Posts Tagged ‘medicare part a’

Medicare Supplement Insurance

Friday, February 24th, 2012

Medicare supplement insurance, also known as Medigap insurance, is insurance coverage designed to fill in the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover, like copayments, coinsurance, and deductibles. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs. Medigap insurance is different from Medicare Advantage because it only supplements the Original Medicare Plan. If you opted for a Medicare Advantage health plan, you cannot also buy a Medigap policy. Although you do have out-of-pocket expenses with Medicare Advantage, they are typically not as great as with Original Medicare.

Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium ($96.40 in 2011 for most beneficiaries). In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable. This means it is automatically renewed each year. Your coverage will continue year after year as long as you pay your premium.

Insurance companies can only sell you a “standardized” Medigap policy. Eleven standard Medigap policies are available in most states. Each lettered plan — A through G and K through N — offers a different set of benefits, filling different gaps in Medicare Parts A and B coverage. All Medigap plans with the same letter provide the same benefits. Only the premiums and the sponsors of the plans vary. Insurance companies that sell Medigap policies don’t have to offer every Medigap plan. However, they must offer Medigap Plan A if they offer any other Medigap policy.

It’s important to compare Medigap policies, because costs can vary. The standardized Medigap policies that insurance companies offer must provide the same benefits. Generally, the only difference between Medigap policies sold by different insurance companies is the cost.

You and your spouse must buy separate Medigap policies. Your Medigap policy won’t cover any health care costs for your spouse.

Generally, standard Medigap policies cover some or all of the cost of:

  • Your Part A deductible and coinsurance (i.e. the 20% that Medicare doesn’t cover) for hospital stays
  • Your portion of your doctor’s bills for Part B services
  • The first three pints of blood annually, if needed
  • Hospice care coinsurance

Medigap plans do not cover:

  • Long-term care to help you bathe, dress, eat or use the bathroom
  • Vision care, eyeglasses, hearing aids or dental care
  • Private-duty nursing
  • Prescription drugs, or any out-of-pocket costs for Part D plans

(AARP Medigap: Your Supplemental Insurance)


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Medicare Part A Coverage Continued

Friday, December 23rd, 2011

Skilled nursing facility care, home health care, hospice & psychiatric hospitalization

In addition to inpatient hospitalization, Medicare Part A also provides medical coverage for skilled nursing facility care, home health care, and hospice & psychiatric hospitalization.

Skilled Nursing Facility Care

Medicare defines a skilled nursing facility as, “A nursing facility with the staff and equipment to give skilled nursing care and, in most cases, skilled rehabilitative services and other related health services.”

In order to be covered by Medicare Part A, stays at nursing homes or skilled nursing facilities must be related to the diagnosis made during a hospital stay. For instance, if your hospital stay was for a stroke, then a nursing home or skilled nursing facility stay for rehabilitation would be covered. A nursing home or skilled nursing facility stay coverage includes charges for a semi-private room, meals, and rehabilitative and skilled nursing services and care.

The coverage is limited to a maximum of 100 days in a 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. If you go back into a hospital or skilled nursing care facility after one benefit period has ended, then a new benefit period begins. You must pay the deductible for each benefit period, and there is no limit to the number of benefit periods. The first 20 days of a benefit period are paid in full (after the deductible), and the remaining 80 days will require a co-payment. As of 2011, this is $141.50 per day. Medicare Part A will not cover long-term care, non-skilled care, daily living, or custodial activities.

Home Health Services

Home health services are described by Medicare as health care services and supplies that a doctor decides you may receive in your home, under a plan of care established by your doctor. Medicare only covers home health care on a limited basis, as ordered by your doctor. It includes limited reasonable and medically necessary part-time care and services, such as skilled nursing care, physical or occupational therapy, home health aide service, speech language pathology, and medical social services. It also includes certain home-use medical equipment (wheelchairs, hospital beds, walkers, oxygen), and other medical supplies.

Hospice Care

Hospice care is for the terminally ill who have six months or less to live. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. Hospice also provides support to the patient’s family or caregiver as well. Coverage includes drugs for relief of pain and to control symptoms, medical, nursing, and support services, grief counseling, and other services. Care is to be provided by a nearby, Medicare-approved hospice caregiver who will visit you at your home. Medicare also provides additional care for a hospice patient in an approved facility, so that the usual caregiver can get a respite. These respite care stays are covered for up to 5 days.

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, 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.


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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.


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


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.


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.


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Compare Medicare Supplemental Plans Before Deciding

Monday, June 21st, 2010

Many senior citizens would be unable to afford medical coverage if it weren’t for the Medicare program. Medicare is a program that is offered by the federal government and it helps to supplement your medical expenses in many different ways. There are a number of different types of Medicare plans that you can choose from, and each of these is going to have its own benefits. For most people, however, they choose Medicare part A and part B because it gives them coverage for hospitalization and their general medical expenses. It may still be necessary for you to supplement your Medicare in some way or another, and you should compare Medicare supplemental plans before making your final decision.

Fortunately, you’re not going to need to be concerned about checking with different insurance agencies whenever you compare Medicare supplemental plans. The reason why this is the case, is because the Medigap policies (Medigap is the name for Medicare supplement insurance) are standardized and they are regulated by the state. If you choose one particular Medigap policy at one insurance agency, you’re going to receive the same exact coverage from any other agency which offers the same plan. This makes it very easy for you to look at a chart and to choose the one that is right for you, not having to worry about the agency that you go with.

Of course, it would benefit you to look at various agencies when you compare Medicare supplemental plans, simply because the prices that they charge are not going to be standardized. As a matter of fact, you’re going to find a considerable variation in the amount of money that you will spend on these various policies. Although some insurance agencies are going to try to convince you that their policy is a little bit better in some way or another, it really comes down to the bottom line. Remember, there is no variation in the coverage from agent to agent.

Of course, you would want to take a good look at the different options that are available under these various plans. When you compare Medicare supplemental plans in this way, you will find that some of them are going to cover things that you will need while others will also cover items that will not be necessary. If you choose wisely, you will be able to be covered for the majority of your out-of-pocket expenses not paying too much for your premium.

Medicare Part D Plans

Saturday, June 5th, 2010

In order to be able to afford your prescription medication, you may want to enroll in Medicare part D. The Medicare part D plans are available for individuals who are already enrolled in either Medicare part A or part B. If you are taking part in the Medicare advantage program and would like to also receive additional drug coverage, you must be enrolled in both parts A and B. It is interesting to note that not all Medicare part D plans are going to be the same and it may be necessary for you to look at these various plans in order to see which one is going to work best for you.

The easiest way for you to find out what is available in the Medicare part D plans is to look at the Internet on the Medicare part D comparison website. You will need to fill out a form with certain information that will help you to find the plans that will work the best for you. Some of the information that they will need is the state in which you reside, whether or not you also have Medigap insurance, the maximum deductible and maximum premium. You can then sort the results from lowest to highest or according to a number of different credentials. At a glance, this will allow you to see the various Medicare part D plans that are available so that you can choose one easily.

Another tool that is available to help you compare between the Medicare part D plans gives you additional options that are not available in the standard search. These will also ask you basic questions, such as the state in which you live and the maximum deductible and premium. You will also be able to provide additional information, such as the type of drugs that are going to be taken on a regular basis, along with whether you are subsidized in any way for your Medicare payments.

Even though these two websites make it very easy for you to be able to compare Medicare part D plans, it may still be of benefit to you to speak to an insurance agent or perhaps to Medicare in order to sort things out. Remember, prescription drugs are very expensive and you need to make sure that you have the right type of insurance coverage in order to be able to afford them regularly.

Medicare Part D Insurance

Wednesday, April 14th, 2010

One of the best ways of getting an understanding of what Medicare part D insurance is all about one must be sure to take the time to go through the same. Part knowledge is dangerous therefore one must have sufficient knowledge in order to make use of the Medicare part D insurance plan. To begin with the Medicare part D insurance is based on prescription drug coverage for those in enrolled with Medicare. This amazing medical insurance plan is offered by privately owned insurance companies. The government has no part in this insurance plan however; all the Private insurance companies have to be government approved in order to come up with a Medicare prescription drug plan. One cannot simply apply for a Medicare part D insurance plan which is only possible for a person who is enrolled with a Medicare part B or part A plan, sometimes it may be both. It is advisable to enroll in a Medicare part D insurance plan at the earliest in order to avoid higher premium payment. 

One is not compelled to enroll with a Medicare part D insurance plan. Before you can actually enroll yourself you need to check whether you are eligible or not. In case you are enrolled with a Medicare advantage plan then by no means can you go ahead with a Medicare part D insurance plan. There are different costs as well as coverages when it comes to a Medicare part D insurance plan, some of the costs involved are the deductible per annum, a monthly fee, co-insurance as well as the coverage gap. As mentioned earlier the monthly fees may differ according to each plan, these are linked to the premium of part B. In case an individual has prescription coverage with part C of the Medicare plan in all probability the coverage cost is collected in the premium of part C. There is a high possibility that some of the Medicare part d insurance plans have no deductible per annum. A better understanding is that the deductible per annum is a complete amount that an individual is expected to pay for prescribed drugs much before the insurance plan will. 

The money that is paid at the pharmacy counter for the purchase of prescription drugs is known as co-insurance or co-payment. Contrary to what some folks may think Medicare part D insurance comes with a cost and is an accompaniment to Medicare part B and part A, it covers prescription drugs. It is very important for you to take into consideration the co- insurance, deductibles, monthly premiums as well as the coverage gap before enrolling for the same. The coverage gap simply means that the exceeded limit on prescription purchases, it then requires an individual to bear the expenditures till a specific pocket limit is met. The moment this happens the Medicare part D insurance plan swings back into action.

Medicare Supplemental Insurance

Tuesday, April 13th, 2010

As one gets older the body begins to give way, all sorts of malfunctions, aches and pains begin to rear their heads. It is not something new or rare to come across an elderly person worrying about their health. No doubt there are some strong, healthy elderly people but eventually the body begins to break down. It is very important for a person to think along the lines of Medicare supplement insurance so that it becomes easier to pay medical bills when they grow older. Preparation for unforeseen medical expenditure is a must, the idea is not to wait till one grows older model to invest in a medical supplement insurance plan but to exercise wisdom in youth. An older person who is covered by a Medicare supplement insurance plan tends to be more peaceful simply because they know that medical expenditure is covered. If you step into the world of insurance you will suddenly become aware of all the different insurance policies, most of these health-related programmes open for older people are created to cater to most of the medical as well as hospital bills which is not a case is Medicare. Medicare supplement insurance plan covers most of the co-payments and deductibles. 

It is normal for most of the insurance health programmes to instruct people to visit particular providers or doctors; however, this is not the case with Medicare supplement insurance. A person that is enrolled with a Medicare supplement insurance plan can visit providers and doctors wherever Medicare is approved. As a matter of fact no one wants to be bogged down with the nagging thoughts of ill-health and medical costs, the best option for these kinds of folks is to invest in the Medicare supplement insurance plan. There are many benefits to the same; discounts are given to people who have their insurance linked to the same insurance firm. Medicare supplement insurance is open for anyone who is enrolled with Medicare part A and part B, it is better to enroll at the earliest. Once a person is eligible for Medicare it is not necessary for them to go through medical underwriting requirements, what’s more, they receive the best rates as well. 

As all the information that you require about a Medicare supplement insurance plan can be found online, you can check for the best options. It is possible for the different rates to be compared online as well; numerous quotes can help you save a lot of money. There are different kinds of offers from leading providers, it is not wrong to go in for the lowest rates for insurance. When it comes to one’s physical well-being there should be no compromise, by investing in a Medicare supplement insurance plan you are only ensuring your medical health. Do not wait till you are old before you start investing, you may just discover that it is too late. Give your health its due importance and then sit back peacefully.

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