Call 480-706-1702
For a FREE In-House Quote

Medicare Part B

What Really Is a “Medigap” Plan?

Many people confuse the term “Medicare Supplement Plans” with “Medigap Plans”. It should be noted that Medicare supplement plans fill in some gaps in coverage in original Medicare which is known as “Medigap”.

There are 10 standardized Medigap plans available for senior citizens, each marked with the letters A to N.  And these plans are only available through private insurance companies, and it is not necessary for the insurance companies to sell all the 10 Medicare supplement plans. Every insurance company selling Medicare Supplement policy have to offer at least Plan A and if they offer any other policy than they must also offer either Plan C or Plan F.

Please note that Medicare Supplement plans can be used only to pay Original Medicare expenses. These plans can be used to cover expenses that you may have in Part C Medicare. If you enroll in Medicare Advantage plan, you can keep your Medigap plan as long as you keep paying the monthly fee, but you will not be allowed to enjoy Medigap plans on the cost of Medicare advantage plans. There are few things that you need to keep in mind before going for Medigap plans.

First and foremost, the beneficiaries must be enrolled in Medicare Plan A and Plan B. Secondly, if the beneficiary has a Medicare advantage plan than they can apply for Medicare policy and you will have to leave Medicare Advantage plan before you can enroll in Medigap. These Medigap policies are only able to cover one person. If anyone from your family want to avail then they will have to enroll themselves.

Monthly premiums will have to be paid to private insurance companies in addition to monthly Plan B premium. You are not bound by any insurance company, you can select any insurance company you like that is licensed in your state. Each standardized Medigap policy is guaranteed renewable, even when suffering from health problems. This means that the company cannot cancel Medicare Supplement insurance contracts as long as you pay the premiums. Medicare supplement plans allow you to use any provider that can accept Medicare. Among all the states of America, Arizona is considered as one of the best places to live after retirement. Arizona provides the best Medicare and Medigap help to senior citizens.

There are two specific Medigap plans (Plan k and Plan L) which are capable of covering out of pocket limits, because once your basic health care costs reaches the limit, your Medigap plan will cover 100% of all the expenses for the rest of your year. It is worth mentioning that original Medicare don’t have the ability to include a yearly out of pocket limit. Remember, Medicare supplement plan is meant to work side by side with your original Medicare coverage. You only need to remain enrolled in original Medicare to take the benefits of Medigap.

Although private insurers are required to offer the same benefits for each Medicare plan, these companies can change the costs of premiums they charge for this coverage. So if you are looking for Medigap coverage, you must contact different insurance companies to find a Medicare Supplement plan that is appropriate for your medical and financial needs. Remember that insurance companies use different methods to price their Medigap plans. Pricing method that company uses may affect the amount of premium you pay when you first enroll in a Medicare Supplement plan, as well as your long-term costs.

Medigap can be used only by people enrolled in traditional Medicare only. It is not a Government-run program but you can buy private insurance to cover some or most of your expenses in traditional Medicare. Medicare advantage plans consist of variety of private health plans for every type of needs. HMOs and PPOs are the most commonly used among the beneficiaries. Most of the plans include drug prescription coverage at no extra cost. Some plans are capable of covering routine hearing and vision services but not all. By law, all plans have annual limits for out-of-pocket costs.

Another difference from the traditional program is that most plans require you to go to the doctors and hospitals within their network and if you want to go out of the network, you will have to pay extra.

If you enroll in Medicare Advantage health plan, you can’t use a Medigap policy to cover your expenses, and it is illegal to sell insurance Medigap policy if you are enrolled in a Medicare Advantage plan. If you want to stay in traditional Medicare, you will need a separate Part D plan to get prescription drug coverage and pay an extra premium for it. A Medigap does not cover drugs outputs of- pocket.

Some states even offer Medigap plans for beneficiaries under 65 years of age who are eligible for Medicare because of disability or under certain conditions. Federal law doesn’t allow states to sell Medicare Supplement insurance for under 65 years, but depending on where you live, some states offer Medigap coverage for beneficiaries under 65 years of age. Every state can have its own eligibility criteria and terms. If you are a Medicare beneficiary under 65 years of age and interested in purchasing a Medicare Supplement insurance, contact your state insurance department to find out if you qualify for Medigap coverage in your state or not.

The costs of medicare supplements in Phoenix AZ

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.

Senior couple choosing 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.

Medicare enrolment application form

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.

Visiting a doctor

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.

Remember

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.

SCAN Health Plan Arizona Expands Medicare Advantage Coverage To Pima County

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.

How Good Is Your Medicare Health Insurance Coverage?

Medicare health insurance is generally designed to offer some coverage for hospitalization and routine health care, but it does not offer complete coverage for most services. In some cases, health care services you may need or want might not be covered at all, or may be covered only in limited circumstances.

Another consideration for Medicare beneficiaries is that not every health care provider accepts Medicare insurance. There is no requirement that doctors or hospitals accept Medicare. Many do, however based on recent and proposed changes in Medicare payment to providers, some doctors and hospitals are limiting the number of Medicare patients they’re accepting, and some providers have said that they will no longer accept Medicare.

When you enroll in Medicare, it’s important to decide how much you want to stay with your current doctor(s), hospital and/or pharmacy. Don’t make assumptions about your health care providers. You may need to ask each provider you see whether or not s/he accepts Medicare. If your provider does not accept Medicare, you may need to ask for a referral to another provider who does accept Medicare, or cover your health care costs from that provider out-of-pocket.

If you’re enrolled in traditional Medicare Part A and Part B, you can choose your health provider. Assuming your provider accepts Medicare, you can see the doctor(s) you want to see and receive services at your choice of hospitals that participate in the Medicare insurance program.

If you’re enrolled in a Medicare Advantage plan, you may have to choose your doctor(s), hospital(s) and pharmacies based on a list of participating providers who have been approved by your Medicare Advantage plan provider. In this way, Medicare Advantage plans are much like a health maintenance organization (HMO). If you choose to go out of your Medicare Advantage provider network, you could end up paying most or all of the costs associated with your care by yourself.

In short, not all health care providers accept Medicare, and not all services are covered. With traditional Medicare Part A and Part B coverage, you can purchase additional Medicare Supplemental Insurance to fill in some of the coverage gaps. With Medicare Advantage plans, some of these gaps are already filled in, but you may pay extra premiums with these plans, or you may find a limited network of health care providers whose services are covered by your Medicare Advantage plan.

Medicare Enrollment: Doing Nothing Can Be Costly!

If you will become age-eligible for Medicare in 2011, you may be tempted to let your Medicare enrollment slip. Perhaps you’re still employed or you have health care coverage through your spouse. Regardless of the reason, if you don’t enroll in Medicare within three months of your 65th birthday, you could end up paying a premium penalty for the rest of your life, based on when you finally enroll in the plan.

When you become age-eligible for Medicare, you have a “special enrollment period” during which you can enroll in Medicare for the first time. The special enrollment period begins three months before your 65th birthday and ends three months after your birthday.

If you don’t enroll in Medicare during the special enrollment period, you’ll be paying a permanent penalty in the form of increased monthly premiums on Medicare coverage. The penalties can vary, and they apply to all Medicare coverages for which you pay premiums. In other words, the penalty will apply to Medicare Part B, Medicare Part C and Medicare Part D premiums.

This is especially important to understand for Medicare Part D coverage. Medicare Part D coverage is optional. If you opt out for a year or two, even if you enrolled in Medicare Part A and Part B plans, you’ll still pay the premium penalty for your prescription drug coverage when you enroll in a Part D plan.

To avoid the premium penalty, many Medicare-eligible beneficiaries enroll in the lowest cost plans possible when they first become eligible. This strategy may have you spending some additional cash up front, but it will prevent you from paying potentially large non-enrollment penalties later.

One other caveat: your eligibility to enroll in Medicare Supplemental Insurance plans begins when you first become eligible for Medicare. If you choose not to enroll in Medicare at that time, you may forfeit your opportunity to enroll in a supplemental insurance plan later. If you eventually want traditional Medicare Part A and Part B coverage, examine the Medicare Supplemental Insurance plans carefully during your special enrollment period.

Medicare Advantage Plan v. Medicare Supplement: Which One Is Right?

Medicare InsuranceIf you are new to Medicare, or will be joining the ranks of the Medicare-eligible in 2011, you may not know much about Medicare, Medicare Advantage Plans and Medicare Supplemental Insurance, also known as Medigap.  In addition, you’ll probably want to take a crash course in Medicare Part D plans, just to be on the safe side.

Traditional Medicare coverage is designated as Medicare Part A and Medicare Part B.  Part A coverage, which pays for hospitalization, has no additional premium, provided that you are age-eligible for Medicare.  Part B coverage has a premium attached to it. In 2010, the monthly premium was about $111, and is deducted from your monthly Social Security check, Railroad Retirement or Office of Personnel Management payment. If you receive none of these payments, you’ll get a quarterly bill in the mail for your Part B premiums.

You can choose some other Medicare options, including a Medicare Advantage Plan (Medicare Part C), an optional Medicare Part D plan for prescription drug coverage, and a range of Medicare Supplemental Insurance plans, collectively known as Medigap insurance.  Medicare Advantage plans take the place of Medicare Part A and Part B coverage and operate much like an HMO plan does.  Medicare Advantage plans generally offer some additional coverage that traditional Medicare plans do not.

You may also be required to enroll in a Medicare Part D plan if you choose to go with Medicare Advantage coverage.  With Medicare Advantage, you’ll still pay your Medicare Part B and Part D premiums. You may also have to pay additional premiums for a Medicare Advantage plan, depending upon the level of coverage you choose.

You can also choose to enroll in one or more Medicare Supplemental Insurance plans. Medigap plans are designated by letter (e.g., Medigap A, Medigap B, etc.) Each letter plan offers a different level of coverage but all Medigap letter plans are the same, regardless of the insurer that provides them. For example, all Medigap A plans have identical coverage; all Medigap B plans also have identical coverage, etc.) Insurers are not required to offer all Medigap insurance plans, and the premiums among insurers can vary.

Medigap supplemental insurance is designed to provide coverage for certain services that Medicare Part A, Part B and/or Part D don’t pay for, or don’t cover completely.  To take advantage of a Medigap insurance plan, you must be enrolled in both Medicare Part A and Part B. You will pay additional premiums for these services to a private insurance provider, and the additional insurance is strictly optional.  Many Medicare beneficiaries choose not to buy supplemental coverage either because they don’t need it or can’t afford it. Also, each recipient must have his or her own Medigap plan. Your Medigap insurance will not provide benefits to your spouse.

Since each beneficiary’s situation is different, your best strategy is to read all information about Medicare prior to enrolling in a plan. When you become eligible, you will receive a Medicare information booklet in the mail. This document has all of the basic information you’ll need about Medicare. You can also visit the Medicare Web site if you have Internet access to find out more information about Medicare coverage, Medicare Advantage plans and Medicare Supplemental Insurance.

Choose the insurance options that offer the best combination of coverage and cost, based on your income, your current health, and the coverage you’re likely to need in a given year. As you age, you may want to review your coverage and make changes to meet your evolving health needs.

Medicare Will Now Pay For Smoking Cessation Counseling

Medicare says it will now extend smoking cessation counseling to its recipients citing the cost of providing health care to smokers as one reason for adopting the benefit. A study commissioned by Medicare found that the agency will spend about $800 billion on smoking-related health care over the 20-year period between 1995 and 2015.

Effective immediately, Medicare will pay for up to eight counseling sessions per year for smokers who want to kick the habit. In 2011, the counseling sessions will be offered under Medicare Part A and Medicare Part B at no cost to interested seniors. Medicare already pays for pharmaceutical interventions and counseling for those who have developed smoking-related illnesses, but did not pay for smoking cessation counseling for seniors who simply want to attempt to quit. Studies show that senior smokers are less likely to try to give up smoking, but those who do try are more successful at quitting than younger smokers.

Research has also shown that counseling is highly effective in helping seniors give up a tobacco habit – even a long-term one.  Seniors who undergo smoking cessation counseling are more likely to quit successfully and are more likely to live longer, even after having acquired smoking related illnesses like heart disease.

Only about 10% of seniors are regular tobacco users, compared with 20% of the general population. Despite this, tobacco-related illnesses remain the number one preventable cause of disease and death among Americans. Because many more smokers are not yet Medicare-eligible, the agency expects to see a larger number of smokers and smoking-related illnesses among newly eligible recipients.

Right now, Medicare estimates that about 4.5 million senior Medicare recipients smoke along with another one million disabled Americans younger than age 65 who receive Medicare coverage. The new coverage is part of the Affordable Health Care Act and is extended to all Medicare recipients, regardless of their age.

Free Quote or In-Home Appt.*