Do You Automatically Get Medicare Part A?
Medicare Part A is a coverage that helps the covered in a situation that requires the covered individual to go to the hospital. This is one of the more popular coverage choices for those that are enrolling in Medicare and paying for the premiums themselves. However, did you know that it is possible that you automatically qualify for Medicare Part A without having to enroll?
Here are the individuals that qualify for automatic enrollment into Medicare Part A:
- If you get Social Security or the Railroad Retirement Board benefits then you automatically qualify for Medicare Part A the first day after you turn 65. Those who are disabled and get Social Security or Railroad Retirement Board benefits will get some or all benefits on the 25th month of the disability.
- If you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease), you automatically get Part A the month your disability benefits begin.
Those who do not qualify in the above categories do not automatically qualify for Medicare Part A but there is still hope for getting the coverage. All you have to do to get Medicare Part A is sign up for the coverage, you may still even qualify to get the coverage premium free.
Medicare Supplement Insurance Can Save the Day
Medicare supplement insurance is great for the people that have no way of paying for the gaps created by a Medicare policy that doesn’t cover your needs. This being said, it is very important that you know what Medicare supplement insurance plan you are paying for and that you are paying a fair premium. It is not uncommon to have the private insurance companies that sell Medicare supplement insurance sell the same policies for different premiums.
Understand that when you are researching Medicare supplement insurance you need to compare the same policies with different companies to the premiums. Some states will have different requirements for what you need to have to get certain Medicare supplement insurance, regardless, you need to make sure that you have the coverage that you need.
The following important change to Medicare supplement insurance will happen later this year: Starting June 1, 2010, the types of Medigap Plans that you can buy will change:
- There will be two new Medigap Plans offered—Plans M and N.
- Plans E, H, I, and J will no longer be available to buy. If you already have or you buy Plan E, H, I, or J before June 1, 2010, you can keep that plan. Contact your plan for more information.
Medicare Benefits: Out-of-Pocket Costs with Original Medicare
Insurance is costly enough if you simply have to pay the premiums that come along every month, but what about the costs that aren’t included with Medicare benefits? The out-of-pocket costs that aren’t discussed freely are usually where you start to lose your tie when trying to pay for medical bills. Medicare benefits are similar to all other forms of insurance in that some things you have to take care of independently.
How to decide if you will pay out-of-pocket with Medicare benefits:
- Your out-of-pocket costs could be greatly reduced if you inform your doctors that you want to sign a Medicare benefits private contract.
- Be very honest when explaining the type of health care and why you need it when trying to get enrolled. You’ve got to know that this will affect your pocketbook if you enroll in Medicare benefits that don’t suit you.
- If you choose to get Medicare services or supplies that are not covered by your Medicare benefits they will be charged at full cost to you. In other words, be careful that the Medicare benefits you enroll in are the benefits that you need to survive.
In short, the message is this, the more research you do during enrollment the more of a chance you have to pay lower out-of-pocket costs. Medicare benefits can only take you as far as you allow them to.
Medicare Enrollment: Enrolling in Original Medicare
Many people are unsure how to go about the Medicare enrollment process due to the fact that there are so many different choices and plans to possibly enroll in. While there are multiple options available to you during Medicare enrollment it is relatively easy to decipher which is best for you. However, if you cannot make the decision and don’t choose which way to go during Medicare enrollment your mind will be made up for you.
If you don’t enroll in a plan during Medicare enrollment you will automatically be enrolled in “Original” Medicare. Here is what you should know about original Medicare:
- You have the right to go to any doctor that you so choose if you choose to go with Original Medicare during Medicare enrollment.
- If you do not enroll in Medicare Part D during Medicare enrollment you will not have any coverage for prescription drugs.
- You do not have to choose a primary care doctor or get a referral to see a specialist if you choose Original Medicare during Medicare enrollment.
- If you don’t have another source of insurance to go along with Original Medicare then you may want to sign up for supplement insurance to go along with your insurance during Medicare enrollment.
Do You Get Medicare Part D Extra Help?
Millions of people who use Medicare Part D assume that they are getting the best coverage possible and therefore make decisions that impact their health in such a manner. Assuming that they have the best coverage that they can afford they make decisions to skip certain treatments to be able to save money. These treatments that would be paid for by Medicare Part D could greatly impact their quality of life.
Many of these people don’t realize that they are eligible for help through a new Medicare Part D coverage known as “extra help”. With this coverage Medicare is starting to change its opinion of what is income and resources and what is not. After doing so you could be eligible to get more coverage. It is assumed that this could help with up to around $3,900 per year in savings.
If you are a citizen of one of the 50 states or the District of Columbia you have passed the first test of being eligible. If your resources are less than or equal to $12,510 for an individual or $25,010 for a married couple living together then you have passed the next portion of qualifications. Resources are bank accounts, stocks and bonds and the like. Resources are not things like your home and car.
Finally, your annual income must be less than or equal to $16,245 for an individual or $21,855 for a married couple living together. Even if you earn more than this but support other family members, have earnings from work or live in Alaska or Hawaii you could still be eligible for support.
Medicare Part D: How to Avoid the Late Enrollment Penalty
Many people who use Medicare everyday as part of their main health insurance coverage are unaware that they can actually be penalized for not enrolling in Medicare Part D as soon as they are eligible. This penalty is in play to try to discourage people from not paying when they have no prescription drugs to speak of and then enrolling in Medicare Part D when it becomes obvious that the coverage will be necessary.
If you enroll in Medicare Part D coverage as soon as you are eligible to get the coverage then you are reducing the possibility of being assessed a late enrollment penalty. This will show that you aren’t trying to avoid paying the premium that everyone is required to pay and you are trying to play by the rules.
To avoid the late enrollment penalty for Medicare Part D it is a good idea to avoid going more than 63 consecutive days without coverage that would be considered credible by Medicare. Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, or the Department of Veterans Affairs.
When you enroll in another creditable coverage it is a very good idea to let the Medicare Part D provider know that you have other creditable coverage right away. To avoid this late enrollment penalty for Medicare Part D it is a good idea to get the contact information for anybody that you inform about this creditable coverage as soon as is possible.
Medicare Part B: Travel Coverage
Most people who are on Medicare insurance know the basics of what is covered through Medicare, but what about parts of Medicare Part B that you are unaware of? Since you are paying for Medicare Part B it is only fair that you know exactly what is covered so you can get the biggest bang for your buck. Here is one unknown area of Medicare Part B, travel coverage.
In general, Medicare Part B does not cover you when you are traveling outside the United States and its territories. However, there are three exceptions:
1) If an emergency arose within the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
2) If you are traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
3) If you live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.
The coverage in these situations would be applicable to your Medicare Part B deductible and you would be responsible for 20% of the amount approved by Medicare.
Medicare Enrollment: Items to Consider
Because of both the confusing nature of Medicare itself and the impact that the right insurance coverage can have on your life Medicare enrollment is a big deal. Since Medicare enrollment is such a big deal it is worth it to you to study hard to keep from making decisions that will negatively affect you and/or your family.
Here are a few things to consider when going through Medicare Enrollment:
What You Need Covered: If you are already suffering from some lingering ailments it is worth it to you to make sure that you have the right coverage on your Medicare policy.
Other Coverage: If you intend on supplementing your Medicare policy with other coverage from another insurer then be sure to speak about this with your insurer before going through Medicare enrollment.
How Much Can You Afford: Like any other insurance policy it is very important that you consider how much your premiums and deductibles will be when going through Medicare enrollment to make sure you can afford your coverage.
Are You On Prescription Drugs? If you need a constant supply of prescription drugs then you need to look into getting the coverage on your Medicare policy when going through Medicare enrollment.
Is Your Doctor Covered? It is all well and good to have the coverage you think you need, but if you can’t go to the doctor you trust then you failed in your Medicare enrollment.
Medicare Benefits: Mental Health Care New for 2010
Medicare is nothing if not difficult to understand and constantly changing so it is always worth it to you to stay up to date on the changes every year to Medicare benefits. One of the new Medicare benefits for 2010 is the addition of “Mental Health Care” to individuals who are struggling with such things as depression, anxiety and substance abuse.
This new addition to Medicare benefits will assist you financially in taking care of the tab when you visit a doctor, psychiatrist or social worker to treat your mental health condition. If you are diagnosed and being treated for your mental health condition then this Medicare benefit will cover more than if you are not.
When you are going to a doctor to be diagnosed for a mental health condition then this Medicare benefit will pay 20% of the amount that is approved by Medicare. This same 20% applies to the Medicare benefit when you monitor or change your prescription that treats your mental health condition.
If you are receiving treatment for your mental health condition, such as trips to see a therapist or going through therapy then you will pay 45% of the Medicare approved amount under this Medicare benefit. This amount will decrease over a 4 year period as part of your Medicare Part B deductible.
Medicare Supplement Insurance Tips
It is very important to anyone on a fixed budget with Medicare insurance to consider purchasing Medicare supplement insurance. This coverage will save the day if you go over your policy limits with your Medicare coverage and it will get you back to solid footing. However, the very idea of Medicare supplement insurance confuses many Medicare patients.
What are some things you should know about Medicare supplement insurance?
- Medicare supplement insurance (or Medigap) is generally only available to people who already carry Medicare Part A and Medicare Part B coverage. This is very important to remember if you are trying to cover your backside but don’t carry Medicare Part A or B.
- Your Medicare supplement insurance will require a different monthly premium that is paid separately from your Medicare coverage. This payment will go directly to the private insurer while your other will still go to Medicare.
- Your Medicare supplement insurance will only carry one person, not one person and a spouse. If you need Medicare supplement insurance for you and your wife you will have to get separate policies and pay separate premiums.
- The costs in many states can vary on Medicare supplement insurance, therefore making it all the more important to shop around. Medicare insurance is not cheap in the first place so make sure you aren’t paying top dollar for your Medicare supplement insurance.
Medicare Part A Helps You Recover
There are many different parts of Medicare coverage and at times this can make it confusing, but the different parts of Medicare such as Medicare Part A can be pretty easy to understand. Medicare Part A is the part of Medicare that deals with hospital stays, in home care and other types of care such as hospice.
Here are a few highlights of Medicare Part A coverage:
- With Medicare Part A your hospital stays are covered as you will have a semi-private room along with meals and general nursing care. This is great for following surgeries and other procedures that may cause a long hospital stay.
- Medicare Part A also covers some hospice care, specifically, drugs, medical and support services. This part of the coverage includes the language that the hospice you choose must be approved by Medicare before beginning the billing process.
- Some home health care services are covered by Medicare Part A with more emphasis given to those that are in need of part time care. This may be in a situation where a patient needs more one-on-one skill work like speech pathology, physical therapy and occupational therapy.
There are other benefits of Medicare Part A coverage but the general highlights are included above. Just remember, if a procedure you are getting ready to have is covered by Medicare, it is likely covered under Medicare Part A.
Medicare Part B: Do You Know what You are Paying for?
We all know that Medicare and Medicare Part B are a maze of uncertainty for even the most well schooled government officials, but do you have any idea what you are paying for? Do you know what Medicare Part B is really offering you and what you are getting in return for your money?
Seniors and other qualified participants in Medicare are worried for good reason about the constant changes involved in Medicare, specifically with Medicare Part B. With a monthly premium of around $100 and a yearly deductible of around $155 this can be a pricey bit of insurance, but are you covered if you go to the doctor you choose?
Insurance professionals are urging the qualifying participants to ask many questions and do much research when deciding on what Medicare Part B plan you will use. The reason is plain and simple, with as much as these plans change it is essential that you know you can go to the doctor in your area or who fits your needs.
Medicare Part B may be especially difficult for those who live in rural areas and may be miles and miles from their physician. If you don’t do your due diligence when choosing your Part B provider you may be stuck driving for hours to see your physician, which will cost you even more.
Medicare Part A: How much are you Really Covered?
The horror stories associated with uninformed decisions when enrolling for Medicare are plentiful, but what about the horrors of the unknown for automatic coverage, such as Medicare Part A. This coverage is basically provided automatically for those who qualify, yet there are a myriad of unknowns as to what it really covers in the event of an untimely hospital visit.
Consider the following scenario: Louise is admitted to the hospital after a nasty fall and has to stay for 31 days to fully recover and go through rehabilitation. Louise assumes that Medicare Part A will cover her for up to 100 days in the hospital as the language reads in her policy, but she then receives a bill for $1,335 for her stay. Why?
Medicare Part A does in fact cover you for up to 100 days in the hospital, however, only the first 21 days are provided free of charge. For each day after that the patient is charged a co-pay of $133.50 per day, which in Louise’s case is 10 days at $133.50 per day, totaling $1,335.
If you are worried about being in the same position then it might be worth your time to look into Medicare Part A a little further with a professional and consider the possibility of adding supplemental insurance to your Medicare coverage.
Medicare Part D: When is it Not a Good Idea?
We are all looking for a way to save an extra buck, that is, unless you are the heir to some unknown fortune that has left you without a worry. However, in this day in age we are all looking for a way to scrimp and save our way out of the “poor house”. One way to do that is to eliminate unnecessary coverage on your insurance, in this case, the question is on Medicare Part D.
Many people are changing the amounts of deductibles with auto insurance and health insurance, while others are eliminating insurance altogether as a cost-cutting measure in difficult economic times. The problem with that is, what happens if everything changes and you need that coverage tomorrow? Can you survive without Medicare Part D?
Let’s play the game of “worst-case scenario” for a moment and pretend that you are suddenly diagnosed with cancer tomorrow. Are you aware that the expensive medications you may have to purchase would be charged to you at full cost without the benefits of Medicare Part D?
Did you know that if you don’t enroll in Medicare Part D right now and you wait until later when the coverage is suddenly necessary that you could have to pay a penalty? This is not a decision to take lightly, make sure you consider all possibilities when turning down Medicare Part D.
Medicare Supplement Insurance: Something to Help Fill the Gap
It is a funny thing to think of the underlying irony involved in supplemental insurance in the first place. Insurance was created to fill in the gaps between what you can afford and what you need to survive, yet plans like Medicare supplement insurance were created to again fill in the gaps between what you can afford and what insurance will help you pay for.
Medicare supplement insurance is a great option for those that are stuck and unable to meet the deductibles and premiums necessary to get the coverage they need. Instead of paying the 20% of medical costs that individuals are required to pay after all of these deductibles and premiums are paid, individuals will pay another smaller monthly premium.
One of the more popular Medicare supplemental insurance plans is Medicare Plan F that will help to eliminate the cost of high yearly deductibles. The monthly premium for this plan ranges from $80 to $200 based on the individual’s age, gender and zip code. This plan only carries the monthly premium, no deductible at all.
If Medicare Plan F is not the Medicare supplement insurance plan that works best for you then don’t worry, there are at least a dozen Medicare supplement insurance plans available.
Medicare Enrollment: Review the Status of Part D
As it is with all insurance plans regardless of who they are offered by, it is important to review every year what has changed with the plan that you are on. With Medicare enrollment in full swing it is time to review each part of the plan and one that is drawing much attention is Medicare Part D.
For those who don’t know, Medicare Part D is the part of Medicare that deals with prescription drugs, offering a chance that otherwise may not be available to help pay for drugs. In 2009 the plans start at around $31.94 and are attached to a yearly deductible that will be $310 for 2010.
According to the Henry J. Kaiser Foundation, the premiums for Medicare Part D will rise about 11% in 2010 which will put them at roughly 50% higher than they were in 2006. Considering that 2006 was the first year that Medicare Part D was offered the reasons for considering where you stand with your Medicare enrollment becomes abundantly clear.
The experts say that Medicare enrollment for 2010 will list roughly 1,576 options to those who are eligible. Region-by-region Medicare enrollment will give between 41 and 55 different options to those who qualify and will be enrolling. All the more reason to really look into what appeals to you and your situation.
Medicare Benefits: A Quick Refresher
It is that time of year again, the time of the year dreaded by adults worldwide, it is the time to enroll in your medical/health plan for next year. This is no different for those who are on Medicare, who must prepare fully for the next year just like anyone else. For those who may be new to the process or those who have forgotten, here is a quick Medicare benefits refresher.
Medicare Benefits Part A: This coverage is provided at no cost to those who qualify, no cost in reference to a monthly premium, though in 2009 the deductible for the year is $1,100. This is for hospitalizations for the individual listed on the plan.
Medicare Benefits Part B: This coverage is provided to those who qualify at an average of $96.40 per month with a deductible this year of $155. This is to cover the cost of doctor visits or visits to other healthcare professionals.
Medicare Benefits Part C:Â Individuals that enroll in this coverage do so to lower the out-of-pocket costs by using the Medicare Advantage Network for fee-for-service plans.
Medicare Benefits Part D: This coverage is provided to those who qualify for $31.94 per month with an annual deductible of $310. This is the only stand alone drug plan offered to seniors, without this plan seniors are responsible for 100% of their drug costs.
Incentives Benefit Medicare Treatments
The CMS has successfully demonstrated that providing financial incentives for health care improvement improves not only the quality of health care but also reduces costs. Three demonstrations – one for hospitals, one for small and solo physicians and one for large physicians have yielded demonstrable results.
The programs that test value based purchasing have yielded encouraging results. The purpose of these demonstrations is to tie Medicare payments to efficiency and quality. Participating hospitals are showing a continued increase in quality. For small and solo physicians also a rewards program has been set up for providing high quality care for patients with chronic illnesses.
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13 million uninsured young adults may benefit from health reform proposals
The Congress has before it a set of comprehensive proposals related to health reform. The implementation of these proposals could mean that uninsured young adults from ages between 19-29 could get insurance. In addition those young adults who are currently insured would not lose their insurance.
This information has been detailed in a new Commonwealth Fund report. The report talks about how stable, affordable coverage can be given to all young adults. This would be possible if health coverage is extended by expanding Medicaid. In addition a health insurance exchange could help this process.
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The New Medicare Scam
As the government works towards a public health insurance program, one more recent event has reignited the question of the efficacy of a Medicare like program. Medicare has been subject to fraud since a long time and the volume of fraud is staggering. Recently a Medicare scam has come to light involving doctors and others in Houston, Boston, Louisiana and New York.
Over 30 Suspects have been arrested and more are being sought for arrest. The scam involved arthritis kits that were never used by several patients. Some of the patients they were prescribed for were dead. Some patients felt the “arthritis kits” were unnecessary and some never received them. Each kit was billed for $3000 to $4000.
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New Oxygen Supplier Rules A Source Of Worry
More than one million people depend on Medicare to pay for home oxygen therapy. New, complex rules that aim to reduce costs are confusing these people. According to WSJ, the new rules underline how complicated and difficult it will be to control the costs of Medicare. The new rules began to affect patients on Jan 1. Under these rules the suppliers will be paid the current rate for the first 3 years. After this, suppliers will have to provide oxygen for 2 more years at a reduced payment rate.
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Medicare Coverage To Be Amended To Protect Patient Healthcare
A new bill called The Medicare Prompt Pay Correction Act has been introduced by the U.S. Senate. This bill is a companion to HR 1392. HR 1392 has 45 co-sponsors currently. Senator Arlen Specter and Pat Roberts introduced the bill. It is meant to correct medicare reimbursement problems connected with cancer drugs. In addition it seeks to provide relief to the national problem in the area of cancer care treatment delivery. Most patients are currently treated in community oncology clinics close to their homes.
As a part of the effort to reduce cancer and fight it, community cancer clinics play a vital role. This is especially so when access to large centers is restricted. With the help of this legislation Medicare beneficiaries will be ensured access to potentially life saving cancer drugs.
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Health Care News Flashes
According to the Chicago Tribune Americans feel entitled to the best health care. Americans are spoled according to the Tribune. Meanwhile Medicare might use the reverse Dutch Auction to set up competition for doctors in regions that are oversupplied. Meanwhile in chatter is the fact that health care reform might go nowhere until the cost is brought to light.
In a survery by the Register in a recent Iowa Poll, it shows an 80 percent satisfaction by the people surveyed with their current health plan. So is there really a crisis?
According to Forbes there are heavy political risks around health care and Obama’ popularity could reduce through future events. The time to act is now. Regressive taxation is being criticized as a disproportionate amount of tax would come to those earning less.
In other news, Obama is open to using Medpac to set Medicare payment rates. Medpac is in a better position to make nuanced medical payment decisions critics say. The power to set reimbursement rates would be transfered from Congress to Medpac as a result of this decision.
Identifying Medicare Part D Lowest Cost Plan Proving A Challenge For Seniors
Health care costs are rising. In the middle of this the findings of a new study show that older adults were not able to identify the plan that would minimize their outgoings. Often they thought that they had chosen the plan with the lowest cost but this was not true. The study will be published in the August 2009 issue of Health Services Research. It is available online presently.
Just by choosing a different drug plan seniors could save several hundred dollars a year. There are so many choices that choosing the correct plan is a challenge. Choices should be limited and beneficiaries should be empowered to make cost effective and informed decisions about the prescription drug plan.
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Three Years Into A Medicaid Experiment, Measurements Are Tough
After about 3 years of a Medicaid Privatization program that according to former Gov Jeb Bush from Florida, could be a national model, crucial data to measure the program’s effectiveness seems to be missing. The number of approvals and denials of patient treatments and prescriptions seem to be missing as well. This comes from an AP/Miami Herald Report.