Posts Tagged ‘original medicare’

Key Facts To Help You Understand Original Medicare Coverage

Tuesday, November 16th, 2010

What is Original Medicare, who qualifies, and more importantly, are you eligible for Medicare coverage?

In the United States, health insurance might be broken down into two general categories–Medicare and non-Medicare private health coverage. Medicare is the government run, Federal health insurance program for people 65 years or older, disabled people who have worked the minimum number of years to qualify for Social Security Benefits, and people of any age who have End Stage Renal Disease (ESRD). All other insurance, with the exception of the Federal Employees Health Benefits program and Mail Handlers is private insurance.

Original Medicare coverage includes medical insurance that covers visits to doctors, Medicare supplies and equipment, hospital outpatient care, and many other medical services, such as labs, radiology, and physical therapy. This is the Part B side of Medicare. The Part A of Medicare helps pay for inpatient services. Part A would include coverage for inpatient hospital days, skilled nursing facility stays, and Home Health benefits.

Generally speaking, eligibility is not complicated. If you are a U.S. Citizen or naturalized citizen nearing the age of 65, or disabled or have End Stage Renal Disease, you are probably eligible. Eligibility questions, however, can be addressed to the Social Security Administration at 1-800-772-1213.

Enrollment into Medicare Part A and B is automatic if you are receiving Social Security benefits at the time you turn age 65. If you have been receiving Social Security Disability Insurance for 24 months, you enrollment is also automatic at the end of the 24 month. Generally speaking, you should receive your red, white and blue Medicare card about 3 months prior to the month of your enrollment.

Those nearing 65 but not yet receiving Social Security benefits must submit an application to the Social Security Administration. All Medicare applicants have a 7 month, initial enrollment period that begins 3 months before the sixty-fifth birthday and ends on the last day of the third month following the month of your sixty-fifth birthday.

To wrap up, Medicare enrollment is done through the Social Security Administration. If you are already receiving Social Security, railroad, civil service, or disability benefits, your enrollment will occur automatically. If not, and you are within 3 months of your 65 birthday, contact the SSA in order to submit an application to begin receiving your benefits.

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How To Make Up Your Mind About Medicare Avantage Plans In 2010

Sunday, August 29th, 2010

If you are in Medicare this year, in 2010, you may be trying to decide if you will join a Medicare Advantage plan or remain with Original Medicare. The choice is between private management of your Medicare benefits and Federal management. Which is best for you? Many of the Medicare insurance companies are re-evaluating their 2010 Advantage program in light of the health insurance reform passed into law by President Obama. The new law will mean significant financial change as subsidies for the plans will be reduced. Although this will not affect the benefits offered to members, it may affect their experience in the plans.

Medicare Advantage plans in 2010

The essential working of the plans, whether they are Medicare Advantage PPO plans, HMO plans, or private fee for service plans, remains largely the same as the Advantage plans in 2009. One significant difference for 2010 is that the costs premium and out-of-pocket costs appear to have generally increased from 2009, and that there are far few plans offering zero premium options, and more plans whose cost sharing more closely mirrors that of Original Medicare.

What are you getting when you join a 2010 Medicare Advantage plan? The Medicare program requires that the Advantage plans offer you the same core services that you receive in Original Medicare. However, the Advantage plans deliver your benefits according to their own policies and procedures. When you join an Advantage plan, that plan takes over management of all of your Medicare health benefits and become the only and single payer on your medical expenses. You are still in the Medicare program, but instead of the Federal government managing your benefits, the private, Advantage insurance takes over. The Advantage plans are not supplemental insurance and will never pay after Medicare. They pay instead of Medicare, and Original Medicare will never pay on charges while you are enrolled in a private plan.

Medicare Advantage PPO Plans and HMOs

Medicare Advantage PPO and HMO plans are in charge of all of your benefits. As mentioned above, that remains true for as long as you remain enrolled in such a plan. The health maintenance organization (HMO) is made up of a network of health care providers, and when you become a member, you are generally required to receive all of your care from within the network. Normally, if you go out of the network, you would pay the charges out of your own pocket. The only exception to that rule is if you need emergency or urgent care services. A PPO, or preferred provider organization, also includes a network of providers. However, the PPO allows you to receive services out-of-network from providers of your choosing as long as they agree to submit claims to the insurance company.

Most Advantage PPO plans and HMOs include drug coverage, also known as Medicare Part D. In 2010, the rules for Advantage Part D coverage remain largely unchanged from 2009. That is, if you need drug coverage and want to join either a PPO or HMO, then you must accept the Part D coverage offered by the PPO or HMO. In other words, you would not be allowed to enroll into a PPO or HMO and have a separate, stand alone prescription drug plan on the side.

So, how do you choose? How do you decide which is the best decision? These are not easy questions, and ultimately how you choose will depend on your research and what makes you feel most confident. It is important to keep in mind that the core benefits of both programs should be the same as Medicare law requires that all beneficiaries have equal access to the same set of benefits. It is also important to carefully weigh your health care needs against the relative costs of private care versus Original Medicare. And finally, when considering the Advantage plan program, be sure to talk not only with plan representatives but to the Original Medicare customer service staff, as well.

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What You Must Know About Enrollment Into Original Medicare

Thursday, July 29th, 2010

What is Original Medicare, who qualifies, and more importantly, are you eligible for Medicare coverage?

In the United States, health insurance might be broken down into two general categories–Medicare and non-Medicare private health coverage. Medicare is the government run, Federal health insurance program for people 65 years or older, disabled people who have worked the minimum number of years to qualify for Social Security Benefits, and people of any age who have End Stage Renal Disease (ESRD). All other insurance, with the exception of the Federal Employees Health Benefits program and Mail Handlers is private insurance.

Although Medicare is now considered to have 4 parts, Original Medicare is most often associated with what is called Part A and Part B. Part A covers hospital inpatient, skilled nursing facility, and home health care benefits. Part B covers doctors’ services, medical supplies and equipment, and hospital outpatient care. Part B also covers many other services such as clinical laboratory services, imaging, ambulatory surgery, cancer treatments, preventive services, and much more.

Are you eligible for Medicare? This is not difficult to determine. Basically, if you are receiving Social Security benefits and you are a U.S. citizen, or naturalized citizen who has resided in the United States for the last 5 years, you are eligible. Persons eligible for Social Security Disability Insurance (SSDI) have a 24 month waiting period before automatic enrollment into Medicare. People with Disability benefits due to Amyotrophic Lateral Sclerosis may have the 24 month waiting period waived. Questions about eligibility should be addressed to the Social Security Administration at 1-800-772-1213.

If you have elected to start receiving Social Security benefits prior to turning age 65, then your enrollment into Medicare Part A and Part B will be automatic. In your case, about 3 months before your sixty-fifth birthday, you will receive an initial enrollment packet including your Medicare card.

If you are approaching age 65 but not yet receiving Social Security Benefits, the procedure is a little different. In this case, you need to initiate the enrollment process yourself by submitting an application with Social Security. You can do this through your local office, or call the number given above for more information. In either case, whether you are already receiving SSA benefits or not, you have a 7 month initial enrollment period to sign up. This includes the 3 months before the month of your birthday, the month of your birthday, and the three months immediately following the month in which you turn 65.

The one stable piece of information to hold onto is that Medicare enrollment is always done through the Social Security Administration. If you are already receiving benefits, your enrollment will be automatic and you won’t need to do anything at all. If you are not receiving SSA benefits by your sixty-fifth birthday, you will need to submit an application through the Social Security Administration. As this is quite an important change in your life, you should not hesitate to seek answers to your questions through the Social Security Administration toll free number, 1-800-772-1213.

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categories: Original Medicare Coverage,Medicare enrollment,Medicare eligibility,Medicare Advantage plans,Original Medicare

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Medicare and Medicare Supplements: The Basics

Friday, February 5th, 2010

In the case of obtaining a Medicare supplement, there are numerous things that you need to know. However, the most important thing that you need to comprehend is Original Medicare itself and how it functions before you can become involved in getting your own Medicare supplement policy.

Medicare started in 1965 as a government-sponsored healthcare program for seniors over age 65 and those who are disabled under certain circumstances. The policies are administered and regulated by the Centers for Medicare and Medicaid Services, or CMS.

Anyone who has reached age 65 and is eligible for social security or railroad benefits can get Medicare, as can anyone who’s disabled and has been on social security or railroad benefit plans for more than a couple of years.

Additionally, people who have end-stage renal disease and require dialysis are eligible for Medicare on condition that they qualify for social security. The objective of Medicare is to behave as health insurance for individuals who need it. The coverage is the same for everyone, and includes two parts:

Medicare Part A covers hospitalization expenses, home health care and hospice care.

Medicare Part B covers doctor visits, surgical services, diagnostic testing, therapies of certain kinds, medical supplies and equipment, ambulance services, plus some preventative care.

However, since these insurance programs are all uniform, some miss out on critical services that they need because they aren’t covered.

Enter the Medicare supplement. When an individual has a Medicare plan of healthcare and it doesn’t cover all of their medical needs, he or she will likely look for the coverage they need in other places. However, those who are retired or disabled are generally living on a fixed income, which makes it difficult to afford the insurance and/or medical services that they need.

Often known as Medigap, this is a government-regulated supplement plan which can be obtained by anyone with Medicare insurance to cover the expenses that aren’t covered by their Medicare plan. You will find different plans to select from, and each one has different benefits and coverage types.

It is easy to consult with many resources online or an actual Medicare supplement insurance agent to find out which plans are best for your specific needs. The supplement works by paying the leftover expenses that Medicare didn’t cover for virtually any health services that you need performed.

It doesn’t matter how much or how little supplemental coverage you will need, because there is something for practically everyone. Once you understand Medicare and what it is lacking, you’ll be able to then go on the hunt for a Medicare supplement that should complete the puzzle.

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