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

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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

What Can Be Done About Climbing Medicare Premiums

It is inevitable that Medicare insurance premiums will increase along with inflation, but there are a few things we all can do to help keep costs down. Although it is true that a majority of doctors and health care providers abide by the rules and are trustworthy, there are also a few people that work the system each year for literally millions of dollars. The direct result has been a rise in health insurance costs, system wide.

Medicare is an insurance program that is provided through the United States Government. It extends medical coverage for those who are 65 and older and those that are disabled even when they’re under 65 years old under some conditions. An excess of one billion claims are processed every year, and without doubt it’s turned out to be the biggest provider of managed health care in the U.S.

The Medicare program has gotten more complex and involved every year, and the recent developments have added an influx of private health insurance providers into the mix. Medicare covers millions of members and manages more than a billion transactions every year. With this level of care comes shortcuts, mistakes and bureaucracy. As a result of this, Fraud and exploitation of Medicare have become system wide.

Quite often, errors in Medicare claims result from honest mistakes instead of Medicare fraud. There could very well be transcription errors or typographical errors. After all, Medicare insurance providers are human, and dealing with mistakes where there is so much paperwork and so many forms is pretty normal. In a situation like this, it’s important that you speak with someone at your doctor’s office and discuss any errors you have found.

But if you discover that your physician is actually charging your insurance for services that are customarily free, or if you find that your doctor’s office is sending out bills for a procedure that you don’t recognize, make sure to take a careful look at it. It may very well be a case of Medicare fraud, which happens to be is one of the main reasons for escalating Medicare costs.

Medicare Fraud Can Come In A Number Of Forms

* You may be charged for products and services that you never get.

* You may be charged for more services than you were actually provided.

* Over-billing or…

* Billing for medical equipment and supplies that were returned.

How To Deal With Medicare Fraud

Review all paperwork and forms you get from Medicare for anything that’s connected to health care. Essentially, the responsibility is yours to catch omissions, errors and even fraud if you suspect it might be happening. If you do so, you can do your part to keep medical insurance premiums at a minimum. We’re all in this together.

The escalating costs of Medicare have been the cause of a good deal of concern from the government, and they’re doing all they can to counter Medicare fraud. Because of that, providers of Medicare are dealing with only private health care providers who have shown integrity and trustworthiness. Those that try to cheat the system are being knocked out.

The fight has been carried out by Medicare service providers like doctors and hospitals, Centers for Medicare and Medicaid Services (CMS), Medicare patients as well as law enforcement agencies and consumer protection agencies. You can also help by thoroughly looking at at your own bills.

The bulk of members of Medicaid facilities do pay close attention to the bills and statements to fight climbing Medicare premiums. To help their efforts you should review your bill for things such as an incorrect social security number, extra charges, services not provided but billed, etc. Those are just some of the things you can be aware of if you want to help counter Medicare fraud and increasing Medicare premiums.

Helpful Tips For Medicare Part d

Government prescription coverage explained

Visit our website for a simplified explaination or Medicare Part d

Medicare Insurance

The Medicare Advantage Program – How Can it Help Me?

If you are eligible for Medicare, you might want to look into Medicare Advantage programs as well. Formerly known as Medicare +Choice, Medicare Advantage is the private insurance option of Medicare. It offers participants the choice of using a private insurance plan instead of Medicare itself. Since Medicare’s for-fee services and restrictions can be significant, particularly in the case of prescriptions, providing people with this option allows many people to get better health insurance coverage with more benefits and lower out-of-pocket costs. And, because the cost of these plans is determined by competition among providers, you can often find an inexpensive plan that covers your needs, becoming an excellent alternative to Medicare itself.

Medicare Advantage (also known as Medicare Part C) allows you to sign up for a HMO or PPO plan…or Fee For Service (FFS) or a Medical Savings Account (MSA)…whatever fits your needs best. Or not. You are not forced to use a private insurer if you feel that Medicare’s coverage is adequate for your needs.

In the past, a Medicare Advantage plan also included the opportunity for much better prescription coverage. However, with the passage of the Medicare Part D prescription plan instituted in 2006, Medicare recipients now must sign up for a private prescription plan, even if they do not sign up for anything else but basic Medicare. However, should you opt for a Medicare Advantage plan, you will find that most companies offering such plans also offer Part D prescription plans. Indeed, you might find it advantageous to get both because the additional cost may be minimal. However, be aware that, while Medicare Advantage plans are standardized, Part D prescription plans are not. So do not sign up for a joint plan automatically. Make sure your prescription plan meets your needs. There are no restrictions on having one plan with one company and the other with another company.

If you do not have medical problems, do not go to the doctor for more than an annual checkup, or otherwise rarely use medical services, a Medicare Advantage plan may not be for you. However, if you have a pre-existing condition, a Medicare Advantage plan may save you significant money in the long run by reducing out-of-pocket costs and because, except for end-stage kidney disease, preexisting conditions do not prevent you from enrolling, although you may need to choose a special needs plan.

If you are interested in looking into Medicare Advantage plans in your area, you can start by going to http://www.medicare.gov/Choices/Advantage.asp

For more information on Medicare benefits and other Medicare application tips, you should visit http://www.medicare-benefits.com today!

Information on Medicare

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

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

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

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

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

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

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

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

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

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

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

Medicare in California

Can I Enroll In A Medicare Advantage Plan If I have Already Other Health Insurance Coverage?

If You Have Other Coverage with your employer, union, or Indian or Tribal Health Program benefits, you need to talk with the plan administrator about their rules before you enroll in a Medicare Advantage Plan.

In some cases, joining a Medicare Advantage Plan might cause you to lose your other health care coverage, or if you drop your employer or union coverage, you may not be able to get it back.

Make sure to carefully explore all your Medicare health insurance options and compare Medicare Advantage Plans to make sure you select the plan that best suits your needs and your budget.

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.

Medigap Options

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.

Why purchasing Medicare supplement plan right when you turn 65 is a good idea

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.

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 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.

Bipartisan Deficit Commision Unlikely To Make Big Medicare Changes

Topics: Health Costs, Medicare

Oct 01, 2010

National Journal: "For all of the attention surrounding President Obama's bipartisan commission on deficit reduction, the country's biggest cost centers — health care in general and Medicare specifically — will likely remain unscathed when the panel offers its recommendations in December. The reason is simple: When congressional Democrats crafted the health care reform package, which became law a little more than six months ago, they did so by squeezing Medicare as much as they could politically … The Democrats' nifty feat of taking out more than $500 billion from Medicare, mostly by reducing provider payments and changing how the system pays private health insurance companies, has handcuffed the Republican budget hawks who serve on the panel. The cuts have left them nibbling around the edges in an attempt to reduce the nation's $2.5 trillion health care tab" (DoBias, 10/2). This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

View the original article here

Will Health Care Reform Kill Medicare Advantage?

It has been six months since the highly contested Patient Protection and Affordable Care Act, also called health care reform, became law. Polls show that people remain worried about how the law will affect their health care. There is a lot of talk about big cuts in Medicare, and seniors are worried their coverage will be reduced or that their doctors will no longer accept Medicare. Should they be worried?

The worst news is for people who love their Medicare Advantage plans. This program pays private insurance companies to enroll seniors in managed-care networks. Many plans offer more benefits than "plain" Medicare, such as dental and vision coverage and health club memberships.

The problem with Medicare Advantage is that taxpayer's aren't getting their money's worth from the program. Much of the recent increases in Medicare costs can be traced to overpayments to insurance companies offering the subsidized plans.You've heard that Medicare is going broke? Well, Medicare Advantage is a big reason for that.

A Medicare Advantage benefit costs the government 14 percent more than exactly the same benefit offered through regular Medicare. In some parts of the country, the difference is as high as 20 percent. That extra money is being eaten up in marketing and administrative costs, and in profits to the insurance companies.

According to the U.S. Department of Health and Human Services, all Medicare beneficiaries, including those enrolled in regular Medicare, are paying for these overpayments through higher premiums. HHS says that this year these subsidies are adding about $3.60 per month to premiums.

But there is no proof that the program is providing better health care than regular Medicare; just that it's more expensive. And for this reason, most of the cuts to Medicare provided in the health care reform law are cuts to Medicare Advantage, not regular Medicare.

These cuts won't go into effect all at once. In 2011, the subsidy going to private insurance companies will be frozen at 2010 levels. After that, the payments will be reduced an average of 12% per year, until costs are more in line with the cost of regular Medicare. Beginning in 2014, the private insurers offering Medicare Advantage plans must maintain a "medical loss ratio" of at least 85%, which is a fancy way of saying that 85 percent of the subsidies and premiums they receive must be paid out in benefits. On the other hand, companies that meet certain benchmarks for quality of service are eligible for a bonus.

Bottom line: according to the Congressional Budget Office, by 2019 the private insurance companies offering these plans will receive $136 billion less than they would have received at the current level of subsidy.

Naturally, the private insurance companies do not like this one bit, and they say they will drop out of the program if these cuts aren't repealed. And when those Medicare Advantage taxpayer subsidies stop being a cash cow for those companies, they might very well drop out of the program. Companies that stay in the program probably will eliminate some of the extra benefits that make Medicare Advantage popular.

Some seniors will be unhappy about this, but it's important for them to understand why it is happening -- Medicare Advantage as it is has been dragging the entire Medicare program closer and closer to bankruptcy.

Before the Medicare program began in 1965, only 56 percent of people over age 65 had any health insurance. Today, without Medicare, the percentage of seniors with health insurance would be very tiny, indeed. It's a sad fact that in our autumn years, nearly all of us will suffer increasing problems with our health. Some ailments -- arthritis, heart disease -- are common, and some are rare, such as mesothelioma cancer, rarely diagnosed before the patient is 50. Either way, senior health care is expensive, and private insurance companies don't want seniors as customers -- unless taxpayers are supplying the profits.

In 2009, while health care reform was being hotly debated in Congress and town hall meetings all over America, some insurance companies deliberately misinformed their customers about what the bill would do to their Medicare Advantage Plans. One major Medicare Advantage provider sent out a letter to its Medicare Advantage customers claiming that Congress and President Obama would cut "important benefits and services" provided by Medicare.

Remember the stories about silver-haired grandmothers marching in protests with signs saying "Keep Government Out of My Medicare"? People laughed at them, but it's possible those were misinformed Medicare Advantage customers.

But the Patient Protection and Affordable Care Act is not cutting any benefit from Medicare. In fact, it is adding a few new benefits. Beginning this week, Medicare patients will not have to pay a co-payment to the doctor for preventive care or for an annual checkup. The health care reform law also will gradually close the infamous "doughnut hole," the gap in Medicare Part D prescription drug coverage that costs some Medicare patients thousands of dollars every year.

Last year, the trustees of the Medicare program announced that by 2017, the part of Medicare that pays hospital bills would be out of money, and Medicare would have to stop paying those bills. This year, the same trustees said the hospital fund should be good until 2029, thanks mostly to the health care reform bill. This tells us the struggle to save the program isn't over, but we're moving in the right direction.

As we get closer to the November midterm elections, watch out for politicians citing the cuts to Medicare Advantage as a reason to repeal the health care reform bill. Without those cuts, Medicare itself is in grave danger.

Barbara O'Brien is a concerned citizen who writes the popular political blog, The Mahablog.

What is a Medicare Supplement?

A Medicare Supplement (also called "Medigap Insurance") policy is private health insurance specifically designed to supplement the Original Medicare Plan. This means it helps pay some of the health care costs ("gaps") that the Original Medicare Plan doesn't cover (like coinsurance and deductibles). Medicare Supplement policies may also cover certain things that Medicare doesn't cover. If you are in the Original Medicare Plan and you buy a supplement policy, then both plans will pay their share of the Medicare-approved amount for covered health care costs. Medicare Supplement policies are sold by private insurance companies.

A supplement policy is not a "Medicare Advantage" (like an HMO or PPO) because it's not a way to get Medicare benefits. Insurance companies can sell you only a "standardized" Medicare Supplement policy. Standardized supplement policies are identified by letters (A through L). In some states, like Texas or Louisiana, you may be able to buy another type of Medicare Supplement policy called Medicare SELECT. Each type of supplement policy offers the same basic benefits, no matter which insurance company sells it. Usually the only difference between policies sold by different insurance companies is the cost. Medicare Supplement policies must follow Federal and state laws. These laws are designed to protect you.

What Medigap Policies Do Not Cover

Medicare Supplement policies do not cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, and private-duty nursing. Any new supplement policy is guaranteed renewable. This means the insurance company cannot cancel your policy as long as you pay the premium. Although some policies sold in the past covered prescription drugs, no new Medicare Supplement policies are allowed to include prescription drug coverage. If you want prescription drug coverage, you may want to join a Medicare Prescription Drug Plan (Part D) offered by private companies approved by Medicare.

When is the Best Time to buy a Medicare Supplement?

The best time to buy a supplement policy is during your open enrollment period. This period lasts for 6 months and begins on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. During this period, an insurance company can't use medical underwriting. This means it can't refuse to sell you any supplement policy it sells, make you wait for coverage to start, or charge you more for a policy because of your health problems. If you buy a supplement policy when you have a guaranteed issue right, the insurance company can't use a pre-existing condition waiting period at all.

Note: You can send in your application for a Supplement policy before your open enrollment period starts. This may be important if you currently have coverage that will end when you turn age 65. This will allow you to have continuous coverage. It is very important to understand your open enrollment period. During this period you can buy any supplement policy the company sells. If you apply for coverage outside of your open enrollment period, there is no guarantee that an insurance company will sell you a policy. After your open enrollment period ends, insurance companies are allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the policy.

Comparing Medicare Supplement costs

The cost of supplement policies can vary widely. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. As you shop for a policy, be sure you are comparing the same type of Supplement policy.

What is Medicare SELECT?

There is another type of supplement policy called Medicare SELECT that is sold in some states, including Texas and Louisiana. Medicare SELECT can be any of the standardized Supplement Plans A through L, however, you must use specific hospitals and, in some cases, specific doctors to get your full insurance benefits (except in an emergency). Medicare SELECT policies generally cost less than other Medicare Supplement policies, however, if you don't use a Medicare SELECT hospital or doctor for non-emergency services, you will have to pay some or all of what Medicare doesn't pay. Medicare will pay its share of approved charges no matter which hospital or doctor you choose.

What is The Best Way to Find the Correct Medicare Supplement? The best way to find the best policy for your particular situation is to consult a professional who specializes in Medicare Supplements.

David Hecker is a Licensed Insurance Agent based in Longview TX. He specializes in Medicare Products. He is licensed in Texas, Louisiana and Arkansas. He can be reached at (903) 918-9091. E-mail: dhecker@cablelynx.com or on the web at: http://www.tx-medicaresupplement.com To receive your "Free" e-mail newsletter about Medicare Supplements, send an e-mail request to: dhecker@cablelynx.com

What Medicare Does and Does Not Pay in 2010

A summary of seniors medicare benefits for 2010:

Considering the fact that most seniors live on a very tight budget, what medicare will and will not pay for medical cost is a major concern for most seniors. Unfortunately, the government is on a yearly basis increasing the medicare premiums and reducing the benefits medicare will pay. This brief article will outline in general the present state of medicare and what medicare will and will not pay in 2010. The article will also discuss briefly the various alternatives available to seniors to fill in the gaps on what medicare does not pay and expects the senior to pay out of pocket.

Medicare Abc's: 2010

Medicare has four areas of coverage: ABCD

Medicare Part A: Hospital Expenses.. If a senior is in the hospital for 24 hours medicare will pay for all hospital cost for the first 60 days after a $1100 deductible. ( note, this deductible is reinstated every 60 days for subsequent admissions or possibly six times a year).

61-90 days- The senior has to pay $275 per day

91-150 days- The senior pays $550 per day

After 150 days- The senior pays 100%

Medicare Part B: Doctor's cost( visits-surgery), including lab test, xrays,etc.

If already enrolled in Part B, the monthly cost for Part B is $96.40, usually deducted from your social security check. If a new enrollee in 2010 the cost is $110 per month..And increases if your income exceeds $82,000

Under part B medicare will pay only 80% of the cost and the senior pays the additional 20%.

Part C: Under Part C the senior can enroll with one of many carriers that will help fill in the gaps where medicare does not pay. It is called Medicare C Advantage Plan. The premiums are relatively low or nothing. However, under a Med C you can expect deductibles, co-pays, waiting periods,etc. Also Med C plans are run like group health plans where the carrier dictates the doctors, the place, the time etc of your medical care much like PPO's and HMO'S.

Part D: Prescription coverage. Briefly, the premium for Part D coverage is relatively inexpensive. However, unless you are taking some very expensive drugs, many national drugs stores offer very inexpensive drug programs to seniors.

Supplemental Coverage: A number of private carriers offer Medicare supplemental coverage. Supplemental meaning coverage that fills in the gaps that Medicare does not pay under Part A and Part B above. In others words, supplemental payments for the co-pays and deductibles previously discussed regarding Part A and Part B that the senior has to pay out of pocket.

Supplemental Coverage VS Part C coverage. As previously stated, Part C coverage by a private carrier is administered much like group health with co-pays, deductibles and a selection of their doctors. Supplemental plans vary in coverage and the yearly supplement premium is based on the degree of coverage.Ther are supplemental plans that pay all of the cost medicare does not pay under Part A and B to plans that may have a $2000 yearly deductible. The advantage of the supplemental plans is that you have control over which doctors you go to,anytime and anywhere. Of course the less you have to pay for coverage of the un-paid medicare cost the more your supplemental premiums will cost. Keep in mind that regardless of the cost for supplemental coverage, the premiums are far less than traditional non-medicare major medical coverage, and with better benefits.

Also, regardless of your pre-existing medical conditions most people have the opportunity to qualify for medicare supplements, so if you are turning 65 be sure to discuss the various supplemental medicare plans available and enroll when the pre-existing conditions are not a factor.

Obviously, this has been a very general overview of Medicare 2010, but hopefully outlines the medicare coverage and supplemental coverages available. And keep in mind that medical coverage is so critical to any senior that it is imperative to consult with an insurance professional in your state to know what alternatives are best for you.

If you have any questions about this issue please contact me at my website and I will direct you to an insurance professional in your area. Hopefuly this brief summary has been helpful and beneficial.

David Burlison, JD and licensed insurance producer in the state of Tennessee
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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 Part What?

Are you confused by Medicare? If you are, you are not alone. When you first begin to learn about Medicare, you are confronted with a whole new set of information. There is Medicare Part A, Part B, Part C, Part D.

If that were not confusing enough, you can add Medicare Supplement insurance to your new knowledge base, and you have a whole new set of Parts (or at least plans). Medigap Plan A, Plan B, Plan C, all the way through Plan L. Now, in 2010, that whole structure is changing yet again.

An then, to add insult to injury, even if you learned how to decipher all of these Medicare Part something or others, you still need to have a basic knowledge of health insurance terms. Deductibles, co-insurnace, co-pays, etc. ad nauseam.

The truth is, if you are like most people newly qualifying for Medicare, you don't care about becoming an expert in Medicare, but you would like to know at least a little about the system that will cover you, perhaps for the rest of your life.

Following is a very simple primer, in which I give you everything you need to know and probably care to know.

Medicare Part A

Part A is the Medicare Part that pays for in-patient hospital expenses. The way I like to remember it is that it pays your expenses (A)fter you get (A)dmitted.

Medicare Part B

Part B is the Part of Medicare that pays for most out-patient expenses like visits to your doctor. The way I like to remember it is that it pays for your expenses (B)efore you get admitted to a hospital.

Medicare Part C

Part C is that Part of Medicare that insurance companies to manage your health care (instead of Original Medicare). You probably know someone who accesses their Medicare benefits via an HMO, or network. That person is most likely participating in a Medicare Advantage Plan (which is another word for Part C).

Medicare Part D

Part D is the Part of Medicare that provides insurance plans for your prescription medicines. This one is easy to remember also. Part D stands for (D)rugs.

I should note that you can't access Parts C & D directly from Medicare. As of this writing, you have to participate in these parts through a privately contracted insurance company.

For example, both Company ABC and Company XYZ offer Medicare Advantage Plans (Part C). You have to enroll with those companies to participate. Every company that offers these plans, is highly regulated and works closely with Medicare.

The same goes for Part D. Both Company ABC and Company XYZ offer Prescription Drug Plans. You have to get your drug coverage through a company that sells one of the plans.

Speaking of plans, what about all of those Medigap Plans? A,B,C,D,E, Etc.?

A Medicare Supplement Plan is also known as a Medigap Plan, because it "fills in the gaps" left by Original Medicare. Remember all of those insurance terms? Deductibles, Co-insurance, etc. These plans (also available only through private insurance companies) pay for some or all of your share of the cost. The plan letter, like "A" or "F" simply have to do with the level of coverage you desire.

So that is all for this primer. I have a 4 year old, and if he walks in any time soon, I am sure I will be tempted to sing that tune... "Now I said my ABC's, won't you sing along with me?"

Get help now with the Medicare Part that is confusing to you. Go now to: MedicareNational.com

At MedicareNational.com, our goal is to help you feel secure, save money and get the plan that is right for you. We Make Medicare... Easy!

Understanding Medicare - Comparing Medicare Part B and Part D

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

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

Coverage differences

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

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

Types of medications generally covered by each plan

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

- Allergy injections

- Blood products, such as plasma protein

- Hemophilia drugs

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

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

- IV flushes, including Heparin and Saline solutions

- Pneumonia vaccines ordered by a doctor

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

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

Medicare Part D may cover the following types of medications:

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

- Medications subscribed for short-term medical conditions

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

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

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

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

Understanding Medicare

What Is Medicare?

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

How Does Medicare Work?

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

How Do I Get Medicare?

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

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

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

Medicare Supplement Insurance

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

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

Should I Purchase Long-Term Care Insurance?

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

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

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

Information on Medicare

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

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

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

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

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

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

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

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

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

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

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

Medicare in California