Read these 15 Learning About Medicare Benefits Tips tips to make your life smarter, better, faster and wiser. Each tip is approved by our Editors and created by expert writers so great we call them Gurus. LifeTips is the place to go when you need to know about Health Insurance tips and hundreds of other topics.
If you are receiving benefits from Medicare Part A or B, you are eligible for Medicare Part D. Medicare part D is optional and provides beneficiaries with assistance paying for prescription drugs. Open enrollment is held from Nov. 15 – Dec. 31 annually and it is when you can select or change your plan. Once people choose a plan they will not be able to change until the next enrollment period except in special situations.
Unfortunately, if you opt not to enroll in Part D when they are first eligible, you will have to pay a higher premium if you decide to join later on. This penalty will be about 1% of the monthly premium. People who sign up late will have to pay this penalty unless Medicare decides they had drug coverage that was as good as Medicare's during the time they were not enrolled in Part D. This is known as “creditable” coverage.
Hospital Visits: ER, inpatient, Rehab
Many will argue that spending on hospital care is the fastest-growing segment of the nation's health care tab. On one hand, critics say hospitals are unfairly using their growing clout in many markets and charging far more than it costs to provide services. On the other hand, hospitals are saying that they are only trying to counter rising labor and equipment costs, while faced with insufficient payments from government and private insurers. Some where does this put the consumer? Hospitals are now demanding bigger payments by telling insurers to pay up or they will stop accepting their patients, thus if we are smart consumers, we may find ourselves falling victim to a high medical bill; thinking our insurance is paying for the bill, when it really is not. The next few tips will help you avoid that surprise.
Open enrollment for the government's drug plan for seniors runs from Nov. 15 to Dec. 31. If you're 67 or older and don't currently have drug coverage, sign up as soon as you can do you do not get penalized a permanent penalty of 1% of your premium for every month you were eligible and didn't enroll. If you have a plan that covers your drug, be sure you get a letter if creditability, so if you decide to switch to the Medicare Part D Plan at a later date, you will not accrue the penalty for the years you chose not to participate. The average savings on drug costs is about 28%. If you're in good health now, simply choose the lowest-cost plan in your area; you should be able to find one with premiums of less than $10 a month. You can compare Medicare Plans in your area at www.medicare.gov/.
Don't forget about Medicare, it's not just for people that are 67 and older! You are eligible for Medicare Part A (the hospital insurance) if your spouse is getting (or eligible for) retirement benefits from Social Security or Railroad Retirement, you are under 65 and getting Social Security Disability Insurance (SSDI) or Railroad Retirement disability benefits (although there might be a 24-month waiting period for most people in this category), or you are under 67 years of age with end-stage renal disease (ESRD) and you or your spouse has met the Medicare work requirement. The number of years of Medicare-covered employment that you need to qualify varies, depending on the age at which you got ESRD. Dependent children with ESRD are also eligible if one of their parents has met the Medicare work requirement. There are also some other medical disabilities that may also be covered under some Medicare programs, but you may have to pay for Part A coverage. Call 1-800-Medicare or 1-800-633-4227 for more information or contact you local State Health Insurance Program at http://www.medicare.gov/contacts/static/allStateContacts.asp for free one-on-one help with your Medicare questions or problems.
Just because you do not qualify for Medicaid does not mean there are no state funds available for you and your family. Double check with your state to see what new health programs your state may be starting. This may take a little research, but a good place to start id your state's Department of Health or by going to the national Department of Health and Human Services website at www.hhs.gov and researching the state funded programs that may be available.
An example of one of these state and federally funded programs is the State Children's Health Insurance Program (SCHIP). This program is generally for families that do not currently have health insurance for their children under the age of 19, who earn up to a certain amount of money a year. Each state determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. In most states, those who qualify for benefits are for little or no cost, this insurance pays for: doctor visits, immunizations, hospitalizations, and emergency room visits, in other states this may cover women who are pregnant. For contact information for your state or to read specific information regarding eligibility in your state please access the Insure Kids Now at www.insurekidsnow.gov/states.htm.
Medicaid is a state and federal government funded program that provides health coverage for people that meet certain state established income and resources levels. Some of the basic benefits that the states must include are: Hospital Care (inpatient and outpatient, physician services, laboratory and x-ray services, nurse midwife and nurse practitioner services, early and periodic screening, diagnostic, and treatment services and immunizations for children and youth under 21, nursing home care, home health services for those eligible for nursing home care and the transportation services for doctor, hospital, and other healthcare visits. Depending on what state you reside in, they may also offer additional services under the same Medicaid program such as physical therapy, personal attendants, and rehabilitation services. To get more information on exactly what is covered and if you qualify, contact your local Medicaid office (which may also be called “medical assistance” in some states) at the Centers for Medicare and Medicaid at www.cms.gov or by dialing 1-800.MEDICARE. You can also find what optional services are available in your state under this Medicaid program by going to www.kff.org/medicaidbenefits.
If you are making more than the poverty level determined by your state, check to see if your state offers a medically needy program such as a “spend down” option. These types of programs are offered in about 35 states and Washington, DC. These programs offer healthcare assistance to certain groups of individuals with high Medical expenses but have incomes above Medicaid eligibility limits.
Medicare Part A is basically the serious care side of Medicare coverage. It covers expenses associated with inpatient hospital stays, skilled nursing facilities, and some home health care. Medicare Part B covers approved outpatient physician services, outpatient hospital services, certain home health services, and durable medical supplies and equipment. Under both plans, Medicare reimburses providers based on its chart of allowed amounts--or the amount the federal government has deemed it considers fair and reasonable for a given service or item. The allowed amounts are derived based on national averages. You are responsible for the co-pay, which is the difference between the allowed amount and what Medicare actually ends up paying your provider, which is a percentage of the allowed amount.
The Medicare benefits application process is quite lengthy, and the best advice is to begin gathering information on the application process, benefits, and coverage specifics at least several months before your eligibility date. In this way, the information can be carefully studied, and questions answered to ensure your benefits are not delayed. The Centers for Medicare & Medicaid Services, or CMS, publishes a "Medicare & You" guide each year that explains the program. It includes information about any changes to the plan, what is covered and what is not, how to pick a plan that is right for your needs, and a lot of other useful topics. You can request a copy of the guide by calling (800) 633-4227 or by visiting www.medicare.gov. You can also use the Medicare Personal Plan Finder, which guides you through a simple set of questions ultimately displaying a list of plans for which you are eligible.
There are three main costs associated with Medicare insurance, premiums, deductibles, and coinsurance rates. The premiums are based on how many Medicare-covered quarters of employment you or your spouse have logged. If either of you have logged at least 40 quarters of Medicare-covered employment, you do not pay a monthly premium for Medicare Part A (hospital) insurance. If you have logged 30-39 quarters, your 2006 monthly Part A premium is $216.00. For those with less than 30 quarters of Medicare-covered employment and who are not eligible for premium-free hospital insurance, the 2006 monthly premium is $393. The Medicare Part B 2006 monthly premium is $88.50.
Beginning on January 1, 2006, Medicare began providing prescription drug coverage to all registered Medicare recipients. This coverage is known as Medicare Part D. The actual prescription drug coverage insurance is provided by private, Medicare-approved companies. You will need to choose a company from among those approved to provide this Medicare benefit based on what each plan covers, as well as how much the monthly premium will be. All plans provide coverage that at least matches the standard Medicare prescription drug plan. Plans with higher monthly premiums are likely, though not guaranteed, to provide more coverage of a wider range of drugs. If you already have prescription drug coverage through a current or former employer, if you are retired, keep in mind that your existing benefit may actually be better than those provided as a Medicare-approved plan. If you choose not to enroll in the Medicare drug plan when you are first eligible, you may be charged a penalty for joining later.
Even though the Medicare Prescription Drug Plan is seen as way fixed-income seniors can benefit, it is necessary to think careful about the total out-of-pocket expenses. For some people the out-of-pocket expenses per calendar year can be as much as $3,600, and this is without the monthly premium. For those lucky enough to have drug coverage under employer-sponsored plans or have enough disposable income to cover their costs, be aware that if you decide you do not want to join at the time you become eligible, you may be charged a penalty if you want to join later on. For those who do stand to benefit, you can find out more about which plans are offered by visiting Medicare's Web site or by calling Medicare at 1-800-MEDICARE. You can also visit AARP's Web site and read up on all the pros and cons of your various options.
To benefit those interested in learning about Medicare benefits, The Centers for Medicare & Medicaid Services is rolling out a Web site for registered Medicare recipients to gain access to information on benefits and request services more conveniently. This information is being phased in state-by-state and is expected to be accessible to individuals. To see if your state is online, you can visit http://my.medicare.gov. Complete a very straightforward online registration form to set up your user name and password, once you have completed the registration process, you can find information on benefits, premiums and coinsurance rates, as well as other topics. You can also do things such as notify Medicare of a change of address or order a Medicare replacement card as well.
Learning about Medicare benefits is one of the smartest decisions to can make. If you already have prescription drug coverage, it is still important for you to learn about the drug benefits available to you under the Medicare insurance plan. Working with the plan administrator of your current policy, you should be able to determine which plan provides better coverage for your particular amount for the premiums, deductibles, and co-pays you will be paying. A great resource to help you decide whether or not to join the Medicare prescription drug plan is AARP's Web site, which has a full suite of articles and tools to help you compare plans and pick the one that is right for you.
Out-of-pocket health care costs are those that you pay yourself and for which you receive no reimbursement. For the Medicare prescription drug benefit, you will have to pay a monthly premium to join a plan on top of existing Medicare Part B, Medicare Advantage, or Medicare Cost plan premiums. Costs will vary depending on which plan you pick. For 2006, you will pay a monthly premium of around $32 a month for standard coverage. For that, you will receive a $250 deductible, which must be met before the benefit starts. As long as your premiums are paid on time and you have met your deductible, you will have a 25% co-pay up to $2,250. You will then have to pay 100% of your drug costs for the next $2,850. Once you have spent $3,600 in out-of-pocket expenses for the calendar year, the benefit becomes active and your co-pay is only 5% for the rest of the calendar year. People with limited income may qualify for extra help in the form of waived premiums, no deductibles, and low co-pays.
Medigap insurance is supplemental insurance privately purchased by individuals. These supplemental policies cover costs not paid for by Medicare that you would normally have to pay for out-of-pocket. Before signing up for Medigap, The American Association of Retired Persons (AARP) recommends considering other alternatives you may have available to you such as Medicare savings programs, Medicaid, retiree health insurance, and prescription drug assistance programs. AARP's Web site and its publications include a wealth of resources to help educate on these options as well as available Medigap plans.
The Centers for Medicare & Medicaid Services, or CMS, is the federal agency that administers the Medicare program. The Medicare insurance program, which turned 40 in 2005, provides health insurance coverage to nearly 40 million Americans. Covered individuals include those age 65 and older, some people with disabilities under age 65, and people with end-stage renal disease. End-stage renal disease, also known as ESRD, is permanent kidney failure requiring dialysis or a kidney transplant. CMS was formerly known as the Health Care Financing Administration, or HCFA, but was renamed in 2001.
|Jennifer Mathes, Ph.D.|