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.
Our bodies have a tendency to grow sick more frequently as we grow older. Although there are various health conditions that are not age specific, our body does become vulnerable to various health conditions, diseases and disabilities as we cross the age 60. This is because of a combination of physical and chemical changes in our body, and the weakening tissues and immune system. That is why, it is recommended seniors have reliable medicare plans. The state of Arizona has introduced several medicare supplement insurance plans which have been designed specifically to help the elderly.
The residents of Arizona can choose whether they wish to have a Medigap policy or the Medicare Advantage. Both of these have been designed to help the beneficiaries manage their medical costs by allowing them access to well respected medical health insurance providers. Each of these have their own way of operating, and provide different packages. Some may provide certain medicare facilities without any monthly premium or recurring costs while others may offer additional services such as dental care while charging the same amount as basic medical coverage. That is why, we cannot say that there is one best plan for everyone, because depending upon the needs and condition of an individual, their preferences may vary.
In the state of Arizona, more than 15% of the population is aged 65 or above (the term ‘seniors’ is used for anyone who is aged 65 or above). Many private healthcare and medicare supplement insurance providers in Arizona exist for the sole purpose of providing additional medicare services to this segment of the population. The question that arises here is why would someone need medicare supplement insurance plans in Arizona when they can avail medicare? The answer is, while one cannot find supplements with no monthly premium or charges (medicare supplement insurance plans are never free), they can be combined with the medicare to provide additional benefits to the beneficiaries. This also helps them by reducing their out-of-the pocket costs by covering their additional expenses, and by allowing them to see specialists of their choice. Normally, seeing a specialist requires a referral from a physician. Depending upon your medicare supplement insurance plan, you might not have to worry about network doctors or referrals to the specialists.
In Arizona, there is no difference between the supplemental plans despite the fact that 10 different plans exist. The difference, however, lies in the premium of the private insurance companies. Depending upon the expenses or services of a company, their charges or monthly premium may differ from what someone else is offering. However, one always has a good choice of a medicare supplement or advantage plan depending upon their medical conditions and prescription needs. This is important because sometimes we face expenses we don’t expect.
For instance, not many people are aware that the cost of prescriptions is not covered in the original medicare or medigap plans. For this purpose, people often need to get the medicare Part D plan. To be eligible for this, one simply needs to be a resident of Arizona aged above 65 and is enrolled in both medicare plans A and B. The amount charged for medicare supplement plans also depends upon the place they live, and their medical condition. This is the reason that some consumers find it quite confusing to search for the right medicare supplement insurance plan providers in Arizona.
The very reason we use the term ‘Medigap’ for medicare supplement insurance plans is because it helps an individual pay the gap between the amount paid by their original medicare providers, and what they have to pay from their own pockets.
If we talk about different Medigap coverage options, we notice that there are 10 different choices. These plans are labeled with alphabet, and are in groups A-D, F-G, and K-N. If you are wondering about the missing letters, it is because plans E, H, I and J are no longer available in Arizona.
The period for Medigap enrollment begins on the first day of the month when you turn 65. Afterwards, you would have 6 months to enroll for the supplement plan provided that you have original Medigap policy. You may choose between plan C and plan D depending whether you require Medicare Advantage plans or prescription coverage.
The important thing that everyone must know is that they must get themselves enrolled for the supplement plans within the 6 month period of open Medigap enrollment. If you do so, the companies would not be able to decline medicare supplement insurance plans to you. Generally, what happens is that companies deny medicare supplement insurance plans to certain individuals when they think that they would incur heavy expenses to the company. At times, the insurance companies also make changes to your monthly premium (by increasing it) if a you enroll outside of the specified 6 month period. However, you would not have to worry about that if you get enrolled within the 6 month period, regardless of your medical condition.
If you enroll for the Plan C (medicare advantage plan), you cannot use a Medigap policy and the companies would refuse to sell you one. However, if you turn back to your original Medicare plan within your first year of joining, you may earn a special right to sign up for a Medigap Supplement plan.
Generally, companies determine the premiums on three basis, that are: non-age-rated, entry-age-rated and attained age rated. Depending upon your needs, you may find a company that offers the best medicare supplement insurance plans in Arizona. You must invest in the right place because a good choice can cover a lot of healthcare costs for you.
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.
Diseases don’t only take their toll on your physical and mental wellbeing – they can also deplete your life savings. Most US citizens over the age of 65 rely on Medicare to cover their healthcare expenses, at least to a certain degree, as its coverage is not comprehensive. As a way to avoid excessive medical costs, Medicare beneficiaries can extend the scope of their health insurance coverage by purchasing one of the supplemental Medigap plans. Read on to find out what really matters when you are considering a Medigap policy for your healthcare needs.
Basic facts about Medicare
Medicare is the national health insurance program, addressing the needs of people aged 65 or above and other people with certain qualifying conditions.
There are 2 ways to get your Medicare coverage: Original Medicare, consisting of Part A (hospital insurance) and Part B (medical insurance) or Medicare Advantage (Part C), which is a standalone plan designed as a substitute for Original Medicare, administered through Medicare-approved private insurance companies.
If needed, users of Original Medicare and Medicare Advantage can add prescription drug coverage by purchasing Medicare Part D. Original Medicare beneficiaries in Arizona can also buy supplemental coverage known as Medicare Supplement Insurance (Medigap), which can only be used in combination with Original Medicare. Medigap and Medicare Advantage are mutually exclusive and you cannot have both.
Medigap – concept and important facts
Medigaps are private health insurance policies designed to supplement Original Medicare and cover some of the costs left out by Original Medicare. These are referred to as coverage gaps, hence the name Medigap. Coverage may include out-of-pocket costs such as deductibles, coinsurance, copayments, as well as hospice or additional hospital coverage.
When you receive healthcare as a Medigap beneficiary, Medicare pays its share of the Medicare-approved amount, after which the Medigap policy pays its share, thus supplementing the costs of your Original Medicare benefits. Medicare doesn’t cover any of the purchase costs for your Medigap policy. One Medigap policy only covers one person.
In Arizona, insurance companies can only sell you “standardized” Medigap policies, labeled by letters (A, B, C, D, F, G, K, L, M, and N). Standardized means that all providers selling a particular Medigap plan must offer the same coverage and benefits.
However, unlike the benefits, the costs of same-lettered plans do differ across providers. This is why, when purchasing a healthcare plan, it is best to choose the plan that fits your needs first and foremost, and then shop for the best price.
Arizona companies are not required to offer Medigap plans to disabled Medicare beneficiaries. Medigap policies are renewable (with the exception of policies purchased before 1992), meaning that your insurance provider cannot cancel your policy, unless you stop paying premiums or the company goes out of business.
Medigap plans offer the following basic benefits:
- Hospitalization – Part A coinsurance plus additional 365-day coverage after Medicare benefits end
- Medical Expenses – Part B coinsurance (usually 20% of Medicare-approved expenses) or copayments for outpatient services
- Three pints of blood each year, if you need transfusion
- Hospice care – Part A coinsurance
Medigap plans – coverage scope and costs
As a rule, Medigap policies sold in Arizona do not include long-term care, vision or dental care, hearing aids, eyeglasses, or private‑duty nursing, but some of them do offer coverage while traveling abroad.
As of 2006, Medicare Supplement plans in Arizona do not include prescription drug coverage. Your Medigap plan comes with a monthly premium, in addition to the monthly Medicare Part B premium. Monthly premiums for Medicare Supplement plans in Arizona range from around $40 to $300, depending on the beneficiary’s age and provider.
How insurance companies set their premiums
The ways in which insurance providers price their Medigap policies are important, as they will affect your present and future expenses. Premium rates can be set as follows:
- community-rated i.e. no-age-rated: premiums are the same, regardless of the beneficiary’s age;
- issue-age i.e. entry-age rated: premiums are based on your age when you first buy the policy. The sooner you enroll, the less you will pay;
- attained-age rated: premiums are based on your current age, and they increase as you grow older.
When to purchase a Medigap policy in Arizona
It is recommended that you join a Medigap plan during the open enrollment period (OEP), when you have a guaranteed issue right to buy a Medigap policy, regardless of your health status (i.e. when the provider is required by law to sell you a Medigap policy).
The 6-month Medigap OEP automatically starts on the first day of the month you turn 65 and are enrolled in Medicare Part B. However, you may have to wait up to six months for coverage of a pre-existing condition.
If you enroll in a Medicare Supplement Plan outside of your OEP, you may be subject to medical underwriting, which can affect the premium rates and whether the provider will sell you a policy or not. This basically means the company can ask you to take a physical, review your health information and then decide whether to offer you coverage, at which price and under which conditions.
Choosing a Medigap policy in Arizona
Arizona residents can choose from 10 standardized Medigaps, offered by around 50 insurance providers. More than half of the beneficiaries statewide use Medigap Plan F, followed by Plan C as the distant second.
Medigap providers don’t have to sell all Medigap plans, but their Medigap offer must include Plan A. If they offer any plan in addition to Plan A, they must offer Plan C or Plan F.
Plan F is also offered as a high-deductible plan. This means that you have to pay for Medicare-covered costs (coinsurance, copays, deductibles) up to the deductible amount of $2,180 before your policy pays anything.
For Plans K and L, after you meet your annual out-of-pocket limit and Part B deductibles ($147 in 2015), the 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).
When choosing a Medigap policy, check if the company offers discounts, such as discounts for women, non-smokers, or married people, yearly payment discounts, multiple policy discounts etc.
Generally, your choice of health insurance policy should match your medical needs but also your financial abilities. When choosing a plan, always consider your current needs and try to foresee future concerns.
Health services in Arizona and the rest of the U.S. are expensive and most people cannot afford to pay the full costs out-of-pocket. Health insurance allows people to receive medical care without incurring huge expenses. Medicare is the federal health insurance program which primarily serves the needs of elderly and disabled people, as well as adults with certain medical conditions. The program has limited coverage, so make sure to check out the medicare supplements in phoenix az before deciding how to cover healthcare costs outside the Medicare coverage scope.
How are medicare supplements in Phoenix AZ structured?
The Medicare program has 4 parts (A to D), each providing different benefits. Parts A (hospital insurance) and B (medical insurance) are also known as Original Medicare (check out this 2015 guide before choosing the right plan).
Part C (Medicare Advantage) is an enhanced alternative to Original Medicare supplied by private insurance companies. Part D (prescription drug insurance) covers prescription drug costs through private insurance companies contracted by the government.
On average, Original Medicare covers about half of your healthcare costs. The rest is covered by supplemental insurance or other forms of personal (out of pocket) payment.
What is Medicare Part A?
Medicare Part A is automatically available (premium-free) to people aged 65 and over who have been employed for at least 10 years and have paid social security taxes during that period. Adults aged 18 to 65 with work-preventing disabilities, dialysis and kidney transplant patients, people with an end-stage renal disease or amyotrophic lateral sclerosis are also eligible for Medicare.
Individuals who aren’t eligible for premium-free Medicare Part A can still enroll by paying a certain premium. Beneficiaries who postpone enrollment beyond the eligibility window may be subject to a late enrollment penalty after sign-up.
What does Medicare Part A cover?
- Hospital services – covers inpatient care (semi-private accommodation, meals, intensive and coronary care, nursing services, medications and supplies) in hospitals, rehabilitation facilities, long-term care and mental care facilities. The first 60 days of your hospital stay are fully covered, after which you are charged a considerable copayment, unless you have supplemental insurance.
- Home healthcare – Medicare covers skilled healthcare services, such as occasional nursing care, physiotherapy, and occupational or speech-language therapy, when provided by a Medicare-certified agency. If your needs include durable medical equipment, you have to pay 20% of the Medicare-approved amount.
- Skilled nursing facility – covers inpatient care in a Medicare-certified facility for a minimum of 3-day inpatient stay. Medicare Part A covers up to 100 days of your inpatient stay. Days 1-20 are covered 100%. For days 21-100, you will be charged a daily copayment of $157, unless you have a supplemental insurance plan.
- Hospice care – includes palliative care and pain relief for terminally ill patients with life expectancy of six months or less, delivered at home or in a hospice facility. To qualify for hospice care, patients must waive curative treatment, but they reserve the right to terminate hospice care and resume curative treatment.
What Is Medicare Part B?
Medicare Part B is available to Medicare Part A policyholders, at a monthly premium. Higher-income seniors may be required to pay more. If you delay enrollment in Part B for 12 months, you are required to pay a 10-percent premium penalty.
Once you turn 65 and join Medicare Part B, you have a six-month window (open enrollment period) during which insurance companies are obligated to sell you any Medicare Supplement Plan that you choose (Medigap), irrespective of your current health condition or past issues. These companies are not allowed to charge you anything extra. Keep in mind that this is a one-time opportunity.
If you have employment-based coverage, you can delay Part B enrollment. In this case, you can sign up later, during a special enrollment period, without paying a late enrollment penalty.
To receive Part B benefits, you must first pay the Part B annual deductible ($147). When you receive healthcare services, Medicare covers 80% of the approved amount and you pay the remaining 20%.
Part B covers outpatient care, preventive services (flu and Hepatitis B shots, cardiovascular, cancer and diabetes screenings), ambulance services, durable medical equipment, as well as occasional home-based health and rehab services that are deemed necessary by your doctor.
Medicare at the doctor’s office
Don’t forget to use the services of healthcare providers that always accept assignment (the Medicare-approved amount). These providers are referred to as participating providers and their contract with Medicare obligates them to accept the amount paid by Medicare for healthcare services as “full payment”. In this case, you only pay the deductible and the coinsurance amount. The doctor directly submits the claim (request for payment) to Medicare without charging you in the process.
Providers that haven’t signed a contract to accept assignment (non-participating providers) are not obligated to see you, but can choose to do so. In this case, you pay the entire cost of the service immediately and get reimbursed by Medicare later. These doctors cannot charge you more than 15% above the Medicare-approved amount (limiting charge). The limiting charge doesn’t apply to durable medical equipment and medical supplies.
Some providers choose to opt out of Medicare and not accept any Medicare payments. Consequently, they are free to charge you whatever they want, they don’t submit a claim to Medicare and you pay the entire cost of the service out-of-pocket. As an exception, Medicare will cover treatment expenses if you have been admitted as an emergency patient.
What is not covered by Original Medicare?
Original Medicare doesn’t cover prescription drugs (except immunosuppressive drugs and oral anticancer drugs), cosmetic surgery (except for reconstructive purposes), routine checkups, most immunizations, healthcare outside of the United States, hearing aids and exams, eyeglasses and contacts, dental care and dentures, etc. Some of these services are covered by supplemental insurance plans, such as Medicare Advantage and Medigap.
It is up to you to do your research, and decide which supplement suits your needs best. The main thing to remember here (again) is that your “optimal plan” will change with time. As you get older, you might have to change to a more expensive supplement, in order to (ironically enough) save money.
For Medicare enrollees who are hoping to catch a break on their prescription drug costs, 2011 doesn’t hold out much promise. Industry analysts say that most major Part D prescription drug plans will increase their premiums for coverage in the 2011 year. Right now, Medicare Part D enrollees pay about $32 on average per month for prescription drug benefits, but a study conducted by Avalere Health says Part D subscribers should plan to pay about 10% more for prescription coverage in 2011.
Part D premiums aren’t limited, so some prescription drug plan costs could rise much more than average. The study cites one plan whose premiums will increase by nearly half for 2010. Avalere Health reviewed the top 10 Part D prescription drug plans, which serve about 70% of beneficiaries who are enrolled in the optional coverage plans.
The study also estimates that about 3 million Part D subscribers will need to switch their current Part D plan for 2011. Most of those beneficiaries should be able to find comparable coverage with their current provider, but about 300,000 beneficiaries may need to find a new provider altogether. Federal regulations require that Part De providers consolidate coverage into “non-duplicative plans” but some industry analysts say that consolidation may mean some beneficiaries will see higher premiums if they stay with their current insurer.
The AARP will eliminate its MedicareRx Saver plan, requiring about 1.5 million subscribers to enroll is the organization’s MedicareRx Preferred plan, which has a premium cost that is 15% higher than the Saver plan. Those already enrolled in the Preferred plan will see a drop of about 11% in the cost of their annual premiums.
The Centers for Medicare and Medicaid Services say the concern could be nothing more than a tempest in a teapot. According to the agency’s figures, most Medicare Part D subscribers will see an average increase of no more than 3% (about $1) per month in their premium costs, even if they need to switch plans.
One reason for the increase in premiums is the improved “gap” coverage beneficiaries will receive beginning in 2011. In the past, seniors who exceeded pre-established spending limits on prescription drug benefits had to pay the entire cost of their prescriptions until they became eligible for catastrophic drug coverage. Beginning this year, those who exceed the plan limits on spending will be eligible to buy prescription drugs at a reduced rate while in the coverage gap. By 2020, the gap should be entirely eliminated.
- February 4, 2011
- AARP, Avalere Health, az medicare, azmedicare, centers for medicare and medicaid services, gap, Medicaid, Medicare Part D, MedicareRx Saver plan, top 10 Part D prescription drug plans
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A new report authored by the Agency for Healthcare Research and Quality (AHRQ) says that one-third of Medicare hospital stays in 2008 involved patients who were dually eligible for Medicare and Medicaid. According to the report, Medicaid pays the Medicare insurance premiums for about 8 million beneficiaries each year, about 18% of all Medicare beneficiaries. Dual-eligible patients account for about half of all Medicaid spending and about one-quarter of all Medicare spending in any given year.
Healthcare expenditures for dual enrollees are likely to be higher because dual enrollees typically have a number of chronic health conditions (some of which make them eligible for Medicare), and are more likely to need catastrophic medical coverage and long-term continuing care services.
The AHRQ report says that the three top causes of “potentially preventable” hospitalizations in 2008 among dual enrollees were bacterial pneumonia, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Other potential preventable hospitalizations included pressure ulcers, asthma, diabetes and urinary tract infections.
Among “potentially preventable” hospitalizations, Medicare and Medicaid spent more to treat pressure ulcers than any other diagnosis. The report also noted that dual enrollees were more than twice as likely to be admitted for pressure ulcers, asthma, diabetes and urinary tract infections than traditional Medicare beneficiaries were, and nearly one-third more likely to be admitted for bacterial pneumonia and COPD than Medicare beneficiaries.
More than half of all hospitalizations among dual-enrollees between 18 and 64 were for asthma- and diabetes-related illnesses, while more than one-third of hospitalizations for dually enrolled beneficiaries over the age of 85 were for falls. One quarter of hospitalizations among elderly dual beneficiaries 85 and above were for bacterial infections, UTIs and bacterial infections, UTIs.
The most likely group of dual beneficiaries to require hospitalization for potentially preventable conditions, however, were those between the ages of 65 and 74. The report, which was presented as a statistical brief, did not include recommendations on reducing the number of potentially preventable admissions among dual beneficiaries, however it does provide a basis for continued research into improved treatments and preventive care that could reduce the number of potentially preventable admissions among dually enrolled Medicare/Medicaid beneficiaries.
- February 3, 2011
- Agency for Healthcare Research and Quality, AHRQ, asthma, bacterial infections, CHF, chronic obstructive pulmonary disease, congestive heart failure, COPD, diabetes, Medicaid, medicare, Medicare insurance premiums, ulcers, urinary tract infections, UTIs
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In something of a surprise announcement, Donald Berwick, Director of the Centers for Medicare and Medicaid Services, says that premiums for Medicare Advantage plans will decrease slightly in 2011. Berwick says that the monthly costs for MA plans for more than 11 million enrollees will drop by about 1%. In addition, enrollees should see some relief from the cost of prescription drugs and the continuation of certain no-cost preventative health care services.
In 2009, premiums for Medicare Advantage plans increased by an average of 15%. Berwick and other Medicare officials say that the health care reform act has provided the Medicare and Medicaid Service with additional negotiating power. Initially, officials used their newfound clout to drop about 300 previously approved Medicare insurance plans offered by private providers. According to Medicare officials, the rejected plans increased out-of-pocket costs without increasing benefits or covered services.
Most of the insurers then modified the plans to provide additional services at reduced costs. Upon reconsideration of the new offers, Medicare approved most of the 300 rejected plans. Fewer than ten of the original 300 rejected plans did not modify their initial proposed coverage, improve their benefits or reduce beneficiaries’ proposed out-of-pocket expenses. Upon review, these plans were rejected a second time and will not be offered in 2011.
Some analysts say that insurance providers are more willing to negotiate with Medicare because they are more dependent now upon Medicare premiums than they had been in the past; a large number of new enrollees are expected in the next decade; and the new health care legislation will open new opportunities for providers in the coming years.
Seniors who have elected Medicare Part D (prescription drug coverage) can also expect to see some decreases in their out-of-pocket expenses if they have significant prescription costs in 2011. The relief comes as part of the Obama Administration’s effort to eliminate the “donut hole” gap in Medicare prescription drug coverage. Reduced out-of-pocket expenses for Part D benefits will not translate into lower Part D premiums, however. Part D premiums are expected to rise in 2011 for most prescription drug plans.
According to figures released by the administration, more than 750,000 checks for $250 have already been mailed this summer to Medicare recipients who have exceeded their basic Medicare Part D benefits. The so-called “donut hole” is a gap in prescription drug coverage that will cause beneficiaries to pay the entire cost of their prescription drugs once their basic benefits are exhausted but before catastrophic drug coverage kicks in. Basic Medicare Part D coverage is exhausted when the beneficiary and his or her insurance company have spent a combined total of $2,830 on prescription medications in a single coverage year.
The problematic coverage lapse isn’t a minor issue. An estimated 3 million more checks will be mailed out before the end of the year, as more seniors qualify for the one-time rebate. The $250 check is the administration’s first step toward closing the donut hole altogether, a process that’s expected to take nearly ten years. Beginning next year, the cost of most prescription drugs will be halved for beneficiaries whose basic coverage runs out. Eventually, the gap will be eliminated entirely, and beneficiaries will maintain annual prescription drug benefits with no gaps in the coverage.
As part of the “gap reduction” plan in 2011, Medicare will “streamline” its Part D plans, which may mean fewer Part D plans to choose from. One of the new Part D rules for 2011 limits carriers from offering more than one Part D plan in a single coverage area. Medicare’s goal with the new rules is to reduce the number of confusing choices that confront beneficiaries during the annual enrollment period, but this may force nearly three million seniors enrolled in popular drug plans, such as the multiple Part D options offered by AARP and CVS-Caremark, to switch plans.
The AARP released a study last month that contradicted the Medicare administration claims that reforms will lower the cost of prescription drugs. In the AARP’s study of brand name drug costs, the organization said that in the last five years, the cost of the most popular prescription medications rose by 41.5%, more than tripling the 13.3% rise in the consumer price index for the same time period. Drug makers say that the AARP is being alarmist regarding the price of brand name drugs because about three-fourths of consumers in the US use lower-cost generic drug formulations.
- February 1, 2011
- AARP, CVS-Caremark, donut hole, drug coverage, gap reduction, medicare, Medicare administration, Medicare Part D benefits, Part D plans, prescription drugs
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