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Welcome to the SeniorSource, your resource for Senior Insurance questions, answers and solutions. All The Plans: The Soup
As these Medicare evolved CMS added letters to differentiate new parts. And as supplement Plans evolved letters were also used to differentiate the Plans. To further confuse, letters are often used to describe Part C plans, or Drug Plans or Networks. We can help, you only need 12 letters, and that is SeniorSource. MedicareMedicare is a federal health insurance for people age 65 or older, under 65 with certain disabilities or any age with End-Stage Renal Disease (permanent kidney failure). A must read/download is a document, most often updated annually, is titled Medicare and You, published by CMS (Center for Medicare and Medicaid Services). We urge all Medicare eligibles to read this document and retain it for reference: http://www.medicare.gov/publications/pubs/pdf/10050.pdf The CMS website is the best reference for information, news, plan limitations, coordination of benefits, legislation, cost and many other questions. Please visit https://www.cms.gov/. SeniorSource is also available to assist. Medicare has four Parts:PART A: Medicare Part Ahelps cover inpatient care in hospitals, skilled nursing facilities, and hospice and home health care. Generally there is no monthly premium if you qualify and paid Medicare taxes while working. Premium Part A: No premium for most working Americans or their Spouses. PART B: Medicare Part Bhelps cover medical services like doctors' services, outpatient care and other medically necessary services that Part A doesn't cover. You need to enroll in Medicare Part B and pay a monthly premium determined by your income, along with a deductible. Most people are automatically enrolled in Part B when they turn 65, but are given an opportunity to NOT elect coverage. Some people, still on an employer plan, or who have other coverage do not wish to pay for Part B if they have coverage elsewhere. If you are unsure of your Part B status, call Social Security at 800-772-1213. Premium Part B: $115.40 per month for those eligible to join in 2011. This premium is most often automatically deducted from your Social Security check. Premium may vary depending upon your income. PART C: Medicare Advantage Plans, also known as Medicare Part C, are combination plans managed by private insurance companies approved by Medicare. They typically are a combination of Part A, Part B and sometimes Part D coverage, but must cover medically-necessary services. These plans have discretion to assign their own copays, deductibles and coinsurance and networks. Premium Part C: If you elect a Part C plan, CMS (Center for Medicare and Medicaid Services) pays your elected carrier a premium. For some carriers/plans, this is sufficient, and you would pay $0. Other plans, with perhaps richer benefits, and lower copays will charge a premium anywhere from $0 to $150 or more per month. Note: most of these plans also have Part D Rx coverage included. PART D: Medicare Part Dis prescription drug coverage, and is available to everyone with Medicare. It is a separate plan provided by private Medicare-approved companies, and you must pay a monthly premium. Premium Part D: Costs vary a great but so do benefits. Most cost effective is about $15.00 per month and may be as high as $90+ per month, depending on carrier, and benefits and coverage through the donut hole. (Donut hole is a deductible after you reach/exceed $2,930 in drug cost (2012) and coverage resumes after you reach/exceed $4,700 in drug costs. To help illustrate; coverage may fit together like puzzle pieces.
For more comprehensive coverage (than just A&B) many elect a Medigap/Supplement that pays for many holes/gaps/deductibles that Medicare Part A and B do not cover. A Part D Rx Card, completes the package. Part C stands alone as a separate form of coverage. It is comprehensive coverage and often includes an integrated Part D Rx card. Part C Plans often urge (or require in an HMO plan) members to use a network of doctors and hospitals to maximize coverage. Additional out of pocket expenses in a Part C plan may take the form of Copays (Examples: Office Visit, Emergency Room, Surgery) deductibles and or coinsurance (example: plan pays 80% and you pay 20% in network, until you pay annual maximum of $1000. This is an example, review plans carefully for point of service costs and annual maximums.) Medigap/Supplement PlansMedicare offers comprehensive coverage but has some gaps, holes and deductibles. Gap plans exist to fill some or most of these costs. Supplement/Gap plans have existed almost as long as Medicare. The best guide to assist you in choosing a Medigap policy is published by the Center for Medicare and Medicaid Services; See link below:
See below available plans, excerpt taken from linked document above, Choosing A Medigap Plan 2011 published by CMS. Medigap policies help to pay some or all the gaps listed below (does not pay premium) Deductible and coinsuranceOn October 27, 2011 the Centers for Medicare and Medicaid Service (CMS) released notices detailing the Medicare Part A and Part B premiums and Deductibles for calendar year 2012. Hospital Deductible:
Hospital Coinsurance:
Skilled Nursing Facility Coinsurance
Part A Premium (for voluntary enrollees only)
Part B
If you make more, you will have to pay higher premiums for Part B Part B Income-Related Premium
Part D Income-Related Premium Adjustment Enrollees in Medicare Part D prescription drug plans pay premiums that vary from plan to plan. Beginning in 2011, Part D enrollees whose incomes exceed the same thresholds that apply to higher income Part B enrollees must also pay a monthly adjustment amount. The regular plan premium will be paid to their Part D plan, and the income-related adjustment will be paid to Medicare. The amounts by income level are below.
Source: http://www.medicareadvocacy.org/2011/10/2012-medicare-premiums-deductibles-and-co-pays/ Like employer health plans, Supplement and Advantage plans premiums are similar in that less out of pocket costs, deductibles copays and coinsurance; and freedom to go to any doctor or hospital has higher premiums. Higher deductibles, copays and coinsurance: and a smaller network and more restrictive access (referrals or authorization required) have lower premiums. As for Supplements, of the ten plans offered (not all carriers offer all ten plans) plan F, the richest plan, has over 43% of all supplement enrollees nationwide and over 68% in Illinois. Plan N is a new plan, since 6/1/2010, with some copays and is a cost effective supplement.
Choosing A Plan: You are not required to choose a plan, but many Americans consider this potentially costly and decide to supplement or replace their Medicare A&B with an Advantage PPO, HMO or PFFS plan. Things to consider: Budget, this first consideration may limit the number of plans you wish to review. Freedom of Choice, Supplements offer the most freedom. Supplements permit the enrollee to go to any doctor or hospital that accepts Medicare, and that is currently covers almost all medical providers. We highly recommend reviewing CMS document "Choosing a Medigap Policy" see link http://www.medicare.gov/Publications/Pubs/pdf/02110.pdf Advantage Plans offering PPOs have networks which are optional, but going out of network may cost quite a bit more. Advantage plans offering HMOs do not ususally permit out of network choice, and may require referrals or authorization for all services, with the exception of Emergency. These plans often have lower premiums but may have more expense at point of service (copays or coinsurance) than many supplements. See link: http://www.medicare.gov/navigation/medicare-basics/coverage-choices.aspx PDP Part D Rx plans and Advantage Plans with an Rx card (MAPD) publish formularies which are approved by CMS (Center For Medicare and Medicaid Services), It is to your advantage to see if your prescriptions are covered and at what cost to you. Look carefully at deductibles, they may vary not only from carrier to carrier, but from plan to plan offered by each carrier. Some higher premium plans cover generic costs through the donut hole (Donut hole is a deductible after you reach/exceed $2,930 in drug cost (2012) and coverage resumes after you reach/exceed $4,700 in drug costs). All plans, through CMS mandate offer discounts for both generic and name brand drugs during the donut hole. CMS has a highly recommended tool, the Plan Finder. Go to link below, it will show available carriers offering supplements and advantage plans in your area. It will also assist in a key factor for many which finding pharmacies and drugs that are covered by the plan(s) you are considering. Go to https://www.medicare.gov/find-a-plan/questions/home.aspx SeniorSource may also assist, please call us with questions or for enrollment material for many carriers. Options That Are Not Permitted: Like an Employer Group insurance choice, you may have many choices but you may not mix, or duplicate choices. Example: you cannot enroll in a PPO and an HMO at the same time, or enroll in the PPO, but take the drug coverage offered by the HMO. With that in mind, the list below are options NOT available to Medicare eligibles. This list is not necessarily complete, please contact CMS or the SeniorSource with questions. OPTIONS or Combinations NOT Permitted:
To help eliminate duplication, during the AEP (Annual Enrollment Period) CMS enrollment rules recognize last application received as valid. So as an example, if you wish to change Part D Rx cards during the AEP, all you need do is submit new application, this will automatically disenroll you from previous carrier/card. Or if you elected a new drug card at the beginning of the AEP and changed your mind or found a better card to suit needs, simply complete new application and submit. But note: if you elect new drug card during the AEP and you are enrolled in an MAPD plan, you will be automatically disenrolled from your MAPD (HMO, PPO or PFFS) plan in favor of the Rx Card only. So it is best to understand the rules and consult with CMS or SeniorSource before making questionable choices. Late Penalties: Most Americans automatically qualify for Part A (Hospital) when they turn 65 and also elect Part B (Doctor/Oupatient) at that time. But some, mostly working or have coverage through a working Spouse, do not elect Part B as they are still covered by another (employer) policy. They do not wish to pay the monthly Part B premium from their Social Security check if they already have coverage through a group plan. Also, many do not wish to buy a Part D Rx at this time if the group plan has adequate Rx Coverage. In this scenario, there is no penalty for late enrollment in Part B or Part D if elected after group plan terminates. For those who do not elect Part B or Part D when eligible and do not have other coverage or reason to not elect, there are penalties. They are as follows: Part B: If you sign up late for Medicare Part B, you will have to pay a "late" penalty premium every month, along with your in addition to your Part B Premium. Your monthly Part B premium will increase 10 percent for each full 12-month period that you could have had Medicare Part B but did not take it. You will pay this higher premium as long as you have Medicare Part B. Part D: The penalty premium is added onto the regular premium that you pay to your Medicare drug plan. You will pay 1 percent of the average monthly prescription drug premium (1 percent of $32.24 in 2011, or 32 cents) for every month you are late. You will pay this higher premium as long as you have Medicare prescription drug coverage. Some strategize that this penalty is not that large and consider taking the penalty rather than paying premium for coverage they do not feel they currently need. But 1 percent per month can add up; and will be added to every premium you pay for as long as you have Part D regardless of carrier. If you do not take prescription drugs we still recommend, if affordable, some type of Part D plan. The least expensive at this time (2012) costs a little over $15.00 per month. Contact SeniorSource or link to the CMS plan finder above for more information. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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