Posts Tagged ‘medicare insurance’

Part A – Overview and Hospitalization Benefits/Requirements

Friday, December 16th, 2011

Our continued discussion of Medicare Insurance will now focus on Part A, which is Medicare’s hospitalization insurance. According to Medicare.gov, the official U. S. government site for Medicare information, Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facilities, hospice care, and home health care. This is called “premium-free Part A,” because most people have paid Medicare taxes while they were working. As long as you have paid Medicare taxes for 10 years, your Part A will not require a monthly premium.

If you aren’t eligible for premium-free Part A, you may be able to buy Part A if you meet one of the following conditions:

v  You’re 65 or older, and you have (or are enrolling in) Part B and meet the citizenship and residency requirements.

v  You’re under 65, disabled, and your premium-free Part A coverage ended because you returned to work. (If you’re under 65 and disabled, you can continue to get premium-free Part A for up to 8 1/2 years after you return to work.)

The Kaiser Foundation states that Part A is funded mainly by a 2.9% payroll tax on earnings paid by employers and employees (1.45% each), which is deposited into the Hospital Insurance Trust Fund. Beginning in 2013, the Medicare payroll tax will increase on earnings for higher?income taxpayers, meaning those with an annual income over $200,000 per individual and over $250,000 per couple. It will increase by 0.9 percentage points, from 1.45% to 2.35%. The Part A Trust Fund is projected to be solvent through 2024.

In general, Part A covers:

v  Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)

v   Inpatient care in a skilled nursing facility (not custodial or long term care)

v  Hospice care services

v   Home health care services 

v  Inpatient care in a Religious Nonmedical Health Care Institution

What does Part A Cover?

Medicare does not cover everything, nor does it cover the total cost for many of the covered services or medical supplies. This means that you will need to pay for some of the costs out of your own pocket. Coverage amounts are based on which Medicare plan you have – Medicare Part A, or Part A through a Medicare Advantage Plan (which we will discuss in later articles). Part A helps to cover only the medically necessary services listed below:

Blood Transfusions

This is blood (pints) that you receive during a covered stay in a hospital, critical access hospital, or a skilled nursing facility.

Hospital Stays

Part A covers inpatient hospital stays, which include a semi-private room, meals, general nursing, and miscellaneous hospital services and supplies. Inpatient care in critical access hospitals and mental health care (up to a 190 day lifetime maximum) are also covered. Hospital stays must last for at least 3 days (72 hours). The time begins the first midnight after admission and does not include any hours on the discharge date.

  • You pay a deductible and no copayment for days 1–60 of each benefit period. (A benefit period is defined by Medicare as beginning the day you go into a hospital or skilled nursing facility, and ending when you haven’t received any hospital or skilled nursing care for 60 days.)
  • You pay a copayment for days 61–90 of each benefit period.
  • You pay a copayment per “lifetime reserve day” after day 90 of each benefit period (up to 60 days over your lifetime).
  • You pay all costs for each day after the lifetime reserve days.
  • Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.

 

Sources used:

http://www.medicare.gov/publications/pubs/pdf/10050.pdf

http://www.kff.org/medicare/7067/ataglance.cfm

http://www.medicareconsumerguide.com/medicare-part-a.html

 

Medicare Program Overview

Friday, December 9th, 2011

This is the first of a multi-part discussion of Medicare Insurance. While everyone has heard of Medicare, and many of us know something about it, very few people have a firm understanding of all the facets of the program. Even those who do have a clear grasp of the program may not be aware of recent changes or modifications.

Medicare first came into being as part of the Social Security Act of 1965, signed into law by President Lyndon B. Johnson. Its purpose in 1965 was the same as present Medicare goals, to provide health coverage to Americans aged 65 and over. The insurance is also currently available to individuals under 65 who have a permanent physical disability, and certain other special circumstances.

Before the enactment of the Medicare legislation, only about 50% of people over 65 years old had health care coverage, and almost 30% of senior citizens lived below the poverty level. Current Medicare insurance provides health care coverage for approximately 47 million Americans.

Individuals qualify for Medicare if:

ü  They are 65 years old or older and eligible to receive Social Security,

ü   and are a U. S. citizen or have been a permanent resident for 5 continuous years,

ü   and they or their spouse has paid Medicare taxes for at least 10 years.

Or

ü  They are people of any age with End-Stage Renal Disease (ESRD) – permanent kidney failure requiring dialysis or a kidney transplant.

Or

ü  They are under 65, permanently disabled, and have been receiving either Social Security SSDI benefits or Railroad Retirement Board disability benefits for at least 2 years.

Or

ü  They are eligible for Social Security Disability Insurance.

Medicare consists of 4 basic parts:

  • Part A (Hospital insurance)
  • Part B (Medical insurance)
  • Part C (Medical Advantage plans)
  • Part D ( Medicare prescription drug coverage)

When a qualified individual turns 65 years old, they are automatically enrolled in Medicare parts A and B. For most Medicare recipients, Part A does not require a monthly premium, but there is a Part B monthly premium. The cost of this premium is deducted from the individual’s monthly Social Security check.

Part C, known as a “Medical Advantage” plan, is managed by private insurance companies. These plans offer all of the coverage that is included in parts A and B, and most plans include drug coverage. They usually offer extra coverage such as vision, hearing, dental, and/or health and wellness programs.

Part D is the Medicare Prescription Drug Coverage plan. It is generally available to everyone with Medicare. It is offered by companies that are approved by and under contract with Medicare. There is usually a premium for prescription drug coverage and the drug coverage is added to the original Medicare plan. If individuals choose a Medical Advantage plan that includes drug coverage, then paying for Part D is unnecessary.

This is just a general overview of Medicare. More detailed information will come as we explore each part of Medicare in detail.

 

Sources used:

  1. http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/medicare-benefits-overview.aspx
  2. http://www.medicare.org/
  3. http://www.aarp.org/health/medicare-insurance/
  4. http://www.kff.org/medicare/

Medicare Supplement Plans

Wednesday, June 16th, 2010

One of the more difficult things that you may need to do whenever you have Medicare insurance is to look at some of the Medicare supplement plans that are available. These plans, known as Medigap insurance help to fill in the gaps where Medicare insurance falls short. They’re offered by private insurance companies and are not available through the federal government. Whenever you have these types of Medicare supplement plans, you’re going to be responsible for paying a premium to the insurance company, along with paying your premium for your Medicare coverage as well.

One of the best things about these Medicare supplement plans is the fact that they are standardized. The states regulate the amount of coverage that is available in each of these plans and if you know which one you want, you’re going to be able to get the same coverage, regardless of which insurance company you happened to choose. This makes it very easy for you to go in and look at a chart of the various coverages that are available through these plans. You can compare Medicare supplement plans very easily in this way, and it does not take long for you to figure out which one would be best for you.

The one major difference about these Medicare supplement plans is the fact that the insurance companies can charge you any amount that they want. Although the plans themselves are standardized, the insurance companies have free reign on the premiums that they are going to charge. It may be to your benefit to look around a little bit at the various premiums that you’re going to be paying. With a little bit of comparative shopping, you may be able to save a considerable amount of money on your monthly insurance bills.

One other thing that you may want to consider is that Medicare supplement plans do come in several different types, as far as the premiums are concerned. For example, attained age policies have some of the lower premiums that are available for individuals that are 65 but the premium will go up on a consistent basis. Issue age policies, on the other hand, differ in the fact that you’re going to be paying the same premium permanently from the time that you sign up. The only reason that it would go up on one of these is because of the fact that Medicare also goes up as a result of cost of living expenses.

What is medicare supplement insurance?

Tuesday, April 20th, 2010

Now-a-days, getting a health or Medicare insurance is the necessity as one does not want to depend on their loved ones in their ripe old age. Therefore, there are a number of insurance policies available in the market to cater to the needs of the many people who are interested in getting insurance. Medicare supplement insurance is one such popular insurance in the market. This medicare supplement insurance is continuously developing for the better or sometimes even for the worse. You should keep a lookout for different trends which you can encounter if you are planning to buy Medicare insurance.

It would interest you to know that it is actually for the first and foremost time, since 1992, that the standard plans of this insurance are undergoing a change. These changes are supposed to be implemented since June 1, 2010. However, some effects have already been implemented as some of the companies have begun to advertise the rates for their new modernized plans. There are two new plans namely M and N which are very promising and they definitely are going to have some kind of effect on Medicare supplement marketplace. They are actually lower-cost, lower- benefit alternatives for some other costlier plans. It should be noted that with the lower cost, the benefits are also limited. Some of the plans like, plan J, are going to be removed, while some other plans are going to undergo major changes.

The medicare supplement insurance is now also going to be available online. Not only this, the companies and agents would also be available online and you can inquire about anything at all that you want. Therefore, before you sign up for any plan you can know the pros and cons of each plan and select anyone which is the best suited to your requirements and budget.  You will not have to undergo any kind of inconvenience or difficulty in doing this, as you just have to log on to the net. This method also saves your precious time and you can select your plan in few minutes.

It will not be a preposterous to say that the medicare supplement insurance plans are going to be super successful in a matter of few years. It would also extend across states and companies. Now, you do not have worry about your health expenses of your retirement they will be well taken care of. This gives you a definite sense of independence and self-respect because you do not have to depend on your children financially after your retirement. You can definitely hold your head up high, and live the way you want and not be obliged to anyone for anything. However, keep in mind that the change in the economic and market conditions is sure to affect the medicare supplement insurance plan and their rates as well as benefits. So, invest wisely and think thoroughly before sign up for any insurance plan.

After all, it is you who has to care and plan for a comfortable old age and life.

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