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.

The New Medicare Prescription Drug Plan Pitfalls

Coverage for the New Medicare Prescription Drug Plan begins on January 1, 2006. Many seniors are feeling confused and concerned about this plan. Here are some of the pitfalls associated with this plan that Medicare eligible individuals will want to be aware of.

1. To join the Medicare Prescription Drug Plan (Medicare Part D) you must choose one Prescription Drug Plan from dozens of plans that are available (there are up to 50 plans in some states). Once you have chosen a plan you are "locked-in" until the enrollment period the following year.

2. Prescription Drug Plan (PDP) providers can change the particulars of their plans at any time with a short warning period for plan enrollees. These changes can include changes to which drugs are covered under the plan, which pharmacies are in the plans network, the charges associated with being a part of the plan and any other detail of the plan. These changes are at the discretion of the plan administrator and can be implemented at any time.

3. For 2006, once you have used $2250 worth of medications, you are 100% responsible for paying for the full amount of the drug until you reach the $5100 Catastrophic coverage limit. This range between $2250 and $5100 where you have to pay for 100% of your drug expenditures is known as the "donut hole".

4. At its greatest level of savings Medicare provides a 49% savings. This is only 7% better than the average savings experienced with a licensed Canadian pharmacy. This greatest savings occurs when people spend exactly $2250 on medication in one year (if you spend more or less than that the savings go down). That means that the greatest savings anyone on Medicare can experience above a Canadian pharmacy's average savings is $157.50 annually (7% of $2250) or $13.13 a month. Is $13 a month worth the risk of being "locked-in" to paying monthly premiums for a plan that can be switched on you at any time. (Note: Some people can save more than 49% if they spend well over $7100 per year. This is in the catastrophic coverage range).

5. If you do not sign up with at Medicare Prescription Drug Plan before May 15th, 2006 then you will be penalized with a cumulative 1% increase to your premiums for every month that you do not enroll in a plan after that date. This penalty is the governments way of forcing people, who do not really need a drug plan, into joining a plan and thus "subsidizing" the Medicare program. 1% of the average plan is 32 cents. So for every month after March 15th, 2006 that people are not in a plan, 32 cents will be added to your monthly premium or basically $1 for every 3 months you do not join. This penalty is however applied to your premium for all future monthly premiums. What many seniors groups are advocating is for people to wait until the May 15th, 2006 deadline and then join the cheapest possible plan (approx. $10 monthly premium) and still order medicines from a licensed Canadian pharmacy like Universal Drugstore.

6. Average monthly premiums, the annual deductible and the Out-Of-Pocket expenditure limits are expected to increase substantially every year. This means you will be required to spend more and more money every year that you are part of the Medicare prescription plan.

7. Unless you are spending more than $800 on medications in 2006 there is no real savings with the Medicare Prescription Drug Plan. This required minimum amount of expenditure to experience savings will increase every year as the annual deductible, the monthly premiums and the Out-Of-Pocket expenditure limits are also increased every year.

8. It will be extremely time consuming and difficult to decipher myriad plans available in each state (all providing different coverage) and to try and figure out which plan is best for you personally. This will be twice as hard for a couple as the prescription drugs used by each person in the couple will be different and therefore they may require different plans. Even once a plan is chosen, there is still the risk of having the plan changed once you have made your decision and you are "locked-in".

9. Drug companies stand to make a ton of money off of the Medicare program. That is why they spent millions of dollars lobbying to get the legislation passed to make Medicare Part D a reality. It is also why Senator Bill Tauzin, a major advocate and motivating force behind getting the Medicare Prescription Drug Plan passed, is now a $2 million a year executive in Big Pharma's trade organization. On Sept. 5, 2003, Sen. John R. McCain (R-Ariz.) told the New York Times, "There's no doubt in my mind that the drug industry got everything it wanted and more," he said. "It perhaps should be called the 'Leave-No-Lobbyist-Behind Bill.' "

10. Plan providers have the ability to negotiate better drug pricing with the drug companies but they do not have to pass the savings on to the consumer or the government.

11. If you join a Medicare Prescription Drug Plan (PDP) at any time after Dec 31, 2005 your coverage is not available to you until the first day of the following month.

12. Action is required to enroll in Medicare Part D (the Prescription Drug Plan part) unlike Medicare parts A and B which are automatic. You are not simply enrolled in the best plan for you. You have to wade through piles of information to decide what is best for you.

13. It is very difficult for persons who qualify for Medicare Part D to be sure if their drugs will be covered under their plans formulary (which can change at any time anyways.) A formulary is a list of drugs covered under particular drug plan.

14. You may not qualify for Medicare Prescription Drug Benefits if your annual income is too high or if you own too many assets.

15. Different plans will have different monthly premiums. The plan you need may have a really high monthly premium. $32.20 is simply the "predicted" average monthly premium.

16. Will your plan cover temporary-use medications (such as antibiotics or heartburn medications) or only chronic medications (such as drugs used for diabetes or heart conditions)?

17. Plans with lower monthly premiums may have higher deductibles and co-pays.

18. Payments for drugs which are not on your plans formulary are not counted towards your Out-Of-Pocket expenditure limit.

19. Payments made by insurance plans do not count towards your Out-Of-Pocket expenditure limit

20. Is your regular pharmacy included in your plans network of pharmacies? Like many people you have most likely come to rely on a pharmacist that knows you and your medical conditions well. However, you may be forced to go to another pharmacy if your pharmacy is not included in your plans network of pharmacies.

21. How many days of medicine can you get at one time? Do you need to keep going back to the pharmacy every month or can you get 90 days?

22. Will your drug be covered by your plan the next time you go into your pharmacy?

23. Does your plan require step-up therapy or prior authorization? Step-up therapy means using drugs in a series of stages or steps in order to treat your condition. For example if you have GERD your plan may not cover Nexium unless you have previously tried ranitidine (Zantac) and/or omeprazole (Prilosec) first. Prior Authorization means that for certain drugs, your plan will not cover the drug without first reviewing your medical and drug history to determine if your treatment steps have been appropriate.

24. The Prescription Drug Plan providers stand to make a ton of money from the Medicare program (drug companies stand to make the biggest windfall).

25. Net cost to the government for Medicare Prescription Drug Benefits is estimated to go from $37.4 Billion in 2006 to $109.2 Billion in 2015 (estimate by Health and Human Services department). However, much higher estimates of the costs of Medicare Part D can also be found from non-government resources. Two years ago Congress reluctantly approved for the plan at a cost of no more than $395 billion dollars over 10 years. A few months later the cost ballooned to $534 billion and earlier this year it shot to $795 billion. Big Pharma is the biggest recipients of the increased dollars added to the costs of this program.

26. Plan may force you to use generics when you are used brand name medications and may not be able to tolerate generic versions.

27. The appeals process for some plans is very confusing and convoluted. (You can appeal to your plan if your drug is not covered.)

28. Many of the big pharmaceutical companies are now making anyone eligible for Medicare Part D, ineligible for their assistance programs. These companies are effectively forcing seniors into a "voluntary" program that may not be right for them. The AstraZeneca Foundation was the first to take such steps.

29. Many people are finding it difficult to obtain accurate, updated lists of what medications each plan will cover.

30. Medicare's own hotline can only answer general questions. For more specific questions you must contact each individual insurance provider.

31. Many people have waited 30 minutes or more when calling the Medicare hotline to get information that they need.

32. Rep. Dan Burton (R-Ind.) in a 60 Minutes segment televised March 14, 2004 said, "Seniors, when they find out what's in that bill, are going to be very angry. The problem is, they're not going to find out about it until after this next election."

Jeremy Cockerill is a licensed Canadian pharmacist who owns and operates htttp://www.UniversalDrugstore.com/ , one of the top Canadian mail-order pharmacies. Mr. Cockerill graduated from the Faculty of Pharmacy at the University of Manitoba with Honors in 1998. Mr. Cockerill recently won the 2005 Manager of the Year award from the Manitoba Customer Contact Association. Mr. Cockerill has been studying the new Medicare Prescription Drug plan since early 2005.

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.

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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!

The Medicare System and Senior Citizens

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

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

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

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

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

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

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

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

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

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

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

Medicare Supplement Insurance Helps With Expenses Not Covered by Medicare

Just when you are ready to relax and enjoy retirement, you realize that medical insurance has become even more complicated. You're presented with Medicare Advantage Insurance, Medicare Supplement Insurance (also called Medigap Insurance), and Medicare Part A, B, and D. What's it all mean?

Let's Start at the Beginning

Medicare is divided into four parts. Part A deals with home health care, hospice, hospital, and skilled nursing care. Part B handles doctors' services, other medical services, and supplies not covered by Part A. Part C allows you to receive Medicare benefits through private health insurance (Medicare Advantage Insurance) in place of Parts A and B. Part D provides prescription drug coverage.

What Is Medicare Advantage Insurance?

With a Medicare Advantage Plan, generally all of your Medicare-covered health care is provided through that plan, which can include prescription drug coverage. These plans may offer more benefits, and lower co-payments than Medicare Part A and B.

Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), private Fee-for-Service Plans, and Medicare Special Needs Plans.

Private Fee-For-Service plans are offered by state-licensed risk-bearing entities with yearly contracts to provide Medicare benefits. They may also offer additional benefits, and do not usually require you to use a network of providers.

Special Needs Plans focus on certain vulnerable groups, such as those who are institutionalized, are dual-eligible, and/or have severe or disabling chronic conditions.

What Are HMOs?

Doctors, hospitals, and insurers participate in HMOs, which provide medical treatment on a prepaid basis. HMO members pay a fixed monthly fee regardless of how much care is needed in a given month. Most HMOs provide a wide variety of services, but members must usually obtain medical treatment from in-network facilities and physicians.

With HMOs, you must see a primary care physician before you can see a specialist. Rather than paying a percentage of the bill every time you receive medical care, you pay a fixed monthly fee, and HMOs often have nominal co-payments rather than deductibles. HMOs generally do not limit lifetime benefits, but will not pay for non-emergency care from a non-HMO physician.

What Are PPOs?

PPOs are made up of doctors and/or hospitals that provide medical services only to a specific group or association at discounted rates. PPO members pay for services as they are rendered, and are generally reimbursed for treatment costs minus co-payment percentages. Physicians may submit bills directly to insurance companies so members pay only a co-payment.

PPO members are not required to seek care from PPO physicians, but members may receive 90-percent reimbursement for in-network care as opposed to 60 percent for non-network treatment. PPOs may also require a deductible. You may have to fill out paperwork for reimbursement, and most PPOs have larger co-payments than HMOs.

You must have Medicare Part A and B to join a Medicare Advantage Plan. You will have to pay a monthly Part B premium, and may also have a monthly premium for the Medicare Advantage Plan for the extra benefits it offers.

When you join a Medicare Advantage Plan, your Medicare Supplement Insurance or Medigap Insurance will not pay co-payments, deductibles, or other cost sharing under your Medicare Health Plan.

What Is Medigap Insurance?

If you do not have a Medicare Advantage Plan, Medigap Insurance can cover expenses that Medicare does not cover. When you have Medicare and a Medigap policy, both pay their share of covered health care costs.

Medigap policies must have standardized benefits, but costs can vary. You may be able to choose up to 12 different Medigap policies (Plans A through L), which have different sets of basic and extra benefits. The benefits of any Medigap Plan (A through L) are the same for every insurance company, and companies choose which policies to offer.

Generally, you must have Medicare Part A and B to buy Medigap Insurance. You will pay a monthly Part B premium, and a premium for the Medigap policy. Medigap Insurance will not cover your spouse, so you both need separate policies.

With some basic insight into how Medicare works, you can select the Medicare Advantage Insurance or Medicare Supplement Insurance that best fits your needs. If you have questions, expert advisors are available online to answer questions, and explain terms. These types of plans can make your retirement more secure so take advantage of sources that can answer your questions before you need Medicare.

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.

Medicare Supplement - Common Terms

Medicare Supplement plans plug the Medicare holes so you do not have the out of pocket costs Original Medicare will leave you with. So let us talk about some of the common terms you need to be aware of with Medicare and a Medicare Supplement plan:

Common Terms:

California Open Enrollment - (Unique to California) the ability of a Medicare Supplement member to switch to another company each year on the month of their birthday. This is a guaranteed issue option. You cannot be denied the transfer because of health status.

Original Medicare - Run by the Federal government and provides both Part A and Part B coverage.

Medicare Part A - is the hospital coverage Medicare pays for. You are responsible for the $1,100 deductible each benefit period (60 days) you enter a hospital.

Medicare Part B - the out patient Medicare coverage for physician, specialist and surgery services. There is a $155 Part B annual deductible you will need to pay the beginning of each calender year when you see a physician.

Part B premium - All Medicare beneficiaries are required to pay for their Part B premium. In 2010 the monthly premium is $96.40. If your annual income is higher than $85,000 your premium increases to $110.50. (other rules apply).
Assignment - an arrangement whereby a physician or hospital agrees to accept the Medicare-approved amount as full payment for services and supplies covered under Part B. Medicare usually pays 80% of the approved amount directly to the physician after the beneficiary satisfies the Part B deductible of $155.00. The Medicare Supplement member pays the other 20%.

Skilled Nursing Facility - (Medicare Part A) A medical care facility used primarily for rehabilitation. Patients are typically in a Skilled Nursing Facility when they are recuperating from an accident, illness or surgical procedure. Medicare typically pays all costs except $137.50 per day. Medicare will not continue to pay for this service is the person has a degenerative condition. In other words, the patients condition should be improving, if not, the coverage is stopped and a long term care policy or medicaid is necessary to continue to pay for these services.

Medicare Part D - Medicare Prescription Drug Coverage. Helps cover the cost of prescription drugs. Must be purchased from a private insurance company.

Part B Coinsurance - After the Part B deductible, Medicare requires you to pay 20% of all Medicare eligible expenses for physician, specialist, ambulance and hospital outpatient services and supplies.

Excess Charges - When your medical bill for Part B services exceeds the Medicare eligible expense. For example; if the Medicare allowable charge for a certain visit or procedure is $100. Medicare Part B pays $80 and the Medicare Supplement pays the remaining $20, if the Medicare Supplement pays for Excess Charges. Some plans do not cover this extra charge.

Initial Enrollment Period - (IEP) Your enrollment is guaranteed if you apply for coverage before or within six months of enrolling in Medicare Part B.
The terms above are some of the most common terms pertaining to a Medicare Supplement plan and you should become familiar with these terms when purchasing a plan. Please contact a Medicare specialist for more information.

I have been assisting clients for over 20 years in the Health Insurance and Medicare Supplement market.

I live in Sacramento with my wife and three children, and offer my services throughout California, Nevada and Colorado. When I'm not busy helping clients, I'm usually fixing my kids flat tires, helping with homework, or fighting with my backyard vineyard.

Getting to Know Medigap

Medicare is now currently paying for only about half of all the healthcare costs for Americans aged 65 and over. The other half of the medical expenses would be up to the people to pay out-of-the-pocket. With Medigap, which Congress standardized in 1992 and revised in 2006, people won't have to worry about the payments because this type of insurance will pay for all medical expenses in excess of what an original Medicare plan covers.

Medigap or Medicare supplement insurance can be any of the 12 supplemental insurance policies named a the letters A through L. Each one of the policies extends a different list of benefits targeted at providing additional coverage that is not available in the Medicare insurance plan. Each of these plans is priced appropriately. Medicare supplement Plans K and L are complementary to the basic benefits offered in Plans A to J. Nonetheless, the plans come at a decreased monthly premium but with raised out-of-pocket expenses.

Plan A is the most basic. Plan B offers everything in Plan A, and also covers the deductible for Medicare hospitalization. Plan C covers everything in Plans A and B, as well as the deductible for outpatient care and some healthcare outside the United States. The same thing applies for others up to Plan J, which covers all Medicare deductibles and most costs under preventive care. Plans K and L work a little differently from the others. They cover most gaps in Medicare coverage but pay only a percentage of those costs. They make up for these reduced payments by placing a cap on an insured person's total out-of-pocket expenses. After the cap is reached, these policies pay 100 percent of all covered costs.

Medigap health insurance policies are issued through private insurance companies and are particularly important to low and moderate-income beneficiaries aged 65 and above, especially those living in rural areas. However, it is available for everyone enrolled in traditional Medicare Part A and Part B, which pay for hospitalization, doctor visits, and other outpatient care. It is much cheaper when compared to other health care plans since, unlike usual medical health insurance plans, medical supplement insurance or Medigap is much cheaper.

It is important to always stay ahead of everything, including medical expenses. We'll never know when we might fall ill and we'll also never know how much our hospital bills will be. To be sure you're covered for the entire cost of your treatment, get supplementary medigap insurance to fill that gap between your Medicare plan and your actual hospital bill.

View the original article here

Supplemental Insurance For Senior Citizens

What Is Medicare?

Medicare is a federal health insurance program for senior citizens and disabled people. Most US seniors do qualify for Part A and Part B of Medicare. There is usually no additional premiums for qualified seniors if they choose Part A. There is a premium, though, which is less than $100 right now for most seniors on Part B. Most social security recipients have the Part B premium deducted from their social security checks so some are not even aware they are paying it.

Medicare is not a new program, and it has been around since the 1960's. So it has helped protect the health of retired and disabled Americans for over a generation now. But even though the traditional plan is not new, there are always new changes. So if you are concerned about Medicare, it pays to keep up. The US government provides a pretty good online resource at medicare.gov. This website can help you stay current, find additional Medicare health plans, and find contact information if you need it.

Why Do People Buy Medicare Supplements?

Even though Medicare is a very large program, it does not cover every medical service that an older or disabled person might need. In addition, there are plan copays, deductibles, and limits. Some beneficiaries choose to purchase a Medicare supplement to help them manage expenses.

What Is A Medicare Supplement?

A supplement, also called a medigap or medsup policy, helps pay copays and deductibles that Medicare does not cover. It is a very specific type of health insurance policy. Private insurers sell these plans, and they are meant to complement the original Medicare plan. A policy owner will be required to pay an additional plan premium for these plans. The cost will depend upon the level of the plan, the age of the covered person, the zip code it is issued for, etc. In this way, it is similar to any other sort of private health isurance plan.

Prescription Supplements

There a newer addition to the Medicare family, and these are called Medicare Part D or RX plans. They are also sold by private insurers, but some of the cost is paid from tax money so the qualified beneficiary will pay a smaller premium. These newer plans help pay for the cost of prescription drugs.

Should You Buy Supplemental Health Insurance?

There is not one right answer for everybody. Sometimes it can be hard to pay the premium on a tight budget. But it can be even harder to come up with the money to cover deductibles or copays if there is no supplement to help. Note that there are different levels of supplemental plans, and these levels provide different types of coverage and have different price tags.

How Much Does Supplemental Insurance Cost?

Let me repeat that the premium will depend upon the coverage level, age, and address of the covered person. There is not one right answer for every Medicare beneficiary. That is why there are so many different options. You should consider your options to find a plan and premium that will work out well for you!

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