plan or to simply adopt a supplement for Medicare.

Though this segment is dedicated to the appropriate supplement for Medicare it is prudent to explain differences in what Medicare advantage plans would provide as well. As stated above traditional Medicare covers certain medical needs for seniors. The government covers (by paying doctors and hospitals) certain senior medical needs based on a fee for service schedule. There are options for seniors to be covered by an advantage plan with 0 out of pocket monthly. It goes without saying that where one medical plan may be ideal for an individual; the same medical plan may fall short of covering another individual's needs. Advantage plans are plans in which the government pays insurers a specific amount monthly for every Medicare member that they enroll (the plans cover hospitals and doctors as well). Individuals covered under advantage plans are able to choose HMO plans which require advantage recipients to choose from a network of health care providers as well as PPO plans which allow for in network providers as well as out of network providers. It should be noted that individuals going outside of the network would likely have to pay additional fees. All advantage plans offer the same benefits (regardless of the insurer). However, the benefit to the Medicare Advantage plans is that they cover things such as hearing, vision and dental care whereas traditional Medicare plans do not. Medicare Advantage has become increasingly popular due to the advantages provided over and above traditional Medicare. However, that is precisely the issue that critics raise. Advantage plans are said to "pay out" more than traditional Medicare plans. The congressional budget office has estimated that over 150 billion additional dollars has been spent in the last 10 years on advantage plans (that would not have been spent with standard Medicare). Ultimately, the additional expenditures mean more money spent by taxpayers. Which is why Medicare Advantage plans have been targeted by government and health care reform.

With Medicare Advantage plans being heavily scrutinized and funding likely to be cut at least to some extent, supplements are becoming more appealing. Where advantage plans offer 0 out of pocket, a supplement for Medicare would require some payment by the senior. Where advantage plans replace traditional Medicare, a supplement for Medicare is literally that...a supplement that covers certain holes left by traditional Medicare. Therefore, Medicare is considered the primary plan and a supplement for Medicare is considered secondary to the plan. Medigap plans are also offered through private insurers at specific cost. Medicare supplement plans are also considered medigap plans as they fill the gaps left by Medicare. Gaps such as Deductibles, Coinsurance and Co-pays can be filled with an appropriate supplement for Medicare. Any doctor that accepts Medicare should accept a supplement for Medicare. Medicare participants must be enrolled in Medicare part b in order to be eligible to buy a Medigap plan. Medicare part b covers things like doctor services, outpatient care, home health services as well as some preventative services. There are several Medigap plans available and participants typically need not go through underwriting if they will attain the age of 65 within the next 6 months(and two months following their 65th birthday). Open enrollment occurs from November 15th through December 31st and this is the time that changes may be made by existing supplement users. Medigap options vary and are labeled A through L. Each plan offers different options to fill the holes left by traditional Medicare plans. Core benefits include hospital coverage for specific periods during Medicare benefit period, approved hospital cost for co-payments during specific periods, skilled nursing coinsurance, doctor deductibles, foreign travel emergency coverage, at home recovery, drug benefit as well as preventative care. Benefits vary from plan to plan and may be viewed in the Medicare handbook. You may also view supplement for Medicare options by searching Medicare resources at the Texas low cost health insurance site.

http://www.texaslowcosthealthinsurance.com, Medicare resources

Coverage Options For Medicare Eligible Individuals

People with Medicare can obtain their medical care through original Medicare or the Medicare Advantage Program (Part C). Medicare Advantage Plans consist of HMO, PPO, Private Fee for Service Plans and Special Needs Plans. Of the more than 10 million individuals enrolled in Medicare Advantage Plans, the majority are enrolled in HMO's (Health Maintenance Organizations) which have been available since the 1980's.

To help your parents (or you) make an informed decision, they need to understand how these plans work, and then decide which plan is right for them. The following is a brief description of each of the plan types.

Original Medicare

If an individual elects to go with traditional fee for service Medicare, they can generally use any doctor or hospital that accepts Medicare assignment anywhere within the United States. However, Medicare does have deductibles, copays and cost sharing requirements that can play havoc with budgets. To help pay these additional out of pocket expenses, many individuals purchase Medigap or Medicare supplement policies.

Medicare Advantage Plans (Part C)

If you opt to go with a Medicare Advantage Plan, you actually trade your traditional Medicare benefits for these plans. Many of the Medicare Advantage Plans are offered to eligible individuals at little or no cost other than continued payment of their Part B monthly premiums.

Medicare HMO's (Health Maintenance Organizations)

These plans cover the same physician and hospital costs as traditional Medicare, but usually with lower out of pocket costs. HMO's are attractive to Medicare eligible individuals because they often provide extra benefits like eyeglasses, hearing aids, and dental benefits which are not covered by traditional Medicare.

Individuals considering a Medicare HMO should be aware that they can only receive medical services from providers who are part of the HMO's network of contracted providers. The HMO usually requires that an individual joining their plan select a primary care physician from those who participate in their network. This primary care physician would then be responsible for all medical care including referrals to a specialist and admittance to a hospital. The HMO will not pay for unauthorized visits to specialists nor non-emergency care received outside the HMO's service area or visits to non-network physicians.

Medicare PPO's (Preferred Provider Organizations)

These plans are private healthcare plans like HMO's. However, PPO's and HMO's do differ into two very important areas. First, Medicare PPO's do cover eligible medical care services obtained from doctors and hospitals outside the PPO network. And, second, Medicare PPO's do not usually require that you obtain an authorization before seeking care from a specialist.

Regional PPO's are available in many areas of the country. These plans serve large geographic areas and must offer the same premium costs and plan benefits to all individuals residing in these areas. Medicare PPO's cover the same types of medical expenses that traditional Medicare does. In addition, Medicare PPO's commonly include a prescription drug benefit. Unlike traditional Medicare, Medicare PPO's have an annual out of pocket limit for benefits covered under Parts A and B of Medicare. The out of pocket limit caps the amount an individual can spend on covered medical expenses in a calendar year. As with any PPO program, when an individual uses a non-contracted provider for covered services, they will pay more out of their pocket.

Private Fee for Service (PFFS) plans

These plans are available to Medicare beneficiaries in exchange for their traditional Medicare Benefits. PFFS don't have a formal network of doctors and hospitals to choose from and not all doctors or hospitals are willing to provide medical services to participants in these types of plans. If an individual is considering enrollment, it is wise to check with their doctor and local hospitals to make sure that they will accept the plan's payment for services before enrolling. Also, the enrollee should thoroughly understand the benefits of a fee for service plan because the fee for service plans decide how much they will pay for Medicare covered services and may charge a higher cost sharing percentage than traditional Medicare. Private fee for service plans may include a prescription drug benefit. If they do not, the enrollee is free to join a Medicare stand alone prescription drug plan.

Special Needs Plans (SNP)

These plans are private plans that provide benefits to Medicare beneficiaries, including prescription drug coverage, who need additional help paying for their medical benefits. These would include individuals who qualify for both Medicare and Medicaid (MediCal in California), those residing in long term care facilities, and those with chronic or disabling medical conditions.

Medicare Prescription Drug Plans (Part D)

Prescription drug plans are available to all Medicare eligible persons regardless of medical history or income levels. When a person first qualifies for Medicare, their initial enrollment period begins three months before their 65th birthday, includes their birth month, and ends three months after their birth month. Otherwise, the annual open enrollment period for prescription drug plans runs from November 15th thru December 31st, with the coverage commencing on the following January 1st.

Medicare drug plans are designed to reduce drug costs for enrollees and protect against catastrophic drug costs. However, there is a monthly cost for these plans. In addition to a monthly premium, the covered individual is required to pay a percentage of the cost of the medications (or a copay) and Medicare pays part of the cost. Costs for a plan will vary depending on the medications taken and the type of plan selected. At a minimum, the plans available must provide a "standard" level of coverage.

For 2010, a standard prescription drug plan will have the following costs:

A monthly premium which varies from approximately $24 per month to in excess of $100 depending upon the plan selected and medications taken.

An annual deductible equal to the first $310 worth of prescription drugs.

After the annual deductible has been satisfied, the insured will pay the following amounts for the remainder of 2010:

25% of the cost for covered medications from $310 up to $2830 in charges, (the plan pays the other 75% of these costs); then

100% of the next $3842.50 in total drug charges (often called the donut hole or coverage gap); then

After exceeding the annual of pocket limit of $4550, 5% of your drug costs or a copay of $2.50 or $6.30, whichever is greater for the rest of the current calendar year.

This describes a "Standard Plan." Many of the prescription drug vendors do offer better benefit plans which forego the plan deductible and substitute copays instead of the 25% coinsurance. Generic medications are available for substantially less than brand names with these plans.

There is a penalty of 1% per month, using the average national premium, for non-enrollment/late enrollment, which is assessed for as long as they remain enrolled in the plan.

This has been just a brief overview of the benefits available to Medicare eligible individuals. For more detailed information, please consult the Medicare handbook, Medicare & You. The handbook is available by contacting Medicare at 1-800-MEDICARE or visiting the Medicare website at http://www.medicare.gov.

In addition, a copy is available at our website- http://www.waldenbrokers.com. Should you or your parents need assistance in selecting a Medicare plan, please feel free to contact us at 818-597-2890.

Edward Walden, CLU, RHU, REBC

Medicare Supplements and Medicare Advantage Plans Are Not the Same Thing

Medicare Advantage Plans, are health plans from insurance companies that have a contract with CMS (Center for Medicare and Medicaid). Individuals who have Medicare Part A and B are eligible to choose a Medicare Advantage plan. Specialized plans exist for people with certain health conditions, but beyond that the general plans are not allowed to decline based on health except for very specific reasons.

When an individual is enrolled in the plan they do not lose their Medicare. They are entitled to cancel their Medicare Advantage plan, and the next month, they can go back to original Medicare. While enrolled in Medicare Advantage, they will have to use the insurance card provided by the Medicare Advantage plan instead of their Medicare card.

These plans may cost the participants nothing, or very little, though many still require the Part B participation amount. A Medicare Advantage plan is not free however. The plans receive a contribution from CMS every month, instead of having that tax money go to original Medicare. That is how the bulk of the plan is paid for, from tax money.

Traditionally, Medicare Advantage Plans were thought of as HMO plans were an insured person had to use the plan hospitals, doctors, and other medical providers to be covered. Many Medicare Advantage Plans are HMO plans. However, PPO Medicare Advantage plans also exist. Fee for Service Medicare Advantage Plans, or plans that will cover any medical providers who accept the insurance, are being marketed aggressively these days.

Your own medical needs and preferences will determine which plan will work out well for you. If your current medical providers contract with the plan's HMO, then you may be very satisfied with comprehensive coverage with very little extra payments. If you like more choice, and area doctors will accept a Free For Service plan then you might consider an "Any Doctor" plan. Be aware that not all doctors work with the Fee For Service plans, even though the insurance company claims it will work with any doctor! A great compromise is provided by PPO plans. You get the greatest coverage at the lowest price inside the network, but will still be covered by other medical providers.

Most, but not all, Medicare Advantage plans also contain Part D, or prescription drug coverage. Medicare Advantage plans may have very low, or no, premium for the insured people beyond their normal Part B premium. Some plans even refund the Part B premium. Also, Medicare Advantage Plans are not allowed to do a lot of risk selection based upon health, so they may be a good choice for less healthy applicants.

A traditional Medicare Supplement is very different from Medicare Advantage. With Medicare Supplements you still use your original Medicare Card, and add your Medicare Supplement health card. These plans are also provided by insurance companies, but they simply supplement the coverage gaps and deductibles not provided by original Medicare Part A and Part B.

If you have Medicare Part A and Part B, your Medicare supplement plan will pay the portion of your medical bill that Medicare will not pay. Of course, Medicare supplement plans differ, and so you need to be aware of exactly which portions a Medicare Supplement plan will pay before you sign up. For instance, Medicare may be 80% of your hospital bill, and your supplement will pick up the other 20%.

Medicare supplements come with premiums, and also may exclude unhealthy individuals. However, they generally provide the broadest access to health care.

Choosing a Medicare health plan can be one of the most important decisions a Medicare beneficiary will make. Let us help you find the right plan to fit your needs, lifestyle, and budget.

Compare Supplemental Medicare Health plans with simple online zip code searches

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

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/

Medicare and Medicare Advantage Update 2010

Q. What are the changes to Medicare in 2010?

A. Medicare is made up of three parts: Hospital Insurance (Part A), Medical Insurance (Part B), and Drug (RX) Insurance (Part D). Part A Deductible for 2010 is $1,100 for a hospital stay of 1 - 60 days, $275 per day for 61-90 days, and $550 day for 91-150 days of a hospital stay (lifetime reserve days). After 150 days, you pay all costs for the hospital. Part A also includes Skilled nursing facility and some home health care but not long term care. Skilled nursing facilities is subject to a $137.50 per day co-insurance for days 21-100. Part B covers Medicare eligible physician services, outpatient hospital services and certain home health services and durable medical equipment. You pay 20% of the Medicare-approved amount after you meet the $155 deductible.

Part D coverage is for both short and long-term prescription needs not given in the hospital, coverage for both brand name and generic drugs and can differ dramatically from one company to the other. Part D is not deducted from your Social Security check.

Q. Can you explain the difference between a Deductible, co-pay(ment) and out of pocket.

A. The deductible is the amount you must pay for health care before Medicare begins to pay. These amounts can change every year. A co-payment is a partial cost you will spend to see the doctor. These can be zero or more. These are out of pocket which are costs that you must pay on your own because they are not covered by Medicare.

Q. What are the differences in HMO, PPO, PFFS, SNP and MSA plans?

A. Health Maintenance Organizations (HMO)- Just like the private sector, HMO is a group of doctors, hospitals and other care providers that agree to give health care to Medicare beneficiaries for a set amount of money from Medicare every month. You get your care from the provider in the plan.

Preferred Provider Organization (PPO)- Doctors, hospitals and providers that belong to the network and with most PPO plans, you can use doctors, hospitals and providers outside the network for an additional cost.

Private Fee for Service (PFFS)- These are sometimes referred to as regional PFFS since the doctor or hospital accepts payments from the insurance plan rather than Medicare. The Insurance plan decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare covered benefits.

Special Needs Plan (SNP) - A type of plan for people with chronic illnesses or conditions with special needs.

Medical Savings Plans (MSA) - A type of savings plan for those people who do not go to the doctor often but need a savings plan to pay some of the costs of the deductibles and co-payments.

Q. My Doctor takes Blue Cross but he does not take Medicare Advantage Blue Cross. What does that mean?

A. Medicare Advantage plans are a hybrid of coverage offered from an insurance company. When you are eligible for Medicare at age 65, you select Part C--Medical Insurance offered by a company. You still pay your premiums out of your social security check for Part B but the government pays the insurance company to administrate the benefits. These Medicare Advantage Plans appear to have many benefits and include Drug coverage (Part D). Medicare Advantage plans are the best of both worlds but they have some drawbacks. If your doctor is not a Medicare Advantage plan doctor, you will pay additional costs to see him/her but with most plans you can see another doctor (usually not available with HMO plan). You will be subject to separate deductibles and separate co-payments and often need a referral for approval before you can get care from the specialist. If you do not get a referral, the plan may not pay for your care.

Q. Since Medicare Advantage provides all Medicare health care through that plan, what if I don't like it? I have heard Doctors payments will be cut and the company I sign up with may stop insuring them. What protection do I have?

A. Since Medicare is a government provided plan for those 65 and older, you have many options for coverage. Every November 15 through December 31 you can switch from one Medicare Option to another--you can enroll in any Medicare Advantage or Part D at this time. This is called the Annual Enrollment Period. (AEP) Your new coverage would begin on January 1. From January 1 to March 31 Medicare members can make ONE plan change to a like kind. For example, you can change to another MA plan. The member CANNOT change Part D coverage during this time unless they have it with the plan they are leaving. This is called Open Enrollment Period (OEP). During Special Enrollment Period (SEP), members must enroll within 63 days of a special event. This is if you move outside the service area, move into or out of a long term care facility, loose credible prescription drug coverage, return to the US from another country or get assistance from the state in which you live, loose coverage under an employer or union either voluntarily or involuntarily.

Q. What other benefits do I get with a Medicare Advantage Plan?

A. You may get extra benefits by selecting a Medicare Advantage Plan. These may include vision, hearing, dental and/or health and wellness program including membership to a specific gym. Because you do not need to buy a Medigap or Medicare Supplement policy, the premium are supplemented by the government and are less expensive than a traditional supplemental plan.

Q. I hear there are many gaps in the Part D (Drug) coverage and I take 5 prescriptions a day. How do I get most of my drugs covered?

A. Every insurance company that offers Part D coverage has a written list of drugs. These include generic and brand name drugs. (Check the web sites or ask your agent for a printed formulary drug book.) Your plan may have several tiers and your co-payment amount depends on which "TIER" your drug is listed. Not all brand names will be covered and these can be very expensive if you have a high copayment or it is not listed. Always ask your doctor whether the drugs prescribed are available as generic. Be sure to ask your doctor whether you can split a high-dose version of the prescribed drugs as

they are often the same price as low-dose version or go to http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/MPDPFIntro.asp?version=default&browser=IE%7C7%7CWinXP&language=English&defaultstatus=0&pagelist=Home&ViewType=Public&PDPYear=2010&MAPDYear=2010&MPDPF%5FMPPF%5FIntegrate=N to compare drug plans in California.

Q. I like what I see--a policy issued by a leading insurance company that does not cost me the same as a Medigap or Medicare Supplement. Why should I buy a Medicare Supplement instead of a Medicare Advantage Policy?

A. That is a good question. If you can afford the individual premiums for a Medicare Supplement with a separate part D, you should do that. You can choose you own doctor as long as that doctor takes Medicare patients. Today many plans are a hybrid and some cost ZERO monthly premium and include a RX plans are also a PPO so people have the freedom of a PPO. As Seniors age, options and benefits become very important and we are here to help you decide which plan is best for you. Be confident in your Medicare Choices.

For the past 30 years, Karen Adams has been an independent insurance agent working primarily in Southern California. She has help hundreds of clients find the right insurance program to meet their needs. Rapidly approaching age 65, she decided to become as knowledgeable as possible about Medicare solutions. "I have written articles about Medicare Supplements and have insured clients who have reached Medicare age. Most Medicare Supplements (MS) are about the same and as long as a doctor takes Medicare he/she must accept the supplement their patient uses (not an HMO plan). Therefore, the advantage from one company over another is how easy they make their payment process, how patient orientated the company is, how large their network of Doctors and the premium they charge for the plan," says Karen. "Then came highly government regulated Medicare Advantage (MA) plans and the ball game changed. Now there is ZERO premiums with Drug coverage. What cost from $200 to $300 a month in premium in a supplement with a prescription drug card now appears to be free. What's that all about? Karen can help you untangle the web of MEDICARE insurance. Call her today or go to http://adamsinsuranceagency.com/ for your personalized quote.

Avoid Rising Health Care Costs With Medigap Insurance

New York medicare supplement coverage is a health insurance and it is generally sold by the private insurance companies. Their basic intention is to cover the gaps in expenses which are not covered by original medicare. There are 10 standardized medicare supplement plans that are currently available in New york, they are labeled A through N.

Though every Medicare insurer offers both the categories A and B, all the insurance companies do not cover all the standard plans of this coverage. Every standard supplement policy is bound to provide the basic core benefits like covering the cost of some of the Medicare co-payments and may be some other deductibles. Some of the companies offer some extra benefits which can be foreign travel and care taken during emergency or recovery care taken at home.

If a person wants to become eligible for medicare coverage in New York, then he will have to enroll in both Part A and B. The state law states that the insurance company will have to accept an enrollment application for coverage throughout the year.

The insurance company cannot deny any such enrollment application and also while making premium calculations the health condition of the individual or his claim history or medical condition cannot be considered as a factor.

Experts feel that New York citizens above the age of 65 must purchase a medicare supplement. Choosing the most suitable plan for you from the right company is really a very tricky matter. It has been seen that the premium may vary by a few hundred dollars from one company to another for the same set of coverage. It has also been seen that rates are varying due to factors like age and gender and the amount of coverage you need. There is no point in delaying taking the policy as in that case rates generally go up.

Let us consider the case of a person paying original medicare (Part A and B) and then having a Medicare supplement policy. At the first level, Medicare will pay their share of the approved amounts and Medicare supplement will pay for the rest of the health care cost of the individual. The medicare insurance policies need to be clearly noted as Medicare Supplement Insurance.

The benefits offered by New York supplement coverage policies are many. Some of them can be mentioned as inpatient hospital care, medical costs and first three pints of blood needed every year. But if you are enrolled in a Medicare Advantage Plan, there is no need to buy a medicare supplement.

View the original article here

How Do You Find the Best Medicare Supplement Insurance Plan?

As of January 1st 2006, 12 different medicare supplement insurance plans were made available to individuals that qualified for this type of coverage. The plans were all given alphabetical classifications. The classification scale ranges from plan A all the way to plan L.

Each of these plans offer different benefits in opposition to their other plans. Plan A, for example is the most inexpensive medical plan for an individual to obtain. While, on the other hand, Plan J offers the most benefits for people but is also the most expensive of the health care plans.

Be aware, that even though there were twelve different plans that were introduced to the health care industry, not every state offers all of these options to seniors seeking health coverage. Massachusetts, Wisconsin and Minnesota have their own plans, however the benefits are generally the same as the twelve advantage plans offered to seniors throughout the remaining 47 states.

The best time to purchase one of these insurance plans is six months after you have been enrolled into a Medicare Part B arrangement. During this time period, insurers are basically forced to accept you as a client, regardless of any pre-existing health care problems that you may have had.

In regards to the amount of funds that you may be asked to render for one of these policies, there are three things you need to be aware of. You need to remember that paying a higher premium for your coverage, does not constitute that it is better for you. Whichever company that you decide to go with, will pretty much end up giving you the same benefits. However, the key thing is finding a company that can attend to your budget needs as well.

Also, just like everything else in this world, Medicare premiums will increase overtime in order to keep up with inflation. You also need to have a keen knowledge regarding the three different methods that these agencies use to set their premiums.

Companies will review over the attained age of an individual, their issue age as well as where the person resides. Typically, the attained age for an individual to be able to receive Medicare is 65. As the person begins to age, their premiums will begin to increase as well.

All premiums are based on your age when you receive coverage. Basically, the older that you are the more money you will be asked to render for a particular policy. Also, people that live around each other will be asked to submit the same amount of money for their coverage. If a company decides to take advantage of community-rated policies, everyone regardless of their age will be able to receive coverage.

View the original article here