Posts Tagged ‘medicare part b’

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 D – Policy costs and the donut hole

Friday, February 10th, 2012

To continue with our discussion of Medicare Part D prescription drug coverage, this article will discuss the costs of Part D and the coverage gap, also called the “donut hole.”

Policy costs


There are many factors that will influence the cost of your Part D coverage. They will vary depending on the types of drugs you use and whether or not your plan covers them. The type of plan you choose is another variable, as is the pharmacy you use and whether or not it is part of a network. There will be a monthly premium that you pay, in addition to the premium that you pay for your Medicare Part B. If you belong to a Medicare Advantage plan that includes prescription drug coverage, then your prescription drug plan costs will be added to the plan’s monthly premium.

Deductibles and copayments:

Most prescription drug policies require the insured to pay an annual deductible of up to $310. After you have paid the deductible, you are then required to pay a copayment on your prescriptions until the combined amount paid by you and the insurance plan comes to $2840. Once you have reached a total of $2840, you are then in what is called the coverage gap, or the donut hole. This is a temporary limit on what the drug plan will cover for your prescription drugs.

Coverage gap or donut hole

As stated previously, you enter the coverage gap or donut hole once you and your insurance company together have spent over $2840 in one calendar year. Once you are in the donut hole, you are then responsible for the total cost of your prescription drugs until your drug coverage kicks in again. In 2011, covered individuals paid 50% of the cost of name-brand prescription drugs and 93% of the cost of generic drugs while in the coverage gap. These costs will drop in subsequent years until by 2020 participants will be paying no more that 25% of the cost of their prescriptions while in the gap.

You are able to get out of the gap when the total amount spent reaches $4550 (in 2011). This includes the pre-gap payments of $2840, plus $1710 paid on prescription drugs while in the gap. When calculating the $1710 spent while in the gap, the actual cost of the name-brand drugs is counted toward the total, not just the 50% discount. Once an individual has reached the $4550 limit, then catastrophic drug coverage kicks in.

Catastrophic drug coverage

With catastrophic drug coverage, the prescription drug plan will cover 95% of the remaining drug costs for the rest of the calendar year. Then it begins all over again.

Some Part D plans do offer additional gap coverage that will cover generic drugs while in the gap, but these plans will have a higher monthly premium. Qualified individuals can also apply for Extra Help. This is a program for people with limited income and resources provided by Medicare and Social Security. You would apply for Extra Help at your local Social Security office.


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Medicare Part B – Coverage, Exclusions, and Preventive Services

Friday, January 6th, 2012

Medicare Part B is the medical coverage that helps cover medically-necessary services like doctors’ services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Some of the most commonly used medical services covered by Part B are listed below:

    Ambulance Services

    Ambulatory Surgical Centers

    Blood (the first 3 units of blood are not covered)

    Chiropractic Services (limited)

    Clinical Laboratory Service

    Diabetes Supplies (note: insulin and certain medical supplies used to inject insulin)

    Doctor Services

    Durable Medical Equipment (like walkers)

    EKG Screening

    Emergency Department Services

    Home Health Services (covers only medically necessary services; you pay nothing)

    Kidney Dialysis Services and Supplies

    Mental Health Care

    Non-doctor Services (such as physician assistants, nurse practitioners, social workers, physical therapists, and psychologists)

    Occupational Therapy

    Outpatient Medical and Surgical Services and Supplies

    Physical Therapy (there may be limits on these services and exceptions)

    Prosthetic/Orthotic Items

    Second Surgical Opinions (in some cases, Medicare covers third surgical opinions)

    Surgical Dressing Services

    Tests (other than lab tests, such as x-rays, MRIs, CT scans, EKGs, and some other diagnostic    tests)

    Transplants and Immunosuppressive Drugs


Medicare Part B does have certain exclusions. Here are some of the more common ones:


Cosmetic surgery, unless particular medical conditions render it necessary

Procedures considered experimental

Hearing aids and fittings

Chiropractic services, except for treatment of subluxation (partial dislocation) of the spine

Most eyeglasses and eye exams (except following cataract surgery that implants an intraocular lens)

Most dentures and dental care

Prescription drugs

Over-the-counter drugs


Part B coverage also offers coverage for preventive services. Some of the most common preventive services are the following:

    Abdominal Aortic Aneurysm Screen (one-time ultrasound for people at risk.)

    Bone Mass Measurement/Bone Density (once every 24 months)

    Cardiovascular Screenings (every 5 years to test cholesterol, lipid, and triglyceride levels)

    Colorectal Cancer Screenings

    Diabetes Screenings (covered if you have certain risk factors)

    Diabetes Self-Management Training (for people with diabetes)

    Flu shot (one per flu season)

    Glaucoma Tests (once every 12 months for those at high risk)

    Hepatitis B Shots (covered for people at high or medium risk)

    HIV Screening (covered for people at any age who ask for the test, pregnant women)

    Mammograms – Screening (once every 12 months for women age 40+)

    Pap Tests and Pelvic Exams, including clinical breast exam (once every 24 months, or once every 12 months for women at high risk)

    Physical Exam – “Welcome to Medicare” exam and yearly “wellness” exams

    Pneumococcal Shot (covered once in your lifetime)

    Prostate Cancer Screenings (once every 12 months for men over age 50)

    Smoking Cessation (up to 8 visits during a 12 month period)


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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 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’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.


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.

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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.

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.

Medigap Policies – The Baby Boomers’ Future Is Now

Tuesday, May 11th, 2010

It wasn’t too long ago when Baby Boomers, or Americans born immediately after the Second World War, were at the cutting edge of business, government and other industries.  Those idealistic children and youth of the ’60s and ’70s had become the country’s decision makers, and become a part of the Establishment a good number of them had opposed so fervently back in their salad days.  But in about ten to twenty years, a lot of Baby Boomers will be eligible for retirement, with about 30 million needing to enter nursing homes and about 12 million needing long-term medical care.  With a lot of uncertainty hovering around regarding Medicare benefits, it may suddenly become a good idea to focus more on Medigap policies.

What is Medigap in the first place?  A Medigap policy is a supplement to standard, or Original Medicare coverage, and aptly fills in the gaps in the existing Medicare coverage.  Currently, there are twelve different types of Medigap policies available, ranging from Plan A to Plan L, and the health care coverage increases as you go up in plan.  Two new plans are set to be introduced on June 1, 2010 – Medigap policies M and N, while Medigap policies E, H, I and J are due to be phased out.  Still, there are a lot of options available for anybody wanting to take advantage of Medigap.

For those who wonder when the right time would be to subscribe to a Medigap policy, it would be best to do so in the first six months after you turn 65.  Open enrollment period would remain active during this period.  Enrollment in Medicare Part B is a prerequisite, and during this six-month open enrollment period, no insurance company can decline to offer a Medigap policy in any case.  But regardless of when you decide to subscribe to a Medigap policy, it is always best to consult with a Medigap or insurance professional to come up with the policy that would best suit one’s financial and health needs.  And with a wealth of online resources available, the Internet could serve as a good guide for Medigap policies as well.  All it takes are a few clicks of a mouse and you can get all the information you need online.

Historically speaking, it was indeed a great time to be young back in the prime of the Baby Boomers’ lives.  Changing technology and culture made the ’60s and ’70s a turbulent, though nonetheless exciting time to grow up, and the experiences of the past combined with ever-changing trends helped Baby Boomers in becoming productive members of present-day society.  And speaking of trends, we believe that today’s technology and variety of options would make it easy for the soon-to-retire or retiring Baby Boomer to select the right Medigap policy to help him or her enjoy the rest of his or her years without having to worry about a lack of funds or a lack of coverage.

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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