Medicare Benefits
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 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.
Medicare Part A and Part B Coverage Limitations: What to Expect
Enrolling in Medicare is an excellent way to ensure you are able to receive the vital health care you may need. However, not all medical supplies and services will be covered by your Medicare Parts A and B. In order to best prepare for your future, it is essential to be aware of some important coverage limitations.
For instance, Medicare doesn’t cover acupuncture, cosmetic surgery, hearing aids, hearing aid-fitting exams, and hearing tests (unless ordered by your doctor). Medicare also won’t cover custodial care, unless you are also receiving skilled nursing care in a nursing facility, in a hospice, or at home. The majority of chiropractic services also aren’t covered, other than for subluxation. Aside from a few exceptions, most dental care, dentures, foot care, orthopedic shoes, and eye-glasses won’t be covered either.
Although Medicare does cover a “welcome to Medicare” physical exam when you first enroll, yearly or routine exams aren’t generally covered. Additionally, many vaccines and prescription drugs, as well as syringes or insulin not used with an insulin pump, won’t be covered by Parts A and B. If you plan to travel, be aware that most medical care won’t be covered by Medicare if you’re traveling outside of the United States.
There are, of course, many valuable services which are covered by your Medicare Parts A and B. Even when services are covered, though, you may be responsible for paying deductibles, coinsurance, or copayments for a number of these services. By being cognizant of coverage limitations in services and supplies, you will be better able to plan, financially and practically, for your health care needs.
Costs and Coverage of Medicare Part A
Medicare Part A is the component of your Medicare insurance that deals with Hospital Insurance. For most people, there is no monthly premium for Medicare Part A, as long as you or your spouse have paid enough Medicare taxes while working. However, while you usually don’t need to pay monthly premiums for Part A, many services will involve some out-of-pocket costs.
Receiving blood in the Original Medicare Plan, for example, will require you to pay for the first 3 pints you get as an inpatient. After that, you will be responsible for 20% of the Medicare-approved amount. An exception to this cost is if you or someone else donates enough blood to replace the blood you received.
For home health care, you pay nothing for the home health care services and 20% of the Medicare-approved amount for necessary durable medical equipment. For hospice care, you will need to cover a copayment of up to $5.00 per prescription for outpatient prescription drugs, as well as 5% of the Medicare-approved amount for inpatient respite care. Also, if you receive hospice care somewhere other than for short-term general inpatient/respite care, you might be responsible for the cost of room and board.
In the case of hospital stays, you will need to pay a $1024 deductible and $0 coinsurance for 1 – 60 days each benefit period. For days 61 – 90 each benefit period, you will cover $256. Following day 90 for each benefit period (for up to 60 days over your lifetime), you will pay $512 per lifetime reserve day.
For skilled nursing facility stays, you will pay nothing for the first 20 days each benefit period, and $128 per day for days 21 – 100. After that, you will be responsible for all costs incurred.
Medicare Advantage Plans will cover the same benefits as your Original Medicare, but costs won’t necessarily be the same. For details on specific out-of-pocket costs, contact your plan directly.
Drug Coverage: Some Important Rules You Should Know
All Medicare Prescription Drug plans have a number of rules, created to meet the needs of beneficiaries and, at the same time, to protect plan providers.
One of the rules for most Medicare drug plans is that they need to cover two drugs, minimally, in each drug category. They also need to cover almost all drugs in the anit-psychotics, anit-depressants, anti-convulsants, immunosuppressants, cancer, and HIV/AIDS classes. Additionally, even when a Medicare drug plan doesn’t have a certain drug on its formulary, another drug with a comparable function which is equally effective will likely be covered.
The plans are usually able to choose which of the drugs in each category they will cover. There are also a number of drugs your plan probably won’t cover, like barbiturates, benzodiazepines, and weight control drugs, although some plans may. Most often, your drug plan won’t cover over-the-counter medication. There are, of course, exceptions, like if your state allows people with Medicaid to receive coverage for these over-the-counter drugs.
Plans must, regardless of which Medicare Prescription Drug plan you are enrolled in, have some sort of a process which allows you to request coverage for a necessary drug not included in their formulary.
Drug plans also have some stipulations to ensure correct coverage use, such as you and/or your doctor needing to contact the plan prior to prescription coverage, demonstration of the medical necessity of the drug, a limit on how many drugs you can get at once, and “step therapy”, which is trying one or more similar, low-cost drug before moving on to a more expensive brand-name version.
Because formularies vary according to plan and because they may change, each plan will have the required up-to-date information you need. To find out what drugs are covered by your Medicare Drug Plan, contact your plan directly.
The Flu Shot: An Important Preventive Service
The Flu Shot is covered each flu season for all beneficiaries in a Medicare program. It is given once a year, either in the fall or in the winter, and is an important factor in staying healthy.
The flu, or influenza, is a contagious infection which is commonly spread though coughing, sneezing, or direct contact. It can cause a number of symptoms, ranging from congestion and a sore throat, to muscle pain and fatigue, to fever and chills, to, albeit rarely, nausea and diarrhea. Some people will have only a few symptoms, others will have many.
Although the flu shot won’t necessarily prevent you from getting the flu, your symptoms will likely be milder if you’ve had your vaccine. It’s a good idea to get your shot between September and November, since December is when the flu begins to gain prominence. However, because flu season is considered to be from November to April, you should get your flu shot even if you missed the fall vaccination.
In addition to getting a flu shot, you can take other steps to help prevent the spread of influenza. Wash your hands often, with soap and water. Try not to frequently touch your mouth or nose. If possible, try not to be in close contact with others who have the flu. If you are sick yourself, stay home from work and keep your distance from people, when possible. Also, make sure you cover your mouth when coughing or sneezing.
Medicare covers a number of essential preventive services, including the Flu Shot. Make the most out of your coverage: remember to get your flu shot each year.
The Recovery Audit Contractor Demonstration Program
The Recovery Audit Contractor demonstration program was created to study whether or not using Recovery Audit Contractors is a productive way to make sure correct payments are being made by Medicare to providers, and whether or not this method will save Medicare money and further protect the Medicare Trust Fund.
Recovery Audit Contractors, or RAC, are companies hired by Medicare to find incorrect payments made by Medicare to health care providers and suppliers. Incorrect payments can, of course, come in a number of forms, including claims erroneously submitted and paid twice as well as, sometimes, underpayments by Medicare. The RAC program will catch and correct both, although it is ultimately intended to help Medicare by recovering money lost by overpayments.
While you may get your money back if a RAC review finds you personally overpaid, the Recovery Audit Contractor Program will not put any other money directly back into your pockets. Even if RAC companies are able to recover lost funds for Medicare, this money won’t be shared directly with beneficiaries. Your Medicare benefits also will not change due to the RAC program.
However, the RAC program does benefit you indirectly. For instance, it saves taxpayer dollars. It also protects the Medicare Trust Funds, which will help future generations as well.
Currently, the Medicare RAC program is in California, Florida, New York, Massachusetts, South Caroline, and Arizona. The Centers for Medicare & Medicaid Services expect RAC to be in use throughout the country by 2010.
Medicare’s Hospital Compare
The Centers for Medicare and Medicaid Services provide an online resource intended to help you make informed choices about your health care. The resource, called Hospital Compare, offers a variety of specific information in order to give you a complete picture of hospitals throughout the country.
The Hospital Compare site allows you to compare hospitals in a number of different ways. For instance, it will enable you to see, using survey information, how patients feel about their hospital experiences. Some topics include pain management, overall quality of care, and staff communication with patients.
The site also lets you look at how mortality rates for different conditions compare with the national death rates for these same conditions, and how often hospitals treat recommended heart attacks, heart failure, pneumonia, and surgery.
You can compare hospitals in terms of how many people with Medicare have had various treatments. You can even see what Medicare usually pays a hospital when it performs certain procedures.
In addition, you may use the Hospital Compare site to figure out which hospitals are accredited. The Hospital Compare site will also provide information on your rights as a patient and how to report a quality complaint. It can direct to you other relevant publications or websites.
By using the Hospital Compare resource, you will be able to make an educated decision regarding which hospitals will likely offer you the highest quality of care. You can find this valuable tool at www.medicare.gov/hospital.
An Introduction to Programs of All-inclusive Care for the Elderly
Programs of All-inclusive Care for the Elderly, otherwise known as PACE, are Medicare programs for individuals over 55 who have disabilities. PACE provides alternatives to nursing-home care, and, through a variety of services, works to offer beneficiaries with options to remain living in their community. You are eligible for PACE if you are 55 years or older, live in a PACE organization service area, are certified by your state as needing nursing home level of care, and are able to, with the help of PACE, safely reside in your community when you join.
To create an individualized health care plan, PACE uses a team of skilled professionals, experienced in working with the elderly. This health care team will work with you to determine the type of care and services you will require to have your health needs met.
PACE covers a wide variety of services, in addition to those covered by Medicare and Medicaid. Some of their coverage benefits may include prescription medication, hospital visits, check-ups, doctor care, home care, emergency services, transportation, necessary nursing home stays, adult day care, recreational therapy, social services, dentist care, nutritional counseling, and X-ray services. There are a number of other services that may be covered as well, depending on your needs.
Enrollment in PACE is does not depend on your financial situation. If you qualify for Medicare, all Medicare-covered services will be paid for. The long-term care offered by PACE will also be covered, either fully or with a minimal monthly payment, if you qualify for your State’s Medicaid Program. If you don’t, you will need to pay a monthly premium for PACE benefits and Medicare Prescription Drug coverage, although you won’t need to pay any deductibles or copayments for services approved by your team.
PACE is one way Medicare can meet your needs. For more information, visit the National PACE Association at www.npaonline.org.
Medicare Provides Information on Dialysis Facilities
If you or someone you love needs regular dialysis, uniform information about available dialysis facilities is invaluable. It’s important to be able to compare your options and to be aware of the quality of care at the facilities you consider.
Fortunately, Medicare provides an easy, effective way for you to compare dialysis facilities through their website, with their “Dialysis Facility Compare Tool”. This tool allows users to access valuable information about specific dialysis treatment facilities. The tool provides basic information about the facility name, address, and telephone number. It also offers the date Medicare certified the facility, shifts beginning at or after 5:00pm, the number of hemodialysis treatment stations, the types of dialysis available, the organization that owns/manages the facility, and whether or not the facility is non-profit. In terms of quality measures, you can find out the percentage of patients at specific facilities who got adequate hemodialysis, who were treated for anemia, and whose anemia was adequately managed. You can find out patient survival information and, ultimately, how well the facility treats its patients.
The compare tool will allow you to search for dialysis facilities by name, city, ZIP code, state, or country. Once you select some facilities you would like to compare, you will have access to the dialysis facility services and quality information. You will also be given contact information for local ESRD Networks and State Survey Agencies, which you can use to get more information about dialysis.
The compare tool will also provide additional resources, such as informational pamphlets, answers to frequently asked questions, definitions of relevant terms, information on complaint procedures, information on patient rights, a patient checklist, and links to other related websites.
You can access Medicare’s Dialysis Facility Compare tool at www.medicare.gov.
A Right to Know: An Overview of the Original Medicare Appeal Process
If you are enrolled in a Medicare plan, you automatically have a number of rights. One of the most essential rights is the right to appeal. The right to appeal (a complaint you make when you disagree with a decision made by your Medicare plan), is guaranteed to all Medicare recipients.
Some conditions under which you may choose to file an appeal are, for instance, if you are denied coverage for care you’ve already received, if you are denied a request for a service, supply, or prescription (or if it is not covered and you think it should be), or if your plan stops paying for a service you are currently getting coverage for.
If you decide to file an appeal, how to proceed depends on what type of plan you are enrolled in. Medicare Advantage Plans and Prescription Drug Plans have specific procedures in place to allow you to use the appeal process. They should include this information in the materials you receive from them. Similarly, Original Medicare also has specific procedures in appealing a decision.
The first step in the Original Medicare Plan is to obtain the Medicare Summary Notice where the service you are appealing appears. Next, you need to circle the item to which you object. You then need to explain, in written form, why you disagree. You will want to write this explanation on the MSN. Include your telephone number and signature. Finally, send it (or a copy) to the address in the “Appeals Information” section of the MSN. You need to file this appeal within 120 days of when you receive the MSN.
It’s essential, when considering filing an appeal, to follow the instructions on your MSN. There are also a number of resources to help you with this process. Call your State Health Insurance Assistance Program for more information, or 1-800-MEDICARE.
Receiving Earlier ESRD Medicare Coverage
Medicare provides health insurance for people 65 and over, people under 65 with specific disabilities, and people of any age with End-Stage Renal Disease. Both Medicare Parts A and B are required to provide ESRD Medicare recipients with coverage.
Typically, dialysis coverage begins the fourth month of your treatments. However, there are some circumstances which will allow you to receive earlier Medicare benefits. For instance, if you participate in a home dialysis training program to learn how to give yourself home dialysis treatments (before your fourth month of treatments), your coverage can begin the first month of dialysis, provided the training facility is approved by Medicare and that you expect to finish the training and give yourself dialysis treatments. You can receive coverage the same month you are admitted to a hospital (also approved by Medicare) for a kidney transplant or preparations for a kidney transplant, if your transplant is within that month or two months following it. If your transplant is postponed over two months after being admitted, your coverage can start two months before your transplant.
Although your coverage will end twelve months after the month you stop dialysis treatments and 36 months after the month of your kidney transplant, there are circumstances which will allow your benefits to be extended. If you get a kidney transplant 12 within months following the month when you stopped dialysis or 36 months following the month you have a kidney transplant, your benefits will be extended. They will also be extended if you start dialysis again in the same time frame.
If you or someone you love has End-Stage Renal Disease, look into your Medicare benefits. When you’re aware of your options, you will find that Medicare can help provide timely coverage for your health care needs.
Facing a Coverage Gap: How to Reduce Expenses
Enrolling in a Medicare Prescription Drug Plan is an excellent way to ensure your continued health, and is often essential in providing a way for you to receive the medication you require. However, there are times when you may experience a gap in your Medicare drug coverage. In fact, most drug plans have some type of coverage gap. For instance, sometimes the gap is in the form of a financial limit. Other times, the gap is due to a lack of coverage for a specific type or brand of medication. Whatever the cause, finding yourself in a coverage gap can be costly. There are, however, a number of things you can do to reduce this financial burden.
One way to reduce your expenses is to switch to a generic version of your required medication. You may also be able to find brand name which is less-expensive than the one you currently use or use an over-the-counter variety. To explore your options, visit the Prescription Drug Plan Finder section at www.medicare.gov, or talk to your health care provider.
Another way to reduce costs is to look at programs offering financial assistance. There are a number of community based and national charitable programs that are designed to help people cover the cost of medication. You may also want to explore whether there are any State Pharmaceutical Assistance programs available in your area. Many drug manufacturers also offer assistance programs worth looking at. If you’d like additional information about assistance programs, there are a number of helpful online resources available. Visit http://www.benefitscheckup.org for a “Benefit Checkup” website, http://www.medicare.gov/pap/index.asp for “Pharmaceutical Assistance Programs”, and http://www.medicare.gov/spap.asp for the “State Pharmaceutical Assistance Program” site.
Finally, if you have limited income and are a Medicare recipient, you may be able to receive extra help covering your costs. To find out if you qualify, visit www.socialsecurity.gov, call them at 1-800-772-1213, or contact your State Health Insurance Assistance Program.
Medicare Hospice Care Coverage
For terminally ill patients, Medicare’s hospice benefit can provide support, care, and rest. Hospice Care primarily includes medical and nursing care, therapy, medication for the terminal and related conditions, and durable medical equipment. Designed to allow quality-of-life for these patients, it doesn’t cover treatment to cure the terminal illness. However, regular Medicare benefits will continue to cover treatments unrelated to the disease.
A number of services are covered by Original Medicare’s Hospice Care coverage. The medical and support care include doctor’s services, skilled nursing, home health aide, and respite care. Medicare Hospice Care also covers physical therapy, speech-language therapy, occupational therapy, dietary counseling, and patient/family counseling. Drugs to control symptoms and provide pain relief are also included, as are wheelchairs, walkers, and wound dressings.
In order to be eligible for Medicare’s hospice benefit, recipients must have Medicare part A. Their doctor and a hospice medical director must certify that the recipient likely has six months or less to live and is, indeed, terminally ill. The recipient must also sign a statement choosing Hospice Care rather than routine Medicare covered benefits. This is important, since Hospice Care does not cover any curative treatments. Finally, the recipient must receive care from a Medicare-approved hospice program.
To find out more, call your State Hospice Organization, your Regional Home Health Intermediary, or 1-800-MEDICARE. If you or someone you love is terminally ill, sometimes Hospice Care is the best option. Although it doesn’t attempt to cure the illness, it can offer comfort and peace.
Costs and Coverage of Prescription Drug Plans
Signing up for a Medicare Prescription Drug Plan is one step in ensuring your continued health. Referred to also as Medicare Part D, drug plans are available both through Original Medicare and as part of many Medicare Advantage Plans. Depending on the plan you select and the company you choose, however, your costs can vary significantly.
Most plans will charge a monthly premium. This premium varies according to plan and is in addition to the premium you pay for your Part B coverage. Your costs for specific medications will also vary, depending on the plan you’ve chosen and the drugs you need. Additionally, your costs will be affected by whether or not you get “extra help”. You may qualify for extra help if you have a limited income, and should call Social Security at 1-800-772-1213 to find out.
By having a number of plans to choose from, you will have the opportunity to find the one that best meets your needs. However, in order to effectively utilize your plan, spend time familiarizing yourself with all the costs involved, the specific medications covered, the benefits of switching to a generic drug, and any coverage gaps. People who are fully prepared when using their Medicare Prescription Drug Plan are more satisfied with their coverage and are able to use it most effectively.
Requirements of Receiving Covered Home Health Care
If you require short-term home health care after hospital treatment, Medicare may help cover your expenses. Although not all services, nor all people, are covered, if you meet the benefit requirements, your Medicare plan can go a long way in ensuring you receive the care you need.
Original Medicare helps pay for a number of services for patients requiring home health care. For instance, although your plan won’t cover personal, full time home care, it does cover part time or intermittent skilled nursing care and home health aides. It also helps pay for wound dressings, for medical equipment, and for physical, occupational and speech-language therapy.
However, in order to be eligible for this type of coverage, your doctor needs to be involved. He or she must decide whether or not you do require home health care, and make a plan accordingly. Your specific care needs must be ordered by your doctor and offered by a Medicare-certified agency. You also must be unable to leave home under regular circumstances, although you can attend religious services and go out to receive medical treatments.
If you require home health care, or think you may in the future, now is a good time to start looking into your options. Talk to your doctor about care options and service providers.
Your “Welcome to Medicare” Physical Exam
If you’ve had Medicare Part B for six months or less, you are likely eligible for a “Welcome to Medicare” physical exam. Offered only once, this physical exam is used to provide you with screenings, shots, and preventative information.
Your Medical history will be used, in part, to help determine some of your risk factors for diseases. Your doctor will also test blood pressure and record your weight and height. Depending on your doctor, you will either be given or ordered an EKG and a vision screening test. You may be given specific shots you need and ordered other tests, according to your medical history and current health. After your exam, your doctor will discuss ways to help you stay healthy and to prevent illnesses. You will leave with a written plan or checklist indicating what other preventative services you require.
In order to prepare for your “Welcome to Medicare” Physical exam, find out about your family’s health history and call your previous health care providers for copies of your medical records. This will help your current doctor create a detailed medical history and more accurately assess your risk factors for specific diseases. Also bring a list of medication you currently take.
Your “Welcome to Medicare” physical exam, in the Original Medicare Plan, will cost you only 20% of the Medicare-approved amount. It’s an important component in keeping you healthy and protecting yourself against preventable illnesses.
Seeking Second Opinions
Sometimes, receiving news about a health condition and necessary surgery can feel terrifying, overwhelming, and very final. However, you do have the opportunity to obtain a second and even third opinion. When facing a serious health decision, these alternate opinions can be essential.
Fortunately, when non-emergency surgery such as hysterectomies or hernia repairs is recommended, Medicare covers a second and third opinion. They will pay 80% of the approved amount, and may help pay for additional tests needed for a further diagnosis. If you have a Medicare Advantage plan, you may need a referral when seeking a second or third opinion.
If you decide you do want a second opinion, there are two fairly simple ways to procure it. The simplest, perhaps, is to ask your doctor to refer you to another doctor or specialist. The other is to visit www.medicare.gov. Once at the site, select “Find a Doctor” under the search tools. You will then be able to check the Participating Physician Directory for a doctor in your area.
If the second opinion confirms the first, you will need to make a decision about surgery. If it doesn’t, though, you should seek a third opinion from another doctor. Again, you can ask your first doctor to refer you, or can find a doctor in the directory. After listening to the opinions of all three doctors, you will be more confident in making an informed decision about your surgery options.
Medicare’s Preventative Services Offers Tips on How to Stay Healthy
Medicare’s preventative services can help provide you with screenings, tests, vaccinations, and information to prevent a number of illnesses. However, according to a guide published by the Centers for Medicare & Medicaid Services, there are a number of things you can do in your daily life to help stay strong and healthy.
When keeping yourself fit, it is important that you are able to maintain or achieve a healthy body weight. One way to do this is by eating well. Limit saturated fats and excess salt. Focus, instead, on eating a healthy variety of fruit, vegetables, grains, and meats (or other proteins). Don’t over-eat, and try to make wise decisions when snacking. Exercise is also essential in keeping a healthy body weight. By choosing an activity or two that you enjoy, you will be more likely to be dedicated to your exercise goal. Spend twenty to thirty minutes being physically active, at least five times per week.
To stay healthy, you should also avoid smoking. If you are currently addicted, it’s a good idea for you to see your doctor for help. Medicare’s preventative services can help you with this by providing help covering counseling in how to quit smoking.
Finally, you can talk to your health care provider about health issues or concerns, and be willing to take any tests your doctor recommends. The screenings and shots provided by preventative services, as well as additional ones, can be important in treating an illness early enough to be effective and, in many cases, preventing the illness altogether.
While the preventative services offered by Medicare are excellent tools in keeping you healthy, your own actions also play a significant role. Be diligent in making strong choices, and enjoy your personal health for years to come.
Medicare’s Preventative Services: Protecting Yourself
The best defense, some say, is a good offense. The same is often true of your health. By taking proactive steps to stay healthy and by utilizing the preventative services offered by your Medicare plan, it is possible to protect yourself from some diseases before you even become ill.
Preventative services, typically offered to you at various reduced costs through your Part B Medicare insurance, include measures like administering shots, monitoring your health, and offering exams, lab tests, and screenings. They also include providing education and information to help you remain healthy.
Services offered to you at no cost and usually covered by your other Part B fees are wide-ranging. Typically, they include a cardiovascular screening every five years, a pap lab test every 24 months, fecal occult blood tests once every 12 months, a flu shot once a year (usually in the fall or winter), a Pneumococcal shot, and diabetes screening if you are considered high risk for developing diabetes. Some of these tests, of course, are gender specific.
Services that are covered but still require you to pay for a smaller percentage of the cost can encompass a one-time, “welcome to Medicare” physical exam, a mammogram every 12 months, cervical cancer screening every 12-14 months (depending on your risk factors), colorectal cancer screening every 120 months, prostate cancer screening every 12 months, bone mass measurements once every 24 months (or more, if you’re at risk for osteoporosis), glaucoma tests once every 12 months, a hepatitis B shot (if you’re at medium to high risk), medical nutritional therapy, and counseling to quite smoking.
Take advantage of the opportunity to protect yourself. Your health is important, both now and in the future.
Need Prescription Drug Coverage?
Prescription drug coverage is an important aspect of any comprehensive health care plan. Whether you use prescription medication on a regular basis or are looking towards the future, deciding on a plan sooner rather than later can save you money and offer you a real sense of security.Medicare drug coverage generally falls under two categories; a Medicare Prescription Drug Plan or Medicare drug coverage with a Medicare Advantage Plan. Depending on the plan you choose, the medication you require, and the brands you use, your costs can differ significantly.
For instance, if you are already regularly using specific prescription drugs, you might want to choose a plan which includes your current medication. All Medicare formularies (the lists of prescription drugs that a Medicare plan covers) generally have two drugs in each category and class of drug used by Medicare recipients and can include both generic and brand name medications.
If, however, you require very costly medication, you may want to look at plans that have high coverage and limit coverage gaps. On the other hand, if you need to reduce costs, you can look at a plan that offers lower copayments for generic brands. You can also consider choosing a plan with a low deductible or low premium in order to balance your budget.
Finally, if you are using a Medicare Advantage plan – or are considering one – you should look for a plan that includes prescription drug coverage. By choosing a plan that consists of hospital and medical insurance as well as prescription drug coverage, you have the potential of saving money while receiving the extra benefits included in your Medicare Advantage Plan.
Before making a decision, consider your options carefully. Once you’ve examined the coverage and costs of each plan, you can better choose the one that meets your needs.
New to Medicare? You Should Know…
Medicare is federally run health insurance. It is specifically designed for individuals who are at least 65 years old, as well as people who have End-Stage Renal Disease or who are under 65 with certain disabilities.
Medicare generally has 4 elements: Part A , which represents your hospital insurance, Part B, your medical insurance, Part D, prescription drug coverage plans, and Part C, Medicare Advantage Plans. Part C, of course, can include Parts A, B, and D.
If you’ve been paying into Medicare while working, you are likely eligible to be automatically enrolled in Parts A and B at age 65. In most cases, if you are automatically enrolled in Part A, you don’t need to pay a premium. Part B, however, usually does require a standard, monthly fee.
If you require prescription medication, or think you may in the future, the best time to sign up for Part D is when you are first eligible; three months before to three months after you turn 65. If you wait, you may be required pay a late enrollment penalty. Because there are a number of options in prescription drug plans, consider the available coverage and potential costs of each.
Finally, you’ll need to decide whether you want the Original Medicare Plan or a Medicare Advantage Plan, such as an HMO or PPO. Many Medicare Advantage Plans may charge extra fees but cover a number of additional benefits, such as vision and dental.
By understanding the four parts involved in Medicare, you can ensure you have the coverage you require. Your Medicare plan, through careful, informed decision making, can help you meet your healthcare needs, both now and in the future.
Medicare Part A: Understanding your Hospital Insurance Coverage
Whether you have the original Medicare plan, a Medicare Advantage plan (like an HMO) or another Medicare health plan, you will, most likely, want to include hospital insurance. Referred to as “Part A”, hospital insurance helps to cover your in-hospital care, as well as any stays in skilled nursing facilities or religious non-medical health care institutions. It also helps to cover home health care and hospice care.
One of the great features about Medicare Part A is that if you paid enough Medicare taxes while working, you aren’t required to pay a monthly premium for part A. If you didn’t pay enough Medicare taxes while working, but are 65 or older – or if you’re disabled and have returned to work – you can still purchase Part A; if you have limited resources, your state may even help you with your premium!
Signing up for hospital insurance isn’t difficult, either. In most cases, in the month you turn 65, you will automatically receive this coverage. Automatic enrollment in Medicare Part A happens at age 65 if you are getting benefits from Social Security or the RRB. You will also be automatically enrolled if you are disabled, 24 months after receiving disability benefits from Social Security or RRB. An exception to these two payment schedules is if you have Lou Gehri’s disease, in which case you will receive Part A the same month you collect your disability benefits.
If you aren’t able to receive Medicare Part A without paying a premium, you will not be automatically enrolled. However, you can purchase it from three months prior to your 65th birthday to three months afterwards, and between January 1 and March 31 of each year. There may be other times you can enroll if you have group health coverage through work.
Having hospital insurance is essential to receiving affordable, quality care. If you have been regularly paying Medicare taxes, you can rest easy knowing you will have the plan in place to allow you to obtain the care you need. If you haven’t, now is the time to look into signing up. Part A may be a vital part of your Medicare coverage.
Exploring your Options: Other Medicare Health Plans
So, you’re familiar with Original Medicare. Perhaps you’ve even researched the Advantage Programs. But did you know that you may have a third option? Medicare offers, in many places, other Medicare health plans worth considering.
Like Original Medicare and Medicare Advantage Plans, the other Medicare health plans will provide you with your hospital and medical insurance, or Part A and Part B. Some also include the option of prescription drug coverage (Part D) or allow you to purchase a Medicare Prescription Drug Plan. The three types of other Medicare health plans include demonstrations or pilot programs, Medicare Cost Plans, and Programs of All-Inclusive Care for the Elderly (PACE).
Demonstration, or pilot, programs are used to test Medicare improvements. These projects are offered to a specific group of people, in specific locations, in order to test improvements in coverage, payment, and care quality. Right now, Medicare is offering a pilot program for people with Medicare who have at least one chronic illness.
Medicare Cost Plans, also available only in specific locations, work much like Medicare Advantage Plans, except that if you need services that are not within the plan’s network, the Original Medicare Plan will pay your Medicare-covered expenses.
PACE, or Programs of All-Inclusive Care for the Elderly, provides long-term care services for elderly people who receive community health care. Available only in some states, PACE serves as an alternative to a nursing home. If you are eligible for nursing home care and are at least 55, PACE can supply you with social, medical, and prescription drug coverage.
Choosing a Medicare plan is an excellent way to prepare for your future. By examining your available options, you will be able to chose the plan that fits your lifestyle. To find out if there are any demonstrations, Cost Plans, or PACE in your area, call your State Medical Assistance Office.
The Difference between Original Medicare and Medicare Advantage
Over 20% of Medicare patients are enrolled in Medicare Advantage Plans, confirming that these privately run companies do, indeed, offer a viable alternative to the original Medicare Plan.
All Medicare Advantage Plans, approved by Medicare and often referred to as “Part C”, must include hospital and medical insurance, and are required to cover the same medically necessary services as Original Medicare. There are, however, some fundamental differences which set them apart.
Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for Services (PFFSs), Medical Savings Accounts (MSAs), and Special Needs Plans (SNPs). One of the key differences between an Original Medicare Plan and one of these Advantage Plans is that an Advantage Plan usually limits your choice of doctors and hospitals, requiring you to choose one from their provider network, while Original Medicare allows you to go to any doctor or hospital that accepts Medicare. If you do go to a doctor who is not on a provider network, you may be responsible for covering the cost of care. Some plans, for a higher fee, allow you to select a doctor who is not an approved provider or use an outside doctor who will agree to their terms of payment before treating you.
Medicare Advantage Plans also often provide extra benefits not traditionally covered by Original Medicare, like preventive, vision, hearing, dental and, in many cases, prescription drug coverage. The added coverage offered by a Medicare Advantage Plan can be a vital help for people requiring these services.
When choosing a plan, consider the cost, benefits, and convenience of each. Visit www.medicare.gov or call 1-800-663-4227 for help. By weighing your choices carefully, you can choose the plan that’s best for you.
