Posts Tagged ‘medicare coverage’

Medicare Part B – Overview, Enrollment, & Premiums

Friday, December 30th, 2011

Medicare Part B is the medical part of Medicare coverage. It includes coverage for doctor visits and outpatient care, physical and occupational therapists’ services, and some home health care that is not covered by Part A. It also covers some preventive services and screenings that are important for maintaining your health and keeping certain illnesses from getting worse.

Enrollment

Enrollment in Part B is usually automatic if you get benefits from Social Security or the Railroad Retirement Board (RRB). It will start the first day of the month you turn 65. If your birthday is on the first day of the month, your Part B will start the first day of the prior month.

If you’re under 65, permanently disabled, and receiving Social Security benefits, you will automatically qualify for Medicare Part B after your 24th month on Social Security.

 If you don’t want Part B, you must follow the instructions that come with the card, and send the card back. If you keep the card, then you keep Part B, and your Part B premiums will be automatically deducted from your Social Security checks.

According to Medicare.gov’s tip sheet, if you didn’t sign up for Part B when you first became eligible, during the initial enrollment period, you may be able to sign up during a later time. The initial enrollment period for most individuals begins at 65. If you’re eligible when you turn 65, you can sign up during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

If you didn’t sign up for Part B during your initial enrollment period, you can sign up between January 1 and March 31 of each year. If you do this, then your coverage will begin on July 1, however, there are penalties for late enrollment. If you sign up for Part B after the initial enrollment period, then you will pay an additional 10% more for each full 12-month year that you could have had Part B, but didn’t elect to do so. For instance, if you sign up for Part B two years after you turned 65, then you could be paying an additional 20% each month for your premium. You may also have to pay this additional penalty as long as you have Part B.

Premiums

The standard monthly premium for Part B is $115.40 in 2011. The amount can be higher if your adjusted gross income is above Medicare’s standard income limits, and these amounts can change each year.

Sources used in this article:

http://www.medicare.gov/Publications/Pubs/pdf/11219.pdf

https://www.cms.gov/MedicareGenInfo/

http://www.medicare.org/medicare-basics/part-b.html

Using Pennsylvania Medicare Supplement Insurance

Monday, September 19th, 2011

It seems Medicare beneficiaries deal with more and more complicated issues on a daily basis.  There are hundreds of choices for plans which compliment basic Medicare coverage, and for those living in the state of Pennsylvania, several Pennsylvania Medicare supplement insurance choices are available.  Most beneficiaries already have a supplementary plan, but may not understand the proper use of these plans.

Most Pennsylvania Medicare supplement insurance plans work with your Medicare benefits to provide extra coverage for expenses.  The problem is, not all of these plans work the same way and not all plans will provide 100% coverage.  It is important that beneficiaries understand their coverage and which insurance plans are available to them before incurring medical expenses.  A full understanding of your Pennsylvania Medigap insurance coverage will help you avoid surprise expenses after visiting a doctor or obtaining medical supplies.

To learn about your plan, read through your policy materials, or call the customer service line for your Pennsylvania Medicare supplemental insurance plan.  Ask the following questions regarding the policy:

– Does the plan cover 100% of any copay after Medicare pays?  If it doesn’t, you will have to pay some of the expenses, so find out what it does cover.  A common set up is for the Pennsylvania Medigap plans to cover 80% of charges after Medicare.  So, if the charge was $100, Medicare might pay $80 and put $20 toward a copayment.  The supplemental insurance would pay %80 of the $20.  This means they pay $16 and you pay $4.  This doesn’t sound like much, but the expenses can mount quickly if you are not aware of them.

-Does the plan cover deductibles.  Medicare has an annual deductible of $110 for its Part B benefit.  This is the benefit that covers visits to the doctor, some supplies and other outpatient procedures.  If the plan does not cover deductibles, you will have to pay this amount each year before your insurance kicks in.

-Does the plan pay for items that are non-covered under Medicare’s Part B benefit?  Some services and supplies are not covered at all under Medicare.  A very good supplement insurance will also pick up some charges for these supplies, although the majority of these plans will only follow after what Medicare actually pays for.

-Does the plan offer a Pennsylvania Medicare Part D Coverage?  You should always know if you have a drug benefit associated with your insurance, because it can save you a great deal of money at the pharmacy!  Standard medical insurance policies hardly ever cover prescriptions, so ask about this benefit before purchasing insurance.

-What providers can you use under the plan?  Generally, most supplemental insurances will pay for services provided by any Medicare eligible provider.  However, there are some plans which operate under a managed care environment, and providers must contract with them.  Make sure your doctor is contracted with the plan, if that is the case.

Once you fully understand your Pennsylvania Medicare supplement insurance, you can avoid extra expenses and surprise bills.

Why Buy Pennsylvania Medicare Supplement Insurance?

Saturday, July 30th, 2011

If you have Medicare as your primary health insurance and live in the state of Pennsylvania, have you thought about obtaining Pennsylvania Medicare supplement insurance?

Many times, individuals believe that Medicare will cover the full cost of their health care, and are surprised when they receive a bill for copayments or deductibles after a visit to the doctor.  Medicare coverage can be hard to understand, but when talking about coverage for things like physician visits and medical supplies, you should know that Medicare would only actually pay for 80% of allowed charges through their Part B benefit.  This means a physician’s visit costing $200 could cost you $40 out of pocket.

For those on a limited retirement income, $40 can be a lot of money.  Even individuals with larger incomes do not want to spend any more out of pocket than they have to, and that is where Pennsylvania Medicare supplemental insurance comes in.  For as low as a few dollars a week, these plans pick up any charges Medicare deems to be the responsibility of the patient.

Also known as Pennsylvania Medigap insurance coverage or Pennsylvania Medigap plans, a secondary policy of this type will always pay copay amounts after Medicare has processed a medical claim.  However, you should shop around for the best plan for the right price. 

Some Pennsylvania Medicare supplement insurance plans cover more than just the copay.  There are plans that will cover the $110 annual deductible and others that will pick up charges for items Medicare does not cover.  An example of this would be syringes used to administer insulin.  Medicare does not cover syringes, but a secondary insurance might pick up some or all of the cost.

Individuals worried about the cost of prescription medication may want to consider a Pennsylvania Medicare Part D coverage plan.  Unlike other plans, which offer medical benefits related to things like visits to a physician, medical supplies, and lab work, Part D coverage plans specifically address prescription medications. 

You should be very careful when looking into these plans, though.  Medicare Part D plans are some of the most complicated insurance plans available. Often there are large donut holes in the policies, which can cost you a great deal of money. 

A donut hole is a place in the annual medication expense where you pay 100% of the cost.  For example, a plan might pay 80% of drug costs up to $3,000.  Then, they might pick up 100% of the cost after $9,000.  Between those two amounts, you foot the bill. That means if you have over $9,000 of medication costs in a year, you will be paying for more than $6,000 of it!

When buying Pennsylvania Medicare supplement insurance of any type, always make sure you read the fine print in the policy.  Never buy insurance when you do not understand what you are paying for, what items will be covered, and understand how much the insurance will expect you to pay out of pocket. Supplement insurance can be a great friend to those with high medical costs, but the wrong insurance can cause unexpected expense.

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