Medicare is a federal health insurance program administered by the Health Care Financing Administration. It is available to eligible persons age 65 or older, persons with permanent kidney failure, and certain disabled persons. If you are eligible for social security – whether or not you are actually taking social security or working or not – you are eligible for Medicare.

 4 Parts of Medicare Coverage
Part A is hospital insurance. All persons mentioned above are eligible and enrollment is automatic; no application is required. Paid for by payroll taxes of every person in an occupation covered by Social Security, it provides four main benefits:

• Inpatient hospital care,
• Post-hospital skilled nursing care for up to 100 days,
• Home health care for the first 100 home health visits and
• Hospice for terminally ill persons.

 Benefits are applied in “periods” beginning on the first day a person receives covered services and ending once the person has been out of the hospital for 60 consecutive days. If you reenter the hospital within this 60-day period, there is no new deductible, but if you reenter after the 60-day period, a new benefit period begins and a new deductible is applicable. Every year deductible and coinsurance amounts are adjusted. For specifics, refer to the Medicare Website at http://www.medicare.gov.

 Part B is medical insurance. All persons entitled to Part A and other individuals who are 65 or older may voluntarily enroll. The initial enrollment period begins three months before you turn 65 and ends three months after you turn 65. By enrolling after this time frame you will pay a higher premium for Part B coverage. Part B is financed through the premiums of its participants and through the funds of the federal government. If you are a recipient of Social Security, premiums are automatically deducted from your monthly benefit. If you are not receiving Social Security benefits, you must make quarterly premium payments. Some of the chief benefits include:

• Doctor’s services,
• Outpatient hospital services,
• X-rays and laboratory tests,
• Physical and occupational therapy,
• Medical Supplies,  
• Home health care and
• Treatment of mental illness within limits.

Besides the premium payments, patients pay an annual deductible which – for 2009 – is $135, plus an additional 20% of Medicare approved charges. Certain benefits may be 100% covered by Part B.

Part C is called Medicare Advantage. You may have previously heard it referred to as “Medicare + Choice”. If you are entitled to Part A and Part B, you have the option to switch to a Medicare Advantage plan which is offered through private companies and its availability varies across regions. Basically, Part C was created by Congress to provide persons with more choices and, in some instances, extra benefits for an additional cost through HMOs, PPOs, etc. This option is rarely, if ever, exercised in this area of the country and if you are considering it or question whether it might be suitable for you, give us a call.

Part D is Medicare prescription drug coverage. Beginning in January 2006, everyone on Medicare was, and is, eligible to join one of the available prescription drug plans. Enrollment is only from November 15^th to December 31^st of each year. Like Part B, a higher premium will be charged for those who delay enrollment past the time of first eligibility. Part D covers approximately 50% of drug costs. These costs vary according the selected plan. Each state has its own set of plans – some as many as 40 plans. In order to determine which plan is right for you, speak with your pharmacist. Each plan has a formulary or list of drugs covered, and your pharmacist will be able to help you identify these. If you currently have a prescription drug plan with an employer or union, speak with your plan administrator to decide whether or not to switch to Medicare Part D.

Medicare will not cover all of your medical costs: So how do you pay the rest?
A Medicare supplement, also known as a Medigap Plan, is designed to fill in the costs that Medicare doesn’t pay for. Federal law has standardized Medicare supplement insurance into 10 plans (A through J). The differences in these plans range from a basic coverage of Medicare deductibles and co-insurance only (Plan A), to broader coverage (with high premiums) in plans up to a plan that covers almost everything except nursing home care not covered by Medicare (Plan J). When shopping for a Medicare supplement, note that these plans are virtually the same from company to company and you only need one Medicare Supplement. Your choice should be made on the comparisons of premium prices and services offered whether or not it is community-rated pricing, any pre-existing condition clauses and special discounts or benefits.

EXTREMEMLY IMPORTANT: Purchase your Medicare supplement policy in the same initial enrollment period discussed for Medicare Part B or when you stop working and drop your group health care plan. During this period of open enrollment, insurance companies are legally required to accept you regardless of your health condition. Otherwise, you will be subject to the underwriting process and may be refused coverage due to health concerns or pre-existing conditions revealed on your health application.

For more information about Medicare and Medicare Supplements speak with your Life Consultant. It can be very confusing and it is best to work with someone who fully understands the rules and processes applicable to Medicare for your unique situation.