FREQUENTLY ASKED QUESTIONS (FAQ)What is Medicare? What are Part A and Part B of Medicare? Part A (Hospital Insurance) helps pay for inpatient hospital care, some skilled nursing facility care, hospice care, and some home health care. Part B (Medical Insurance) helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A doesn't cover. Part B helps pay for such covered services and supplies when they are medically necessary. What is a Medicare Supplement plan? A Medicare Supplement Insurance plan is a health insurance policy
sold by private insurance companies. They must follow federal and
state laws. These laws protect you. The front of the Medicare Supplement Insurance plan must clearly identify it as “Medicare Supplement Insurance.” Costs that you must pay, like coinsurance, co-payments, and deductibles, are called “gaps” in original
Medicare plan coverage. You might want to consider buying a Medicare Supplement plan to cover these gaps in Original Medicare coverage. Some Medicare supplemental plans also cover benefits that the Original Medicare Plan doesn’t cover, like emergency health care while traveling outside the United States. A Medicare Supplement Insurance plan may help you save on out of pocket costs. If you buy a Medicare Supplemental Insurance plan, you will pay a monthly premium to the private insurance company that sells you the policy. What is Medicare drug coverage (Part D)? Starting January 1, 2006, new Part D Medicare drug coverage was available
to everyone with Medicare. Everyone with Medicare can get this coverage
that may help lower drug costs and help protect against higher costs
in the future. Medicare drug coverage is insurance. A private insurance
company will provide the coverage. You choose the drug plan and pay a monthly premium. Like other health
insurance, if you decide not to enroll in a drug plan when you are
first eligible, you may pay a penalty if you choose to join later. If you don’t join a Part D plan by May 15, 2012, and you don’t
currently have a drug plan that, on average, covers at least as
much as a standard Medicare drug plan, you will have to wait until
November 15, 2012 to join. When you do join, your premium cost will go up at least 1% per month for every month that you wait to join. Like other health insurance, you will have to pay this penalty as long as you have Medicare drug coverage. If you join by December 31, 2012, your coverage will begin January 1, 2012. What are "open enrollment" and "guaranteed issue" in Medicare? Also, if you are enrolled in a Medicare Advantage plan and you are
involuntarily terminated by the plan due to the Medicare Advantage
insurer ceasing to offer the insurance plan, or you're moving out
of the insurance plan's service area or the plan becomes insolvent,
within two months of the insurance plan's termination date you have
a "guaranteed issue" right to buy Medicare Supplemental Insurance plans A, B, C or F without having to medically qualify. Finally, if you enrolled in Medicare Part B at age 65 but remained covered under group insurance beyond the six month open enrollment period, upon termination of the group health coverage in many states, including Florida Medicare, residents are eligible for two months. What is creditable coverage? Creditable coverage is any previous health insurance coverage that can be used to shorten the pre existing waiting period, such as a health insurance coverage under a group (employer) health plan or an individual health insurance policy. However, if there was any time that you had no health insurance coverage of any kind, and during that time you were without health insurance coverage for more than 63 days in a row, you can only count the creditable coverage you had after the break in health insurance coverage. What is a Medicare approved amount? This is the fee that Medicare sets as reasonable, which providers who accept "Medicare assignment" will charge for a covered medical service. Otherwise, the Medicare approved amount may be less than the actual amount charged by a doctor or supplier for a service or supply. Do I have to wait to switch to a different Medicare supplement policy? No, but the length of time you've had your Medicare supplemental plan will affect how your new Medicare Supplement policy covers you for pre existing conditions. If you've had a Medicare Supplement Insurance plan for at least six months and you decide to switch, your new Medicare Supplemental Insurance plan must cover you for all pre existing conditions. If you've had a Medicare Supplemental Insurance plan for less than six months, the new Medicare supplement policy must give you credit for the time the older policy covered you. What happens to my Medicare supplement plan if I move? Because your Medicare Supplemental Insurance plan is guaranteed renewable, you will still have insurance coverage if you move. If you move to a new state, however, the Medicare supplement insurer may quote you a different premium. If you have a Medicare Select insurance plan, which contain network restrictions, you must change your Medicare Insurance coverage. But you have the right to buy Medicare Supplemental Insurance plans A, B, C or F in the state you move to without having to medically qualify. What is the Donut Hole? A term used in Medicare when the medication cost sharing is exhausted after the initial coverage in a Medicare Part D plan and before the cost touches the threshold to qualify for the “catastrophic” program. Due to the absence of cost sharing the Part D enrollee will pay the full price of the prescription drug. The donut hole is also referred to as the “coverage gap”. What are Federal Employee Health Benefits? Health insurance benefits provided to Federal employees. People who are eligible for the Medicare Part D plan also qualify for “creditable coverage” under FEHB. Both Medicare Part D coverage and FEHB are similar to each other and people who are switching from one to the other do not have any increased benefits. What is catastrophic coverage? These are programs run by the government to protect insured people from huge out-of-pocket expenses for prescription drugs under Part C and Part D. Every year the government sets fresh limits for a minimum amount of out-of-pocket expenses in order to be eligible for catastrophic coverage. This is only applicable to on-formulary medication expenditure incurred in that calendar year. What is the Federal Poverty Level? The federal government has set up an income level to distinguish people who are impoverished and can qualify for different types of assistance. Why switch to a different supplement policy? Some reasons why a person may look for new insurance policy: Paying for benefits that are no longer required; want more benefits than are currently available; want to change the company even though the present policy provides all the needed information; want a less expensive policy with similar benefits to those that they currently have. Is it allowed for a person to enroll in a Medicare prescription plan and supplemental policy with drug coverage together? No. People, who are enrolled in a supplemental plan along with drug coverage and also have Medicare Part D, should inform their insurance company so that they can remove your name from the drug coverage and adjust the premium accordingly. It is not possible to get drug coverage back once it is being removed even though the person is enrolled in the same supplement policy. Can the supplement insurance company drop the coverage? Policies that are bought after 1992 are guaranteed renewable so the insurance company can’t drop you. But the policies that are bought before 1992 may not have the option of guaranteed renewable so the insurance company may refuse to provide supplement coverage. In case the person is dropped he or she has the right to enroll in another coverage. In what cases does the person have to pay late enrollment fee? It depends on the condition whether the policy has “creditable prescription drug coverage”. In such conditions the supplement coverage pays almost similar to Medicare’s standard prescription coverage. People who enroll in the prescription drug plan without creditable coverage may have to pay a higher premium in comparison to when they were first eligible. As a person grows older they need prescription drug coverage more often than before. It is the responsibility of the insurer to send you a yearly notice to let you know if your prescription coverage is still creditable. These notices are essential when a person wants to join a Medicare prescription plan later on. |
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Medicare is a federal program established to assist with health insurance. It applies to those aged 65+ and those who are younger but who suffer from certain health conditions that make them eligible.
If you are eligible and not enrolled automatically, you can sign up for Medicare by calling Social Security. If you are receiving social Security or certain other benefits, you may be automatically enrolled in Medicare. If you are unsure, call Social Security for assistance on 1-800-772-1213.
Basic Medicare covers those services that the government deems to be medically essential. Medicare Part A provides coverage for inpatient services in skilled nursing and hospital stays, hospices and home healthcare. Part B provides coverage for outpatient care including preventive care, doctor visits and lab tests. Part D provides coverage for most prescription drugs. Part C is privately sponsored Medicare Advantage plans that provide coverage for the gaps that Parts A, B and D don't fill.
There is various payments required by Medicare, which can include cost sharing, premiums and deductibles. There are certain government programs that assist with Medicare payments such as Low Income Subsidy payments for those with less income and fewer assets.
Some people have employer group health plans if they are actively employed. If this is the case it's possible that they will want to delay their Part B application while this plan is in effect.
If a person has creditable coverage for their prescription drugs, which is equally good if not better than regular Part D coverage, they may wish to delay Part D enrollment or forget it altogether. Creditable coverage will often be granted as part of some healthcare plans that are associate with Medicare, such as Veteran Affairs or Tricare.
Medicare can be supplemented with other useful plans such as Medigap, retiree plans and Medi-Cal (for those on a lower income or with fewer assets) which are not government sponsored, but privately issued. Other examples of private health plans include the popular Advantage plans which are comprehensive in their coverage. They include Medicare Part A and Part B but these are paid as part of the plan's premiums.
No. If your Medicare benefits are based on retirement, you must wait until age 65 to enroll. If you enter into retirement at age 62, you may have continued medical insurance from a previous employer or else you would have to purchase temporary health insurance from a private insurer while you wait to become eligible for medicare.
It is advisable to submit your Medicare application three months before your 65th birthday. You should receive your Medicare card around one month later, then coverage will start as soon as you turn 65. Those getting social security benefits will be enrolled in basic Medicare Part A and B automatically. If you don't wish to pay premiums for Part B, you may terminate your enrollment.
Termination of Part B enrollment is taken seriously and as such a form cannot be submitted online. You will be required to attend an interview with social services and may face a surcharge. To terminate enrollment, form CMS-1763 can be filled in person or over the phone and the consequences will be made clear to you.
If you are older than 65, you'll usually be required to sign up during the GEP or general enrollment period. This takes place between January 1st and March 31st and coverage commences on July 1st. There will most likely be a late enrollment penalty for those who sign up during the GEP which would mean a 10% rate increase for each month that you were eligible but did not enroll in Medicare.
If you have a low income or few assets, you may be eligible for financial assistance courtesy of the Medicare Extra Help program. This helps with monthly premiums, co-payments on Part D and annual deductible payments. Your Extra Help application also gets the ball rolling for the Medicare Savings Program, which assists with other Medicare-related costs. You will be contacted by the state with instructions to apply.