Shane Flait asked:


Medicare is a government regulated healthcare program for those 65 and older. You’ll probably be on it, so it’s important to understand how it works.

In this article I summarize the different parts and coverages that come under the Medicare program.

Medicare is a program with different parts. Only the first - Part A - is free if you contributed enough FICA over the years. The other parts each cost an amount depending on your income and choices of ’supplemental coverage’ they offer.

Let’s take a look at what each part is about. Medicare is divided into components:

Part A - hospital insurance

Part B - medical insurance (this is optional)

Part C - additional insurance coverage

Part D - offers voluntary prescription drug coverage offered via private vendors

Part A is called hospital insurance. It covers most costs of your stay in the hospital as well as some follow-up costs after being in the hospital. It also pays some outpatient medical services, including medically necessary equipment and supplies, home health care, and physical therapy. Under most circumstances (if you’ve paid enough FICA taxes), you don’t have to pay a premium for Part A.

Part B is medical insurance. It’s optional. If you elect it, the monthly premium is deducted from your Social Security check automatically. It provides for certain out-of-hospital treatments and is intended to help pay doctor’s bills for treatment in or out of the hospital. It also covers many other medical expenses you incur when you’re not in the hospital, such as the costs of necessary medical equipment and tests.

Medicare Part B has spawned additional insurance coverages to supplement what it and part A don’t cover. The first is the ‘Original Medicare Plan’. Here, you pay your Part B monthly premium and then pay for additional services as you use them. With this plan you might also choose to buy Medicare Supplement Insurance, or “Medigap” insurance. The term Medigap implies that these insurance policies will cover the gaps in Medicare payments. Medigap doesn’t fill all the gaps, but it helps. More types of coverages are relegated to part C.

Part C: Medicare Managed Care and Private Fee-for-Service plans are offered by private insurance companies. Managed care plans generally fall into two main varieties:

1) health maintenance organizations (HMOs) and

2) preferred provider organizations (PPOs).

HMOs are generally less expensive than PPOs but usually more restrictive in their services and choice of doctors.

With these latter two plans in Part C, you must still continue to pay your Part B premiums, and you may also have to pay an additional premium to the insurance company as well as any related deductible or co-insurance payments. However, the services you receive may be more comprehensive than those offered through the Original Medicare Plan.

Medicare Part D requires you to join a Medical Drug Plan (MDP) in either of two categories of such plans:

1. You can join one of the Medicare Prescription Drug Plans (called PDPs). These plans add drug coverage to either of your Original Medicare Plan, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) plans, and Medicare Medical Savings Account (MSA) plans. Or

2. Join a Medical Advantage Plan - like a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) or some other Medical health plan that includes prescription drug coverage.

Through these plans, you get all your Medicare coverage of Part A and Part B including prescription drugs (Part D). These Plans are called ‘MA-PDs’

In either category you’ll usually pay a separate monthly premium for the drug coverage in addition to your Part B premium.

After joining a specific MDP, the plan mails you membership materials including a card to use when you get your prescriptions filled. When you use the card, you may have to pay a copayment, coinsurance, or a deductible amount depending on your plan

What to consider when comparing which MDP to choose:

Look for the Coverage, Cost and Convenience to you from each plan. These will be different.

Coverage - check if the type of prescription you want comes under that plan.

Cost - see what costs and payment schedule that plan offers you.

Convenience - make sure the plan’s pharmacies include the ones you want to use.

You can switch your plan each your from November 15 to December 31.

Be sure to apply for Medicare coverage three months before your 65th birthday so you can start it when you turn 65.

If you’re on Medicaid, they’ll automatically enroll you in a MDP if you don’t join yourself. Under Medicaid, in most cases, you’ll pay from nothing to about $5.60 out-of-pocket for each covered drug.



RAGSDALE

Chad Kiser asked:


As so many changes are made in Medicare it can be confusing and frustrating trying to determine what the eligibility requirements are and what services they cover. There are a few basic guidelines that should be helpful in showing you how to apply for Medicare.

In order to meet the eligibility requirements either your spouse or you had to be employed for a minimum of ten years in some type of employment that included Medicare coverage, you must be 65 or older as well as a permanent resident or citizen of the US. There are some exceptions to the coverage criteria when it comes to people with disabilities or with certain diseases. While there is no income limits or guidelines for Medicare itself there are some requirements of a medical nature concerning delivery of any services as a person must show that they have a legitimate need for those types of services.

Medicare has two parts; Medicare Part A in considered hospital insurance and helps to pay for care that is received in a hospital, home health, hospice or nursing facility. Medicare Part B is considered medical insurance and it helps to pay for doctors, outpatient hospital care and other related medical services.

Now that you know the basics of what is required to be eligible for Medicare you need to know how to apply for it as well. You may be automatically enrolled in Medicare if you have not yet reached 65 and are already receiving Railroad Retirement benefits or Social Security. If the event that you have a disability you may automatically be enrolled beginning on the 25th month of being disabled.

Most people should enroll themeselves three months prior to their 65th birthday. By applying for Medicare early you may be able to avoid having a delay in starting your coverage. To get started applying, you should visit the local Social Security administration office and make sure you data is in order or contact the Railroad Retirement board if you or your spouse was employed by the railroad industry. A quick note, if you do not enroll for benefits during this 10 month period, you will have to wait until the first quarter of the next year.

The other piece to remember is that you will need to enroll in or apply for a Medicare Medigap program if you need supplement coverage. This means if you want help paying the copay, you need a supplemental insurance package.



DALLAS

Ron Mark asked:


Health is something we seriously begin to think of only after experiencing a more or less severe disorder. In our natural, daily attitude we use health as a premise for making the best of our time, and most of our deeds focus on different issues. Nevertheless, health insurance programs have been designed as a manner to cover this particular aspect of our lives without being necessary to keep track of it constantly, and this proves to be a very suitable manner of dealing with health issues, because it is more or less probable that at a certain point we should experience one disorder or other. Medicare part B, as well as Medicare part D, stands for a health insurance program covering some specific medical services within the perimeter of a wider program, that is, Medicare.

In fact, Medicare part B is meant to cope with tasks that Medicare part A does not. In order to be selected as a Medicare part B beneficiary, one has to meet all the general conditions levied by the entire Medicare program, namely, a certain age – the citizen has to be at least 65 years old – or, if not, they must satisfy other specific stipulations, for instance, continuous dialysis for permanent kidney failure.

The services covered by Medicare part A are as it follows: inpatient hospital stays, home health care, psychiatric inpatient care and hospice care. It is obvious Medicare part A covers a relatively small portion of the entire range of medical services and products. Medicare part B, Medicare part C, as well as Medicare part D have been designed to cover whatever remains uncovered under Medicare part A. Part B of the Medicare health insurance program has a wider range of covered services and programs than part A.

Therefore, the package provided by Medicare part B is much wider, including, just to mention a few, physicians’ services, X-ray therapy and other sorts of therapy, items necessary to fractures and dislocations, a variety of diagnostic tests, durable medical equipment, prosthetic devices, some types of therapy, some vaccines, some preventive services, psychologists’ services and even rural clinic services. This is not a complete list of items and services insured by this part of Medicare. However, before enrolling one should pay attention both to what is and what is not covered by part B.

Medicare part D assists beneficiaries in the purchasing of prescription drugs. Whoever is eligible for other parts of Medicare program and is actually enrolled in one of them may subscribe to part D as well. Irrespective of the specificity of the items covered by Medicare part D, this portion of the program works differently, that is, clients must choose one of the many plans within part D offered by Medicare. The main two programs are the so called stand-alone Prescription Drug Plan, or PDP, and Medicare Advantage Plan, or MA-PD. Due to the fact that part D is designed to work this way, enrollees have the possibility to choose the insurance of a certain class of drugs supposed to be necessary in the coming year. The plans are flexible as they can be changed each year according to the beneficiary’s needs.



MORAN

moremoola4me asked:


We are working on a medicare Part B claim that hasnt been paid. They are saying it is bundled and will not give any other information. We already use the AQ with the 25 modifier for injections, IV’s, etc. Please help. Thanks

LIGHT