Here is what Medicare wants you to know about the Medicare Part B Cost of Living Adjustment in 2010:  “In 2010, social security benefits won’t have cost of living adjustments. This is due to the decline in consumer prices and the expected low inflation.”

This leads to the following information as to how Medicare Part B will be assessed in 2010.  This is straight from the horse’s mouth in relation to Medicare Part B:

“Most Medicare beneficiaries will continue to pay the same $96.40 Part B premium amount in 2010. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less ($170,000 or less for joint filers) will not have an increase in their Part B premium for 2010.

For all others, the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium. The Medicare Part B premium is increasing in 2010 due to possible increases in Part B costs.  If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $110.50 per month.”

Here are the individuals that qualify for automatic enrollment into Medicare Part A:

1. 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 25^th month of the disability.
2. 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.

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.

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.

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.

Here are a few highlights of Medicare Part A coverage:

1. 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.
2. 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.
3. 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.

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.

MA plans will provide beneficiaries with their Hospital Insurance (Part A) and Medical Insurance (Part B), all medically-necessary services covered by Original Medicare, and, in many cases, optional extra benefits such as vision, dental, hearing, and prescription drug coverage – for additional cost, of course.

In fact, many of your out-of-pocket costs in a Medicare Advantage Plan will vary significantly.  For instance, many MA plans will charge, on top of your Part B premium, another monthly premium.  Your costs will also vary depending on whether or not your MA plan has a yearly deductible or any other deductibles for certain health care services.  Costs can increase if your plan requires you to pay more for each doctor’s visit or health care service.  If you frequently require health care or if you need more costly services, this can also increase your out-of-pocket costs.  If you decide you want extra benefits, you can expect to pay more for these as well.   

There are, of course, some ways to reduce costs.  First – and perhaps most importantly – research available plans carefully.  Contact Medicare, at www.medicare.gov or at 1-800-MEDICARE – or call your local SHIP to find out more. Once you’ve selected a plan, be sure to familiarize yourself with your MA plan’s rules, and to follow them vigilantly. 

The right MA plan can allow you to receive the medical coverage you need.  However, unexpected costs can put a strain on your budget and, in some cases, even make receiving the care you need a significant hardship.  An awareness of the out-of-pocket costs involved in your Medicare Advantage plan can help you prepare for those expenses, and allow you to financially arrange for your future.

How assignment in Medicare works is when you choose health care providers already enrolled in Medicare – and who will accept assignment – you then assign Medicare to pay those health care providers. 

A health care provider who accepts assignment will agree to be paid by Medicare and to accept the Medicare-approved amount for services.  They will also agree to charge you (or your other insurance providers) only the Medicare deductible or coinsurance.   

When a health care provider accepts assignment (and in certain situations, they are required to do so), they need to submit your claim directly to Medicare, and should not charge you for submitting the claim. 

If your health care providers do not agree to accept assignment, they must submit a claim to Medicare but can charge you more than the Medicare-approved amount.  Even if they don’t accept assignment, though, they are usually limited in what they can charge (referred to as a “limiting charge”).  This charge can be up to 15% more than the Medicare-approved amount.  Not all services and supplies have a limiting charge, and sometimes you’ll need to pay for supplies or services before being reimbursed later.  

If you need to find health care providers who accept assignment, an excellent resource is www.medicare.gov.

Usually, Part A doesn’t call for a monthly premium if you or your spouse paid enough Medicare taxes while you were working.  In this case, you will most likely be automatically enrolled when you turn 65.  However, if you don’t qualify for premium-free Part A, your monthly premium for this component of your Medicare coverage can be up to $423.00.  If you have 30 – 39 quarters of Medicare-covered employment, your Part A monthly premium will be $233.00

Your Part A deductible, per benefit period, will most likely be $1,024.00, and your coinsurance amount will be $256.00 a day for the 61^st – 90^th day each benefit period.  For each lifetime reserve day, coinsurance will be $512.00 for the 91^st – 150^th day. 

For your Part B, your monthly premium will likely be $96.40.  However, some people will pay more, depending on their modified adjusted gross income.  For your Part B deductible, you will need to pay $135.00 for the year, and then 20% of the Medicare approved amount for services after this deductible. 

To find out more, visit www.medicare.gov.