Medicare is actually the federal health insurance program for different categories of people including who are aged 65 or older. It also includes younger people with disabilities, and people having End-Stage Renal Diseases. Every country has its own Medicare policies while the unfortunate countries don’t even have the basic medical insurance plans. The different parts of Medicare help in Phoenix, Arizona cover specific services, some of them are mentioned below:
Hospital Insurance (Plan A):
This Medicare policy covers inpatient hospital care, care in a skilled nursing environment, hospice care, and some health care.
Medical Insurance (Plan B):
This medical insurance covers some specific doctor’s services, outpatient care, medical supplies and preventive services.
Medicare Advantage Plans (Plan C):
This type of special plan is mostly offered by private companies 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 they may also offer prescription drug coverage.
Prescription Drug Coverage (Plan D):
This plan adds the prescription drug coverage to the original Medicare Advantage plan. These plans are mostly offered by insurance companies and other private organizations approved by Medicare.
In United States, essentially every 65-year-old person enrolls in Medicare and most of them also receive additional coverage. One medical plan of additional coverage is through supplements to traditional Medicare which includes prescription drug plan to cover some or all of the payments.
Now the question which confuses most people is which Medicare is plan is right for me?
Not every plan is right for everyone. There are numerous Medicare supplement insurance plans which are also sometimes called Medigap plans. What we need to understand is which plan is the best for us. Some of the Medicare supplement plans in Phoenix, AZ are mentioned below:
Full Coverage Plans:
Full coverage plan is the most comprehensive plan. It has the ability to pay for all of your expenses that are already approved but not have been paid by Medicare. This plan includes all your deductibles, co-pays and co-insurances 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.
The high deductible Plan is similar to Full Coverage Plan, when you meet the deductible, you pay for all expenses that are approved but not paid by Medicare . In 2015, the deductible amount was $2180. This amount usually changes every year. This plan works probably best for those who are healthy and think that they will require less expenses or those who are willing to take some risk in exchange for a much lower cost rate.
An important point to keep in mind it is that the Original Medicare plan still pays the fair share of medical expenses – for example, Medicare generally pays 80% of your medical/sickness costs and are responsible for 20%. Only 20% of this applies to your deductibles. Think of the high deductible Plan as a plan where you pay the difference to minor expenses, but if you have large expenditures for health, your maximum amount for the year is $2,180, and then your Medicare Supplement high deductible plan picks up all other expenses approved but not paid by Medicare.
Mid Range Plans:
There is a wide variety between 9 full coverage and deductible plans – so if you are not familiar with one of these two options , you have much more to choose from.
Basically, Medigap plans are sold to provide additional coverage for already covered Medicare services. The aim of a good Medicare Supplemental Insurance plan is to reduce some costs for services that are partially covered by traditional Medicare plans.
Medicare insurance plans offer twelve standardized service plans so that consumers can easily compare policies and costs. Medigap plans are labeled A through L, and offer more comprehensive set of covered services. A Medigap policy A example is the most basic Medigap policy. Medigap Policy B will cover all policy Medigap and will offer some improved benefits, however it will not provide as many benefits as Medigap Plan C does. Medigap policy only covers one person at a time, whether a participant is eligible for coverage through her husband or wife. Each participant must have their own Medicare insurance. Just as Medigap insurance plan is optional, participants pay Medigap insurance in addition to Medicare Part B and Part D premiums optionally.
Features of a Medicare Supplement Plan:
- The doctor’s Choice – Individuals can choose their preferred doctors and hospitals (as long as the patients receive Medicare) .
- Access to specialists – Individuals can see specialists without a referral.
- Convenience – Virtually no claim forms to file.
- Freedom – coverage that travels with you anywhere in the US
- Guaranteed changes – Medicare supplement plans are automatically renewed as long as the individual continues to pay their premiums on time, without twisting one or more of the basic facts after the first application registration.
To get a Medicare Supplement plan, you must have Medicare Plan A and B. You must continue to pay the monthly premium of Part B in addition to your monthly Supplement plan premium. You can get this plan during your Medigap open enrollment period, which is a six-month period starting in the first month, you are 65 years or older. During this period, you cannot deny coverage because of past or present medical problems. For more information, visit www.azmedicare.info now!
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.
Pima County, AZ residents will have an additional Medicare Advantage plan option for 2011. SCAN Health Plan Arizona will expand its coverage area to include Pima County residents, beginning January 1, 2011. Currently, the SCAN Health Plan Arizona only offers coverage in Maricopa County.
The current plan offers Medicare Advantage coverage to about 8,000 beneficiaries and has provided Medicare Advantage coverage in Arizona for three years. SCAN Health Plan Arizona says it has agreements in place with most of the leading hospitals and health care providers, and will focus its MA coverage on “affordable and accessible senior health care.” The SCAN Health Plan Arizona Medicare Advantage plan earned 3.5 out of 5 stars on its Medicare Part D (prescription drug coverage) but the Medicare Advantage plan itself does not yet have star ratings. The company’s California-based Medicare Advantage plan earned 3.5 out of 5 stars for its health care coverage and 4 out of 5 stars for its Medicare Part D coverage.
Eligible beneficiaries are those persons who are eligible for Medicare Part A and Medicare Part B, and who live in either Maricopa or Pima County. Updated plan information will be posted on the SCAN Health Plan Arizona Web site prior to the open enrollment period. Premiums for 2011 have not yet been determined, but in 2010, SCAN Health Plan Arizona did offer $0 premium plan options, exclusive of the Medicare Part B premium, which every enrollee pays. In 2010, the Medicare Part B premium was about $100 per month.
SCAN Health Plan is the nation’s fourth largest Medicare Advantage provider and serves about 130,000 enrollees in California and Arizona. To enroll in the program, eligible Medicare beneficiaries must choose the SCAN Health Arizona plan during the open enrollment period, which runs from November 15, 2010 to December 31, 2010. Coverage will begin January 1, 2011.
- February 5, 2011
- arizona, AZ, az medicare, azmedicare, Health Plan Arizona, medicare arizona, Medicare Part B, Pima County, SCAN, SCAN Health Plan Arizona Medicare Advantage plan
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