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What is Part D of Medicare?Ever since January 1st 2006, Medicare Part D has been helping people manage the costs associated with prescription drugs. Original Medicare was somewhat inadequate in its scope to offer comprehensive assistance, and it still has its critics, but Part D Medicare plans helped to make the Medicare initiative far more popular today. Part D is available to citizens over 65 years of age and therefore most likely to spend large amounts of money on medication, provided they have bought into a PDP or Advantage plan as well as their medical/hospital cover. Who Buys Part D of Medicare?Anyone who qualifies for Medicare A and B can also purchase prescription drug cover as a PDP (prescription drug plan) or a Medicare Advantage plan. Two thirds of enrollees buy the PDP which has fewer options and therefore costs less, but is limited in services outside medication. With 29 million people enrolled in Part D of Medicare and 1,975 stand-alone policies currently on the market, the numbers speak for themselves as far as the popularity of these beneficial plans is concerned. Pricing of Medicare Part D plansPrices vary from state to state as far as plans are concerned. Medicare prices are set by law, and local agents will be more than happy to help you find the best Medicare supplemental policy in your locale. There are also many resources available online which will serve as a guide to determine rates. Enrollees must pay a set deductible of $310 and will usually have to pay a quarter of costs as co-insurance up to the amount of $2830.00. Once a policyholder reaches the $2830.00 tidemark, they enter the Donut Hole or coverage gap, whereby they have to pay the full amount of medication fees until they have spent $4,550.00. These out of pocket expenses can be avoided by purchasing gap coverage when entering into a policy. Spending is counted between the beginning of January and the end of December annually. Medication expenses are such that many people reach the coverage gap, often early on in the year. In 2011, 27% of Medicare Part D policyholders spent over the Donut Hole threshold, without qualifying for subsidization due to low income. A further 6% of these spent enough to receive coverage on the other side of the “Donut” which is known as catastrophic coverage. If an individual is concerned that they will almost certainly hit the Donut Hole over the course of the year, they may wish to apply for gap coverage which will extend your policy to cover you above the $2,830.00 mark – for a higher premium. Savings of up to 75% can also be made by opting for generic drugs instead of branded names. As a ball-park figure, average premium spending was around $40.00 per month last year and rates rise by around $3 with each successive enrollment period. Medicare D Low Income SubsidiesThose who are of a lower income have a low-income subsidy available to them, provided they fall below the 150% poverty line. This will cover a portion of, or all costs for premiums, deductibles and copayments. Over 10 million citizens qualify for this extra support. Medicare Part D: a Most Welcome AdditionPart D of Medicare and Medicare Advantage plans have been a real godsend to those who have found it difficult to manage prescription drug expenses in the past. Those in the later stages of life generally need this service more than younger generations, but have less disposable income available to them. Additionally, there are helpful services for those with less money and those who spend more on drugs than the average person. Talk to a licensed agent and you’ll realize that there really is a lot to gain from enrolling in these useful plans.
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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.