Medicare and You
Health insurance as you age:
Health is an exquisite blessing which we accept wholeheartedly, but we also need to accept ill health in the autumn of our lives. The declining years bring copious physical and mental vicissitudes. The US health insurance system comprehends it and offers a variety of coverage plans. Most of the US citizens who belong to the age group of 65 and above, bank on Medicare to cover the cost of health care to a certain degree. The Medicare does not offer a comprehensive coverage plan, so the Medicare beneficiaries opt for the supplemental Medigap plans to widen the scope of the coverage. These plans are not only for the elderly people, but the people with certain disabilities are also eligible for these plans.
What is Medicare?
As mentioned above, Medicare is a national health insurance program that addresses the needs of people who are above 65 or have certain qualifying disabilities. The Medicare coverage is not much comprehensive. It can only be availed in a couple of ways. The first one is original Medicare consisting of Part A and Part B or Part C. Part A is the hospital insurance while Part B is medical insurance. Part C is a standalone plan which is used as a substitute for original Medicare, Part C is also known as Medicare advantage. It is administered by Medicare-approved private insurance companies like AzMedcare that operates in Phoenix, Arizona. In some cases, the users of original Medicare and Medicare advantage can get prescription drug coverage after purchasing Part D. Besides buying part D, they can also go for the Medicare supplemental insurance or Medigap. The users have to choose among Part D and Medigap as these are mutually exclusive.
What is Medigap?
Medigap coverage plans exist at the portfolio level and support the original Medicare coverage. Medigaps are the private health insurance policies just to supplement the original Medicare plans. Both Medicare original and Medigap plans pay their share and cover the medical costs individually. The Medigap plans cover the costs that are left out by original Medicare. The cost which is not covered in the Medicare plan is known as the coverage gap and as the name depicts, Medigap fills this gap. Similarly, Medicare does not cover the amount exceeding Medicare-Approved amount and the purchase cost for the Medigap policy.
AZMEDICARE; Arizona Medigap policy provider, makes Standardized Medigap policies available for the people of Phoenix. These standardized Medigap policies are aligned with the Arizona Medgap polices. These policies are labeled by letters A, B. C. D. F, G, K, L, M and N. These are called as standardized policies because all the services providers offer the same coverage plans that meet a certain set standard. It should also be noted that all these plans have same benefits but their cost varies from one company to another. Well, the selection of the Medigap plan is entirely based on your needs. You can chose the plan which best suits your requirements. The Medigap policies are renewable and the insurance provider cannot cancel your policy unless you are not willing to pay the premium amount.
Benefits of Medigap policy:
First and the most valuable benefit of Medigap policy is hospitalization. Along with the Part A coinsurance, it gives additional 365 days coverage for hospitalization. Secondly, it bears the medical expenses that are not borne by the Medicare Part B coinsurance. It also covers the copayments for outpatient services. Medigap policies also cover three pints of blood yearly, if the patents needs blood transfusion. Palliation of chronically ill, terminally ill or seriously ill patient’s pain is quite costly, so the Medigap care provides Hospice care coverage as well.
When to buy Medigap policy in Arizona?
It is better to buy the Medigap policy in the open enrolment period. This period automatically starts when you enters the first day of the month when you turn 65. This period is comprised of six months. You must be previously enrolled in Medicare Part B. if you enroll outside the OEP period, the premium rates would be affected. You may also be required to take a physical review of your health information. The price and conditions out of OEP period differ from OEP.
How to choose the best level of Medigap policy?
Living in Arizona, you have the option of choosing among 10 standardized Medigap offers. You have also the option to choose the best insurance provider among 50 companies. These providers don’t sell all the Medigap plans, but their offer must include plan A. In addition to plan A, Plan C or Plan F can be added. Plan F, a highly deductible plan as you have to pay the deductible amount of $2,180 before the policy starts paying you. On the other hand for the Plans K and L Medigap plan pays 100% of the covered services for the rest of the year.Plan N pays 100% of the Part B coinsurance (except up to $20 copay for some doctor visits and up to $50 copay for ER treatments that don’t require inpatient admission).
This might seem a bit complex but you need to thoroughly read ins and outs of each and every plan. You can also check the discounts offered by the company as AZMEDICARE offers discounts for women, non-smokers, or married people, yearly payment discounts, multiple policy discounts etc. Your medical policy should be tightly aligned with medical needs along with your financial abilities. AZMEDICARE provides medicare supplement insurance plans in Arizona and stresses that you should choose a plan, considering the currents needs and the related concerns in the future. For you ease, AZMEDICARE provides 6 types of medicare advantage plans. Health maintenance organization plans, preferred provider organization plans, private fee for services plans, special needs plans, point of services plans and medical savings account are these types. You can choose what suits you the best. ADMEDICARE will also suggest the best option if you seek assistance in any of the stages of Medicare advantage plans.
Medicare is basically a federal health insurance program that includes the services such as lab tests, surgeries, doctor visits and medically necessary supplies, such as walkers and wheelchairs. Medicare plan is for those people who are 65 or older. Younger people are also included if they have certain disabilities, and people with End-Stage Renal Disease also called as ESRD, who have permanent kidney failure requiring dialysis or a kidney transplant.
Medicare plan has generally two parts that have different features like Medicare Part A and Medicare part B. In general, Part A covers the services such as home health services, hospital care, nursing home care and skilled nursing facility care. While in general, Part B covers two types of services. First includes medically necessary supplies or services that are needed to diagnose or treat a medical condition, while second includes preventative services, or health care in order to prevent different illnesses. It also covers things like clinical research, mental health treatment, ambulance services, durable medical equipment, limited outpatient prescription drugs and second opinions before a surgery.
The above mentioned features are related to Medicare plan. There is another plan of Azmedicare i.e. Medicare Advantage plan. This plan is available for Arizona residents only. This plan includes a series of Healthcare Plans. These plans are created in partnership between Medicare and Private Insurance companies. They provide cost effective healthcare services to those beneficiaries who are medicare eligible. Medicare advantage plans and Prescription Drug Plan sponsors must have a contract with Medicare in order to sell Medicare insurance plans (such as a Medicare HMO or a Medicare Part D Prescription Drug Plan.
Medicare Advantage plans, also referred to as Medicare Part C plans or MA plans. Approved private health insurance organizations manage and administer these plans. Participants who are selected to receive Medicare benefits through a Medicare Advantage provider must receive all Medicare benefits (including optional Part B and Part D plans) through the provider. Every plan is not accessible in all states or in all service areas but it depends on the terms of the contract between the plan and Medicare. The plan must renew their contract with Medicare every year, so that the availability of a plan in a specific service area is subject to change as a result of the annual contract renewal.
There are five types of plans available in Arizona:
Preferred Provider Organization (PPO) is a managed care plan in which you use hospitals, doctors and providers that belong to the network. People do not need a referral from a primary care physician to go to a specialist. For an additional cost, people can receive services outside of the network.
Health Maintenance Organization (HMO) includes a group of hospitals, doctors and other health care providers who agree to give health care to Medicare beneficiaries for a set amount of money from Medicare each month. In an HMO, people need a referral from a primary care physician to go to specialists and usually get all their care from the providers that are part of the plan.
Medicare Savings Account (MSA)
This type of health plan has two parts:
- First part includes special type of savings account used for health related expenses only. Medicare deposits a set amount per year into customer’s account and the money can remain in the account if customer does not use it by the end of the year.
- High deductible health plan (minimum of $2000): With this type of plan, Medicare pays the premium for the MSA plan and makes a deposit into the MSA established by the beneficiary. The money in the MSA can be used to pay for health services provided before the deductible is met and for services not covered by the MSA plan. After the deductible is met in a given year, Medicare-covered services are covered by the health plan.
Private Fee for Service (PFFS) is a private insurance plan that accepts Medicare beneficiaries. People may go to any doctor or hospital they want. Rather than the Medicare program, the insurance plan decides how much people pay for the services they get. They may have extra benefits the Original Medicare Plan does not cover. They may pay more for Medicare covered benefits.
Special Needs Plan (SNP) is an HMO type plan but it provides membership to only to those people who are eligible for both Medicaid and Medicare or who have chronic disabling conditions or who reside in certain long term care facilities. Special needs plan is designed in such a way that provides medicare health care and services to those people who want benefits from things the most like focus on the care management and special expertise of the plan’s providers.
There is another plan i.e. Medigap which is also known as medicare supplements. It is a health insurance policy sold by few private insurance companies in order to fill the gap in the original or basic medicare plan coverage. Medigap policy covers all the features that are even not included in original basic medicare plan and it helps to pay some of the health care costs. If any customer is registered in the original medicare plan and have medigap policy as well then later will pay both shares of covered health care costs. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs. 80% of the medical bills are paid by medicare while the remaining 20% is paid by medigap or medicare supplements.
Customers don’t need to pay any bills if they get plan F Medicare supplement because medicare pays its part and the supplement pays the rest. Cost varies in all Medigap policies while the benefits in plan A through N are same for all insurance companies.
Azmedicare provides the best services and best rates for Arizona residents. It represents the top insurance companies of the state. It has many plans and all are at affordable prices. Many has zero monthly premiums. Azmedicare empowers customers to take charge of their health.
Some equate ‘the golden years’ as a time of playing with the grandchildren, a time of enjoying walks with your better half, and slowing down a bit. However, aging may bring a lot of discomfort too. This is also the time when different diseases attack you which may require special medical care to fight against.
Living in Arizona, it is not easy for every person to afford the medical expenses when the person is above the age of 65. Our US government health department offers Medicare for people in the age group of 65 or above. This Medicare insurance doesn’t fully cover the medical expenses of hospitalization and other treatment. It only pays a part of the expenses which is not more than a certain percentage in most of the cases. If unfortunately a person suffers from any serious disease, it becomes almost impossible to bear the expenses. The US health department has authorized some private companies to sell supplemental standardized plans.
In Arizona, 12 different supplemental plans are available to enhance the scope of the Medicare insurance coverage. These companies sell these plans to the people who are already enrolled in the Medicare Part A and Part B. The supplemental plans are known as the Medigap plans. The name “Medigap” says is all, it fills the gap of Medicare insurance coverage. The plans are standardized however the premium cost of each company is different. AZMEDICARE offers the best premium packages at the most affordable rates in Arizona.
Your Medicare insurance plan alone does not facilitate much. It doesn’t cover deductibles, co-insurance and other similar costs. Medigap is the solution to cover these deductibles. You can buy a Medigap policy to pay for your Original Medicare deductibles, co-payments, co-insurance, and other costs.
Benefits of buying Medigap insurance:
Medigap policies have four required benefits that must be included and five optional benefits that are only included with some plan options. Each of the Medigap policies present required benefits. These include:
1. Required benefits:
Part A hospital care co-insurance:
Medicare Part A covers in-patient hospital stays. But if your stay lasts longer than 60 days, you have to make a co-insurance payment for each day you are still in the hospital. After a certain point, Medicare stops covering your inpatient hospital costs altogether. If you have a Medicare Supplement insurance policy, it will cover the co-insurance costs e.g., if the co-insurance is $300 per day for days 61 to 90 of your hospital stay. Beyond 90 days, there’s a $600 co-insurance per day. If you have a Medigap policy, it also will cover any in-patient hospital costs after Medicare stops covering them. It will do so for up to 365 days after you use up your Medicare benefits.
Part A hospice care co-insurance or co-payment:
Medicare Part A hospice care covers respite care and prescription drugs for pain relief. However, there is a 5% co-insurance for respite care and a $5 co-payment for each prescription drug. If you have Medicare Supplement insurance, it will pay for the co-insurance and co-payments. It is also noted that Plans K and L cover only a portion of the co-insurance and co-payments.
Part B co-insurance or co-payment:
Medicare Part B covers preventative services and necessary supplies to diagnose and treat medical conditions. Part B only pays 80% of the Medicare-approved amount for a particular service. So if the Medicare-approved cost for a service is $500, Medicare only pays for $400 of it. If you have a Medigap policy, it will cover the remaining 20% and both the Medicare and Medigap pay their own share.
First 3 pints of blood:
Medicare only covers the cost of blood for the 4th pint and beyond for a blood transfusion. It doesn’t cover pints 1 – 3. If you have a Medigap policy, it will cover the first 3 pints of blood and support the Medicare policy.
2. Optional benefits:
These optional benefits are not included in all of the Medigap plans. Here’s the detailed benefits:
Part A deductibles:
Medicare Part A covers a range of hospital costs. But before coverage starts, you need to pay a deductible. In 2016, the deductible is $1,288 per benefit period. 9 out of the 10 Medicare Supplement insurance plan options cover the Part A deductible. The only plan option that doesn’t cover it is Plan A. While the Plans K and M cover 50% of it, and Plan L covers 75% of it.
Part B deductible:
Medicare Part B covers a range of preventative and diagnostic services. Before the initiation of the coverage, you need to pay a deductible. In 2016, the deductible is $166 per year. If you have Medicare Supplement Plan F or Plan C, your policy will cover the Part B deductible. No other plan options include this coverage except the mentioned above.
Part B excess charges:
In some cases, a health care facility will charge up to 15% more than the Medicare-approved amount for a service. If you have Medicare Supplement Plan F or Plan G, your policy will pay for the extra charges. No other plan options include this coverage.
AZMEDICARE and Medigap Insurance Plans:
All these aforementioned plans are offered by AZMEDICARE in Arizona. These plans not only cover senior citizens, it also covers people having certain disabilities. The company offers all these plans at a great premium cost. It doesn’t matter if you buy the Medigap policies in the open enrollment period or not, it will cost the same. You can also visit http://azmedicare.info/medicare-supplements/ or further information. Or call for an appointment.
Keeping the importance of health of elderly people under consideration, US health department has provided an option to choose a health insurance program of managed health care or health care organization. It is basically a substitute of Medicare Part A, and B and known as the Medicare advantage. It offers an extra coverage like health programs, dental, and vision. It also contains the Medicare prescription drug coverage Part D. You might be thinking that what actually is the Medicare plan and what is the difference between Medicare and Medicare advantage plans. Here is the comparison between both:
Difference between Original Medicare and Medicare Advantage Plans:
Original Medicare plans are directly administered by the US federal government. This plan primarily include Part A and Part B. Part A is for the hospitalization while Part B is for medical coverage. The enrolled patients pay deductible and coinsurance when they get the health care which usually reaches up to 20 percent of the Medicare approved cost. The attractive feature of Original Medicare plan is paying for the part B premium only because there is no Part A premium for those who have at least 10 years of work experience in the US. Once you have the Medicare plan, you can go and see any doctor or hospital in Arizona that accepts Medicare. No referral forms are needed to see the specialist because you are pre authorized after enrolling yourself in Medicare original plan. Medicare original plans provide you the basis of buying the Medigap plans that serve as the supplemental coverage. Original Medicare also gives an option to avail Medicare drug coverage but you must have a separate Prescription drug plan from any of the private insurance company.
On the other hand, the Medicare Advantage plans are sold by the private insurance companies that are authorized to provide Medicare benefits. These are state approved private insurance providers. AZMEDICARE is among these insurance companies in Arizona. Besides covering Part A and Part B of the original Medicare, the advantage plans also covers extra benefits which include vision and dental care. Medicare advantage plans have three major types of providers: (HMOs) Health maintenance organizations, (PPOs) preferred provider organizations and (PFFS). If you have a valid Medicare advantage plan while the original Medicare plan has expired then its expiration doesn’t harm you. You can pay a deductible or copay a fixed amount per office visit.
Unlike original Medicare plan, the Advantage plans has a limited network of doctors and hospitals. Besides this, you might need to choose a primary physician and get referrals to see the specialist. Medicare advantage plan restricts you to avail the Medigap supplemental insurance. If you want Medicare drug coverage, opt for a plan that includes both health and drug coverage and is usually known as a Medicare Advantage Prescription Drug Plan. You usually can’t have a separate Part D plan with the Medicare advantage plan, unless you are in a Medicare Medical Savings Account (MSA) or a PFFS plan.
Medicare advantage and AZMEDICARE:
Medicare advantage plans are also known as the Medicare Part C of MA plans. These plans are administered by the state authorized health insurance organizations and AZMEDICARE is one of these organizations. AZMEDICARE offers benefits including optional Part B and Part D plans. Medicare Advantage providers follow the rules provided by the original Medicare. It may also be noted that this policy may cost our-of-pocket expenses in the form of higher premiums and deductibles. Standalone prescription drug plans are also covered by the AZMEDICARE. These plans are offered to the eligible participants. Each Medicare Part D plan provider determines the prescription drugs that are covered by the plan, the cost of the Part D premium, the amount of a participant’s co-pay and/or deductible, coverage limitations and the out-of-pocket cost of a drug to the participant. Medicare part D coverage is only for the participants who either have Medicare Part A and Part B, or have a Medicare Part C plan that includes both Medicare Part A and Part B coverage.
Eligible participants may not elect to carry only Medicare Part D coverage. If a participant has Medicare Part A and/or Medicare Part B, she/he may choose a stand-alone prescription drug plan provider. Medicare Part C plan participants must work with their plan provider to acquire prescription drug coverage; they do not purchase stand-alone prescription drug plans.
The Plan C is offered by AZMEDICARE that contracts with Medicare to provide you with all the hospital and medical insurance benefits. Moreover, Medicare advantage plan includes health maintenance organizations, preferred health service provider organizations, private fee-for-service plans, special needs plans and Medicare medical savings account plans. If you are enrolled in under such program then you may also be offered prescription drug coverage.
Besides all this, full coverage plan is also offered by AZMEDICARE. The full coverage plan is the most wide-ranging. It can pay for all the expenses that are approved but not yet been paid by Medicare. This plan includes all your deductibles, copays and coinsurances that originally Medicare is not supposed to cover. Full coverage plan is typically the most expensive of all the plans, and is well suited for those who think that they will have medical expenses and/or for those who want the peace of mind knowing that all approved expenses will be covered.
AZMEDICARE does not recommend any plan. The company gives you the option to choose the plan which best suits you. You can select the Medicare original plan as well as the Medicare Advantage plan. Once you have enrolled yourself in Medicare plan, you will be able to enhance the scope of the insurance with twelve different standardized sub plans. You can visit http://azmedicare.info/ to learn more about these plans. Compare all the plans and choose the most suitable for you.
In the state of Arizona, about 15% of the population is aged 65 year or above. Generally, anyone who has turned 65 falls under the category of “elderly”. When we think of the elderly, one thing that comes to mind is the health care and medicare insurance plans. The reason is fairly simple. This age group is more prone to healthcare problems and diseases than others. Research shows that the majority of global healthcare and medical charges are attributed to the elderly.
Having Arizona medicare supplement plans for the elderly is so important because of the the fact that there is multiple diseases and healthcare conditions that affects the elderly. There are many conditions and diseases that generally target an individual aged 65 or above at once. While the weakening tissues and weaker organs makes even the routine tasks difficult for an individual, the weaker immune system allows many other diseases to attack a person as well. The result of this is what we see in the form of multiple prescriptions.
Normally, when we see someone taking different pills and medicine, we imagine that they have it all covered by some health insurance company. However, it all takes its toll on the pocket when one realizes that these are not covered under the original medicare plan. Yes that is right! One has to purchase additional Arizona medicare supplement plans to cover the cost of prescription and other medical utilities and services.
Realizing this need, the medicare and the insurance companies joined hands to introduce several Arizona medicare supplement plans. A total of 10 different Arizona medicare supplement plans are available which are A, B, C, D, F, G, K, L, M and N. Some other plans such as Plan E,and H etc are no longer available. Under these plans, all the private insurance companies provide same services under a specific plan. For instance, all the private insurance companies would provide insurance for prescription drugs under the Part D.
However, there is no restriction on the charges for a specific plan. Some companies include multiple packages within a specific medicare supplement plan. For instance, under the Part D, a company may offer a cheaper plan with a specific list of drugs they would cover, while offering a more costly package which covers a comprehensive list of medication.
Here is what you need to know about different Arizona medicare supplement plans.
Plan A and B
Plan A and B are also called the “original medicare” plans because they only cover the basic medicare. Basically, both plan A and Plan B give similar benefits. However, there lies some minor differences about the payment. For instance, if you go for Plan A, you would be liable to pay your medicare expenses for both Part A and Part B.
Under Plan A, you get more coverage. So, it would be ideal for you if you want more coverage but don’t think that you would be relying too much on the healthcare services. The benefit that you would get under Plan A is that you won’t have to pay any extra if you need extra medicare coverage. However, at times, you might have to pay some extra cost. The Plan A would include basic coverage for your hospitalization, medical expenses and hospice care.
If you opt for Plan B, you would get basic benefits of hospitalization and medical expenses only. However, there are some additional benefits besides these, such as, you get a little added coverage for hospitalization. If you want more coverage for hospital expenses, then this is the right plan for you.
The benefits that you get depend upon the plan your select at your Arizona medicare supplement plans provider.
This is what you should opt for if you need some extra insurance. The Plan C includes coverage for the things that are generally not included in the original Plans A and B. By opting for Plan C, you get most of your medicare expenses and costs. You can have a sense of security that most of your expenses are covered. However, there are certain restrictions upon the amount you can spend, this depends upon the package you choose. At times, you may have to pay additional costs if your doctor charges more than the allowed limit. Apart from benefits covered under Plan A and B, the Plan C also provides skilled nursing, and medical emergency help for abroad travels.
The Plan D covers the medical prescription costs. It often surprises people when they find out that their prescription is not covered under their original Arizona medicare supplement plans and thus they have to make these expenses out of their pockets. At times, there are medicines that are very costly. So, it is better to have a Plan D if you wish to have your prescription costs covered.
Plans F and G
These are only plans that cover the excess charges when you see a doctor. So, even if your doctor charges extra than what your medicare Part B covers, you can rely upon these plans to take care of the rest. These plans are good for those who prefer to see specific doctors, even if they charge a bit extra but don’t wish for additional out of pocket charges.
Plans K, L, M and N
If you have low budget, these are the plans that you should go for. These plans offer basically the same benefits as other Arizona medicare supplement plans do. However, you get the benefits at a lower monthly premium. However, they do offer an out of the pocket maximum under which, you have an annual limit to the amount you will have to pay out of your pocket.
Please look at different the Arizona Medicare Supplement Plans to select the one that is best for you.
Medical and health insurance is one of the most basic needs, not only for the elderly but for people from all age groups. Even while looking for employment, many people look at the health care packages provided by a company before making a decision. While there is no limitation to the age to get sick and disease or disability can strike anyone at any time, the elderly are at a much greater risk because of the several changes that take place in human body as it ages. For the elderly, a good medicare coverage plan along with reasonable medicare supplement plans is the best option.
Who is Eligible for Medicare?
First of all, let’s discuss what is a medicare plan? Medicare is a Federal health insurance plan that can be availed by people aged 65 or above. However, certain younger individuals who carry disabilities may be entitled to avail medicare plans as well.
Apart from this, people who have end-stage renal diseases are also eligible. This means any individual who has a permanent kidney failure and requires a regular dialysis or a kidney transplant is also eligible for medicare plans in Arizona even if they are younger than 65.
Now, the next question is: can anyone avail a medicare plan? The answer is yes for anyone who is a citizen of the US and meets the requirements of lawful presence and residency.
When can I apply for Medicare?
Once you know that you are eligible for medicare, the next question that arises is: when to apply for medicare? For elderly, the initial enrollment period is the first chance where one can apply for medicare. When does it start? It starts 3 months prior to your 65th birthday which includes the month you are born in and the 3 months after the month of your birthday. It ends afterwards.
What is included in Medicare Plans?
Generally, medicare covers different services such as visits to a doctor, different tests, surgeries, and other required supplies. However, there are two types of medicare plans.
- Part A.
Part A generally covers the services related to hospital. This includes hospital care, nursing, hospice care, and home health services.
- Part B
Par includes 2 different types of services.
The first one is limited to the services necessary to diagnose or treat a medical condition. This includes the required medical supplies as well.
The second part is quite different from the first type. Instead of treating or diagnosing a medical condition, it focuses on taking cautionary steps to prevent some disease. This includes services like clinical and medical research, ambulance services, medical equipment. It also includes limited outpatient prescription drugs.
These two parts are called “original medicare” together. However, there are Part C and Part D of the healthcare as well which include medicare advantage and medicare prescription drug plan respectively.
What is Medicare Advantage?
While these plans sound good and helpful, there are times when one wishes that one had more – perhaps a more comprehensive medicare coverage, especially if one is elderly. To tackle this problem, several medicare advantage plans were created through a partnership between medicare and private insurance companies. This helped bring efficient healthcare to the eligible beneferiacies in a cost effective manner.
The medicare advantage, or the Part C, are available in five different types of plans in Arizona.
- Health Maintenance Organization (HMO)
In HMO, a group of doctors or hospitals agree to give health care services to a person by in exchange of a monthly premium. Generally, the beneficiary gets all the care from the plan providers. However, to see a specialist, you would require a referral from a physician.
- Preferred Provider Organization (PPO)
In PPO, your plan provider provides you a complete managed care plan. Your complete managed care plan would include doctors, hospital, and providers. Under this plan, unlike HMO, you would not need a physician’s referral to see a specialist. However, you must pay extra if you wish to receive services outside of your original network.
- Private Fee for Service (PFFS)
If you are a medicare beneficiary, then the PFFS is a private insurance plan for you. Under this plan, you are free to visit any doctor or hospital of your choice. However, the cost of it is decided by your insurance plan provider. While you may have to pay more for the benefits that are covered under your medicare, this plan also provides extra benefits that are not covered by the original medicare plan.
- Medicare Savings Account (MSA)
Under this plan, your medicare pays a premium for your MSA, which then covers your medicare costs by making appropriate deductions, particularly for those which are not covered under your medicare plan. This plan is of two types.
The first type is the saving accounts where your medicare would deposit the annual premium. If you do not use the money by the end of the year, it would remain in your account. Under the second, type, you require a minimum of $2000.
- Special Needs Plan (SNP)
This plan is only limited to the people eligible for both medicare and Medicaid. The people wishing to avail this plan must be living in long-term healthcare facilities. Those who have some chronic condition or disability are also eligible for this plan. The plan focuses on fulfilling the needs of those who can benefit from focused care management services, or those who require special expertise of the plan providers.
In short, when it comes to the medicare and medicare supplements in Phoenix, AZ the options are limitless. However, one must do proper research on plans offered by different private healthcare insurance providers and select a plan regarding medicare supplements that best matches their needs.
Have you ever wondered what diseases are associated with aging? Disease is not something limited only to the elderly. Of course there are healthcare and medical insurance plans that cover people from all age groups. Similarly, even infants and teenagers catch diseases, some of which often prove to be fatal. However, despite all this, there are various health problems associated with old age. there are a number of diseases associated with growing older. Often, we call these the side-effects of aging.
Who are Elderly?
It is an accepted fact all over the world that people with above 65 are known as “elderly”. This group is naturally considered to be very vulnerable to different health problems. That is why, discussing senior healthcare Arizona plans is very important not only due to the burden it gives to the caretakers, also because of its impact on society. Aging is a natural process, one day we all will fall in the same category. So, by understanding senior healthcare Arizona plans, we help ourselves as well as the society we live in.
How is Aging associated with Health
One of the major problems about the disease associated with age is that we cannot tell specifically as to at what age would some particular disease or health condition affect a person. This is mainly due to the difference between the chronological and biological age. Similarly, the physical activities and diet of a person also plays a major role. A person who is in his 40s but doesn’t exercise, has a drinking problem, and doesn’t take care of their diet might have organs that function like that of a 60 year old. Similarly, someone in their 60s who takes a healthy diet and have a healthy lifestyle might be in a better physical shape than those, who are younger than them in terms of chronological age.
Problems associated with Old Age
With the process of aging, certain biological, physiological, and chemical changes occur in our body. These changes naturally affect the functioning of almost all major organs in our body. These results in various diseases and conditions associated with aging.
The most commonly known disease is Alzheimer’s which is a form of dementia. This disease commonly affect our cognitive functions. Common symptoms include impaired reasoning and memory dysfunction. However, it is important to note here that occasional instances of forgetting something are normal, and not a sign of Alzheimer’s disease.
Another system that gets affected with old age is the respiratory system. As you age you have a reduced ability to cough out mucus and other foreign particles from the respiratory system due to poor of damaged lungs. This condition can be very serious if the person happens to be a regular smoker. This can lead to increased risk of infection and bronchospasm.
Muscles and Bones
Age also affects our physical strength as the muscle mass and strength declines with age. This results due to the bones becoming brittle and joints experience wear and tear over time. Strength of ligament and tendon also reduces significantly. Our bones also suffer from problems such osteoporosis because bones start weakening once we turn 40. This problem can be seen more commonly among women.
Another bone problem associated with age is osteoarthritis. In this, the protective cartilage at the ends of the bones wears down, increasing friction and causing pain. This also affects our movement and ability to perform day to day physical tasks. This disease is also very common among the elderly.
However, with proper treatment, adequate intake of calcium and vitamin D, and physical exercise, the osteoporosis can be tackled easily. One must frequently visit a doctor and get regular bone density scans for optimum results.
Reduced Functioning of Tissues
As we grow older, our tissues become less sensitive to the hormones that regulate their function. Apart from these, the hormones themselves are also affected and the blood levels in them change. This affects the regulation of sex hormones. In females, it results in reduced estrogen synthesis, increased risk of osteoporosis and vaginal dryness. Similarly in males, it generally results in erectile dysfunction.
Our overall metabolism slows down, and the cholesterol and fat problems become more common.
Eyesight and Hearing
When we talk about common diseases among the old people, eyesight and hearing are among the first ones that come to our mind. When we turn 40, our eyesight starts weakening. This starts from presbyopia or far-sightedness which is the inability to see close objects. As we turn 60, cloudy areas also begin to form in our eye’s lens, which causes blurry vision. Moreover, our hearing also begins to declines.
However, by using glasses and hearing aids, we can overcome these problems to a great extent.
Lack of Nutrients
As we age, our sensation of thirst and hunger decreases. This results in dehydration as we do not feel thirsty even when our body requires water. Moreover, our digestive system also weakens which results in malabsorption of carbohydrates, vitamins (B12 and D), folic acid, calcium and proteins. This lack of hydration, and poor absorption of the required minerals and nutrients results in an imbalance of electrolyte in our bodies. Malnutrition is also a common problem.
Apart from all these, various others problems, such as prediabetes, type 2 diabetes, heart disease, stroke, and weight loss can also affect the elderly. That is why, it is important to have a reliable senior healthcare Arizona plans provider, especially if you live in Arizona to ensure that your elderly get the attention and care that they deserve. Although the aging process cannot be reversed, with proper care and a healthy lifestyle, you can delay the aging effects of your loved ones and help them live a happy life.
In the sphere of health insurance, US citizens have various coverage options at their disposal. Medicare is the national health insurance program, administered by the US federal government through private insurance companies. The Medicare supplements in Phoenix AZ, also known as Medigaps, are the coverage choice of most Medicare policyholders who don’t get additional insurance through their employers or Medicare Part C (Medicare Advantage).
What are Medigap and Medicare supplements in Phoenix AZ?
Medigap is a type of supplemental insurance designed to help with the gaps in the Original Medicare. Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance).
The Medigap policies are standardized by the Centers for Medicare & Medicaid Services (CMS), operating within the Department of Health and Human Services (HHS).
They are regulated on a state level (by state insurance departments). However, the CMS prescribes the minimum coverage that various Medigap plans must provide across the country.
Medigap only supplements Original Medicare and cannot be used as a standalone plan. To purchase a Medigap policy, you must have Original Medicare (Parts A and B).
Note: Medicare beneficiaries can’t be covered by Medicare Advantage and Medigap at the same time.
Medigaps are sold by private companies. When you join a Medigap plan, you will pay your provider a monthly premium in addition to your monthly Part B premium.
Medigap policies up-close
To protect seniors, all Medigap policies are standardized. This means that under the law, all Medigap policies must provide the same basic set of benefits. This basic coverage includes Part A and Part B coinsurance amounts, as well as additional hospital benefits not covered by Original Medicare, as given below:
|Part A Hospital Coinsurance:
||Days 61-90 of a hospital stay (in each Medicare benefit period).
||Days 91-150 of a hospital stay. (Medicare covers these 60 days only once in a person’s lifetime).
|Additional Part A Hospital Benefits:
||Covers additional 365 days of hospital care once Original Medicare hospital benefits are used up.
||100% covered by all Medigaps
|Pays for the Part B coinsurance after the annual deductible is reached.
||100% covered by Plans A, B, C, D, F, G, M, and N (plan N requires up to $20 copayment for some office visits and up to $50 copayment for outpatient ER visits.)
|Part A and B Blood Coverage:
||Pays for the first 3 pints of blood/year.
||100% covered by Plans A, B, C, D, F, G, M and N.
|Part A Hospice Coinsurance:
||Covers coinsurance for outpatient prescription drugs and inpatient respite care.
||100% covered by Plans A, B, C, D, F, G, M and N.
Medigap plans available in Arizona
As of 2013, Arizona residents can choose from a total of 11 standardized policies (A, B, C, D F, High Deductible F, G, K, L, M and N). F and High Deductible F are considered separate plans.
Note: As of June 1, 2010, plans D and G have different benefits than those sold before.
Plans E, H, I and J are no longer available, but people that already have them can generally keep them.
All same-letter Medigap plans offer the same benefits, regardless of the provider. In contrast, the costs of same-letter plans vary greatly between providers (based on location, plan level, health and age). Costs can even vary between providers in the same city.
Make sure to get as much information as you can about the plans, their benefits and costs before making your final decision.
All insurance companies selling Medigaps are obligated to offer Plan A. If their offer includes any other Medigap plan, they must offer either Medigap Plan C or Plan F.
Medigaps can also be purchased as Medicare SELECT plans. In this case, in order to receive full insurance benefits, you’ll have to use hospitals and, occasionally, doctors within your plan’s network (except in cases of emergency).
These policies are generally cheaper than other Medigap policies, provided you go to a Medicare SELECT point of care.
If you receive care outside the Medicare SELECT network, you’ll be responsible partially or fully for the costs not covered by Medicare. Medicare will pay its share of approved charges no matter which hospital or doctor you choose.
What Medicare Supplemental Insurance can do for you
Due to the coverage gaps in the Original Medicare, most people choose to buy additional insurance. Medigap policies serve as protection against excessive expenses created by these gaps and unforeseen medical circumstances. This includes longer hospital stays, copayments, deductibles, and health care outside the U.S.
People usually choose supplemental insurance based on their current or potential medical needs, their budget and the insurance company ratings.
As a result, some people opt for a plan which provides more comprehensive, so-called “first dollar coverage”. First dollar coverage means that the Medigap policy pays the deductibles and copayments, with zero out-of-pocket costs for the beneficiary.
Others choose cheaper plans which cover only the most costly services if a medical situation arises.
Healthcare providers may charge more than the Medicare-approved amount for their services and some Medigaps cover these excess costs as well. This gives policyholders more latitude when choosing their hospitals and doctors.
Note: Plans A and B provide basic coverage, and their premiums are the lowest.
The most popular Medigap plans in Arizona and the U.S. are Plan F (40% beneficiaries nationwide) and Plan C (13% beneficiaries nationwide). They are also more comprehensive than other plans.
Medigap plans don’t include prescription drug coverage. For this purpose, you can enroll in a standalone Medicare Prescription Drug Plan (Part D) offered by Medicare-approved private companies.
When to purchase a Medigap policy
The best time to buy a Medigap policy is during the 6-month Medigap Open Enrollment Period. This period starts the month you turn 65 and enroll in Medicare Part B. For the duration of this period:
– You have a guaranteed right to purchase any policy available in your area.
– The insurance provider can’t refuse to sell you a policy or charge you more if you have pre-existing medical conditions.
However, in some cases, the provider can refuse to cover your costs for certain conditions for up to 6 months (pre-existing condition waiting period).
There are also eligibility windows outside the Open Enrollment Period. For instance, certain qualifying life events can make you eligible for a special enrollment period. These events include moving to a new state, certain income changes, as well as changes in family size (marriage, divorce and childbirth).
The recent changes in the U.S. healthcare system have extended the coverage scope of Medicare and the program continues to grow and provide benefits. You can get your Medicare coverage through Original Medicare or the different private Medicare Advantage plans. You can also enhance your Medicare coverage with the Medicare supplements in Phoenix AZ.
The concept of medicare supplements in Phoenix AZ
Medicare is the national health insurance program, administered by the federal government through private insurance companies across the country. The program is available to all U.S. citizens who are 65 years of age or older, including seniors with a permanent resident status of at least 5 years. People under 65 receiving disability insurance benefits and people of any age with certain qualifying conditions (dialysis patients, kidney transplant candidates and ALS sufferers) are also eligible.
How is Medicare structured?
Medicare has 4 parts (A ,B, C and D), each covering a different aspect of medical care. Parts A and B are known as Original Medicare.
Part A (hospital insurance) covers inpatient care in hospitals, skilled facilities and home care.
Part B (medical insurance) covers outpatient care, doctor visits, medical equipment and preventive care.
Part C (Medicare Advantage or MA) offers all the benefits of Original Medicare, but is run by Medicare-approved private insurance companies.
Part D (Medicare Prescription Drug Plan) subsidizes the costs of prescription drugs. Similar to Medicare Advantage, it is administered through private insurance companies.
Seniors aged 65 and older who have paid 10 years of social security taxes can receive their Part A insurance benefits premium-free.
Medicare plans can change the coverage scope, costs, pharmacies or providers in their network annually. You should stay up-to-date with the changes in your plan to make sure it still meets your needs next year.
Types of Medicare Advantage plans
Health Maintenance Organization (HMO) plans: Your choice of doctors and hospitals is restricted to the HMO network, except in emergencies. A referral may be required for certain tests or specialist appointments.
Preferred Provider Organization (PPO) plans: In addition to medical care within the PPO network, you can choose doctors or hospitals outside its scope, but it will cost you more.
Private Fee-for-Service (PFFS) plans: You can go to any doctor or hospital that agrees to treat you. The plan determines yours and their share of the costs.
Special Needs Plans (SNPs): These plans focus on medical care for specific population groups, including people suffering from chronic conditions, nursing home residents and dual beneficiaries of Medicare and Medicaid.
HMO Point-of-Service (HMOPOS) plans: For a higher copayment and coinsurance, you can receive certain services outside the network.
Medical Savings Account (MSA) plans: These plans are a combination of a high-deductible plan and a bank account. Medicare deposits money into the account and the policyholder uses these funds to pay for medical care.
How Medicare Advantage plans work
Medicare Advantage is another way to get your Medicare coverage. If you join an MA plan, you’ll get all your Part A and Part B benefits through the plan, not through Original Medicare.
Part C plans are run by private local or regional plans, approved and regulated by Medicare.
You can join an MA plan when you are first enrolled in Original Medicare or during the annual open enrollment (Oct 15 -Dec 7).
Medicare Advantage plans usually include Medicare prescription drug coverage at no additional cost.
If your MA plan includes drug coverage and you join a Medicare Part D plan, your MA policy will be cancelled and you’ll be returned to Original Medicare.
Note: All Medicare Advantage plans cover emergency care.
In addition to your Part B premium, you usually pay a monthly premium for your Medicare Advantage Plan.
Each month, Medicare pays a fixed amount to your Medicare Advantage provider, regardless of the amount of medical care received. You pay what the plan requires for each service.
All MA providers must follow certain Medicare rules. However, they have the right to set their own out‑of‑pocket costs and rules regarding their services.
These rules can change annually. Your MA plan will keep you updated about any changes in the coverage, costs, provider networks and service area through the Annual Notice of Change.
MA plans have different monthly premiums, co-payments, coinsurance and out-of-pocket limits. The monthly costs and availability of MA plans in Arizona vary from county to county.
Your Medicare Advantage plan can’t charge you more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
Providers can join or leave your plan’s network and your plan can change the providers at any time of the year. If this happens, you may need to choose a new provider.
When to consider a Medicare Advantage plan
Choosing the optimal health coverage option requires careful consideration of each plan’s specifics. Additionally, you have to take into account your current health status, financial stability and potential health concerns. It is wise to consider an MA plan in the following scenarios:
- Original Medicare doesn’t cover prescription drug costs. To get drug coverage, you’d have to purchase a separate Medicare Part D plan. In contrast, the majority of MA plans include drug coverage. The medicare.gov site has online tools where you can compare different plans and check how much you’d pay for your medications.
- Original Medicare has no limit on the costs you’d have to pay out-of-pocket. In other words, you pay a portion of the costs each time you receive medical care. Medicare Advantage plans are required by law to set an out-of-pocket maximum. Once you reach this limit, your plan will cover all your expenses.
- Original Medicare charges a 20% coinsurance. Due to the different cost structure of Medicare Advantage, this amount could be lower or the plan may charge a co-payment instead of coinsurance. Co-payments are fixed amounts you pay for medical care. Lower costs are usually compensated by higher monthly premiums.
- Some Medicare Advantage Plans offer dental care, vision and hearing services, wellness programs, assisted living facilities and nursing home care. These services are not covered by Original Medicare.
- If you want to enhance your Original Medicare coverage, Medicare Advantage is an alternative to the private Medigap supplemental plans. Medigap plans are designed to help with the deductibles, co-insurances and co-payments in Original Medicare. Depending on your particular needs, Medicare Advantage could be better suited for you than Medigap. Familiarize yourself with both alternatives so you can make the right choice.
If you’re using Medicare or planning to join the program, you’re probably wondering if you should get some form of supplemental insurance. Life is unpredictable and an accident or a debilitating illness can result in thousands of dollars spent in treatment costs. If you want additional insurance against life’s unexpected surprises and costs, checking out the different Arizona Medigap plans is a good place to start.
Arizona Medigap plans in the USA
The US healthcare system is multi-leveled and complex. More than half of all coverage is delivered through programs such as Medicare, Medicaid, the Children’s Health Insurance Program and the Veterans Health Administration.
The majority of US citizens under 65 are insured through their employers. Some have private insurance, while the rest are uninsured. Public sector employees are ensured through the government.
Before you decide if Medigap is the right choice for you, familiarize yourself with all your health insurance options. It’s the only way to make an informed decision about your healthcare future.
You can do research on the topic online or consult insurance providers. You can also talk to people already using the choices you are considering.
What is Medicare?
Medicare is the federal health insurance program serving seniors over 65, regardless of their current health, medical history and income.
Individuals under 65 may be eligible for Medicare if diagnosed with end-stage renal disease (ESRD) or a qualifying long-term disability.
Medicare eligibility is linked to a person’s social security benefits. The program is available to people over 65 that have worked for at least 10 years, with social security and Medicare withholding tax deducted from their pay during that time.
Medicare is structured as follows:
Medicare Part A covers inpatient hospital care, limited skilled nursing care and hospice care. It’s premium free for people who have paid into social security for at least 10 years.
Medicare Part B covers non-hospital expenses, like doctor visits, blood tests, X-rays, diabetic screenings and outpatient care. Part B is available for a monthly premium.
Medicare Part C i.e. Medicare Advantage is offered by private companies as an alternative to Original Medicare. It often bundles all the coverage aspects of Medicare into one plan.
Medicare Part D covers the costs of prescription drugs. It’s available as a stand-alone plan through private companies. You can also get your Part D through Medicare Advantage.
Medicare enrollment is mandatory. As long as you have Medicare Part A, you can consider yourself covered. However, if you only have Part B, you may be subjected to a tax penalty for not having essential coverage.
What is Medigap designed to do
Medicare does provide a lot of coverage, but its scope is nonetheless limited. The purpose of Medigap is to help cover some of the costs left out by Original Medicare, like copayments, coinsurance, and deductibles.
This extra coverage allows beneficiaries to better control and predict their annual medical expenses.
Original Medicare and Medigap work together to provide better coverage. First, Medicare pays its share of the Medicare-approved amount for your healthcare services, after which Medigap covers its share.
A few points to remember:
Medigap plans are available as stand-alone policies from private insurance companies, for a monthly premium.
There are 10 standardized Medigap plans available in Arizona, identified by letters (A – D, F – G and K – N). The word standardized means that same-letter plans must offer the same benefits regardless of the insurance provider.
Premiums for same-letter plans vary greatly between providers, so you’ll have to do some research before choosing a plan.
Plan rates can vary depending on your age, place or residence, provider and plan type.
The most comprehensive and popular plan in Arizona is Plan F. This plan covers pretty much all out-of-pocket costs for Parts A and B. The other plans cost less, but allow more gaps to remain open.
Medigap policies are renewable. As long as you pay the monthly fee, your provider cannot terminate your insurance even if you have health problems.
The best time to buy a Medigap policy is when your Medicare coverage begins. If you join Medigap within the first six months of enrolling in Medicare Part B, insurance companies are obligated to sell you a policy regardless of your health status.
After this deadline, you can be denied coverage based on health issues, at the provider’s discretion.
Medigap policies don’t include prescription drug coverage. For this purpose, you will need a Medicare Prescription Drug Plan (Part D).
Reasons to buy a Medigap plan
When contemplating additional insurance, make sure to ask your doctor if Medicare will cover the services and supplies you need. Overall, Original Medicare doesn’t cover many services and items required by many seniors.
According to experts, you should get a Medigap policy if you can afford one, even if you’re currently in good health and don’t need additional insurance.
You won’t need a Medigap plan if you qualify for Medicaid, have an employment-based medical retiree option, if you’re already using a Medicare Advantage plan, and of course, if you are extremely wealthy.
Depending on the plan, Medigap will either pay all or some of the costs not covered by Medicare.
Your Medigap policy is designed to protect you against excessive out-of-pocket costs, especially if you are ill or severely injured, require prolonged hospitalization or require more care as you age.
For instance, if you are hospitalized and you only have Original Medicare, you’ll be required to pay a hospital deductible of $1,216 for each benefit period. For inpatient stays exceeding 60 days, you’ll be responsible for a portion of the daily costs from the 61st day onwards (coinsurance).
These costs will go up the longer you remain hospitalized. Once your lifetime limits are exhausted, you will have to pay the inpatient costs in full.
The same applies to doctor appointments and medical procedures. Your deductible is $147, after which you’ll have to pay 20% of the Medicare approved amount for doctor services and medical equipment. Depending on the bill, this can be a substantial amount.
Also, keep in mind that:
- Even if you finish this year without needing your Medigap policy, the situation may change next year.
- You should do your homework and check the provider’s reputation, including the claims-paying ability, service and customer care quality.
- If you move to another state after you retire, you may need to change your Medigap plan.
- One Medigap policy covers only one person.