Info on Medicare, Medigap, Prescription Plans and related policies

How to Apply for Health Insurance When Retired

Filed under: Senior Health Insurance — Alston @ 1:46 pm March 23, 2014

Retirement often means that you put employer-related job stress in your rear view mirror.  For most people it also means that you leave your medical plan and other benefits behind.  The lucky few that get retiree coverage may still have to scramble to find a low cost policy for their spouse and their children.  Few employers will cover former employees even fewer will cover their spouses or families.

Understanding the coverage options that you are eligible for when retired is important. The cost of premiums over the months and years can add up to tens of thousands of dollars. The financial impact of having the wrong insurance can wipe out years of savings.

Please note that time is of the essence. You may have 60 days or less to make a decision about your retiree coverage. Please ask your broker about the deadlines involving any option you are considering.

When you retire, you may be faced with a myriad of health insurance choices. Depending on your age and other factors your choices may include Medicare, COBRA, an individual health plan, a federally subsidized Obama Care plan and/or a state subsidized Medicaid policy. Which one is likely to work best for your retirement?

This post will cover the following options:

  • Medicare
  • COBRA
  • Individual/Family Insurance
  • Medicaid

Medicare

If you are age 65 or older or disabled, you will probably qualify for Medicare. If so, this will probably be your best option. The coverage is good, the cost is low and you most providers will accept payment from Medicare.

Original Medicare includes Part A and Part B. Most Americans who qualify for Medicare will get Part A without a monthly premium. However, without Part B your doctor visits will not be covered. Without part C or D your prescriptions will not be covered.

You can request quotes and information from insurers offering plans that coordinate with Medicare including Part D prescription drug plans from this site.

COBRA

This is rarely the best option. Before the Affordable Care Act stopped companies from denying enrollment and increasing rates based on an applicant’s medical history, this was one of the only viable choices for people with significant medical issues. Since other options are usually less expensive, COBRA is less attractive today.

COBRA allows you to continue to have employer-sponsored group insurance for a period of time. You can expect one change regarding who pays for the coverage. You can expect that you will pay 100% of the cost. Larger companies are required to offer COBRA, but are not required to pay for it.

Individual or Family Insurance

If you do not qualify for Medicare or Medicaid your best option will likely be to purchase an individual or family health insurance policy. In every state you will have programs offered from various private health insurance companies.

If you qualify for a subsidy through the Affordable Care Act, you will pay less money for your policy. Please note, however, that if you qualify for Medicaid or Medicare you will not be eligible for a subsidy.

Medicaid

If your income is below the federal poverty limit you will probably qualify for Medicaid. In some states the income limits are higher. It can also be higher if you have a child or are pregnant.

Medicaid is a very inexpensive way to get healthcare but it has drawbacks. Since the payments made to doctors is often very low, the more established or experienced doctors are generally opt out of the program.

No matter which option you choose, be sure that you understand your policy. You should know what providers (doctors, hospitals and pharmacies) you can receive medical services and prescriptions from and what your cost shares (deductibles, coinsurance and copays) will be.

Medicare Supplemental Insurance Comparison Plan B

Filed under: Senior Health Insurance — Alston @ 9:13 pm January 25, 2012

Medicare supplement plans pay some of the costs that Medicare does not pay. Medicare beneficiaries buy this coverage form private insurers. A Medicare supplement policy does not replace Medicare. They are designed to supplement the coverage that is offered through Original Medicare.

Other names for these policies include Medigap, Med sup and Gap. Medicare beneficiaries can get their medical bills covered by other polices that have similar names. Medicare Advantage policies provide benefits to Medicare beneficiaries, but they deliver these benefits differently.

You can get rates for Medicare Supplemental policies via this website. You will get premium information as well as much of the other information you will need to carefully compare the plans and make a decision.

It is important to note that the full cost of the medical care you receive will not always be covered by insurance. Original Medicare covers costs in the hospital with Part A. Part B covers costs in doctors’ office. There are copays, coinsurance and deductibles you may need to pay when you need care for a medical condition.

Another important issue to be aware of is that not every Medicare beneficiary is a senior. Some are many years too young to be a senior and qualify by virtue of having a disability.

The person who buys a Medigap policy will generally have less to pay because they can file a claim for the costs the Medicare does not take care of. However, no combination of policies pays the full cost every time.

These blog posts should give you a good overview of what is and is not covered by the various Medicare supplement policies. However, the information is not comprehensive and, depending on when you read this, it may not be entirely current. The information is based on the way Medicare and Medigap work in 2012.

There are ten Medigap or Medicare Supplement plans. No matter which insurance carrier you purchase a Medigap Plan B from, you will get the same benefits when claims are file for you. The same is true for the other nine plans.

Medicare Supplement Plan B

Plan B pays for the Medicare Part A coinsurance. It also pays for hospital costs for up to an additional 365 days after Medicare hospital benefits are exhausted.

Unlike Plan A it does pay the hospital deductible. This is separate from the hospital coinsurance. For 2012, the hospital deductible is $1,156. Unlike many other health insurance deductibles, this deductible is not an annual deductible. It is a per benefit period deductible. This means that you can pay it more than once during the same twelve-month period.

Hospital costs not covered by Medicare:

  • Hospital Deductible- $1,156 in 2012
  • Coinsurance for days 61 through 90 of a hospital stay. $289 per day in 2011.
  • Coinsurance for days 91 through 150 of a hospital stay. $578 per day in 2011. (Lifetime reserve days)
  • All costs for each day beyond 150 days.

With a Medicare supplement plan B, your costs are mostly covered for the first sixty days of a hospital admission during each benefit period.

Some costs are not covered. These costs include the cost of a TV or telephone in your room. Neither the insurance companies nor the federal government are willing to increase their rates to cover these costs for people.

If your stay lasts more than 60 days you will be responsible for $289 per day for days 61 through 90. These costs will be paid by a Medicare supplement plan B. Medicare will pay the rest.

If your hospital admission lasts more than 90 days, you will start using your lifetime reserve days. Medicare gives you 150 lifetime reserve days. For each of these days that you use, you will be responsible for $578 per day.

If you use all of your lifetime reserve days, Medicare stops paying entirely. However, a Medicare supplement plan B will pay the cost for another 365 days once in your lifetime.

In Your Physician’s Office

A Medicare supplement plan B will pay for doctors’ coinsurance unless a doctor charges more than the Medicare approved amount. The current coinsurance amount is 20%.

This plan will not, however, pay for your Medicare Part B deductible. This deductible is $140 in 2012. Medicare does not pay towards your deductible. It pays 80% of the approved amount of your expenses in excess of your annual deductible.

Hospice

Without a Medicare supplement you will be responsible for $5.00 for each prescription drug given to you for hospice care. You will also pay 5% of the cost of inpatient care. A Medicare supplement plan B will pay these costs for you.

Medicare Supplemental Insurance Comparison – Plan A

Filed under: Senior Health Insurance — Tags: — Alston @ 9:43 am October 2, 2011

Medicare Supplemental Insurance Comparison – Plan A

Medicare supplement plans are private insurance policies that pay costs that Original Medicare does not pay. Original Medicare consists of Medicare Part A and Part B. Although even the best policy will not pay 100% of the costs that Medicare doesn’t pay, these policies can make a huge difference if someone is hospitalized for a long period of time or otherwise needs a lot of medical care.

For Medigap rates, information and an opportunity to speak with a broker who can help you decide on a good plan, you can request Medicare supplement quotes from this website.

These blog posts should give you a good overview of what is and isn’t covered by the various Medicare supplement policies. However, the information isn’t comprehensive and, depending on when you read this, it may not be entirely current. The information is based on the way Medicare and Medigap work in 2011. For more detailed information please view this document.

The rules and regulations for Medicare are federal and therefore apply to all 50 states.  However, the market for the supplemental policies and the Part C policies are different in each area.  You can use this website to get Alabama Medigap quotes as well as quotes for any other state in the union.

There are ten Medigap or Medicare Supplement plans. No matter which insurance carrier you purchase a Medigap Plan A from, you will get the same benefits. The same is true for the other nine plans.

Medicare Supplement Plan A

Plan A pays for the Medicare Part A coinsurance. It also pays for hospital costs for up to an additional 365 days after Medicare hospital benefits are exhausted.

It is important to note that Plan A does not pay the hospital deductible. This is separate from the hospital coinsurance. For 2011 the hospital deductible is $1,132. Unlike many other health insurance deductibles, this deductible is not an annual deductible. It is a per benefit period deductible. This means that you can pay it more than once during the same twelve month period.

Hospital costs not covered by Medicare:

  • Hospital Deductible- $1,132 in 2011
  • Coinsurance for days 61 through 90 of a hospital stay. $283 per day in 2011.
  • Coinsurance for days 91 through 150 of a hospital stay. $566 per day in 2011. (Lifetime reserve days)
  • All costs for each day beyond 150 days.

With a Medicare supplement plan A you will pay the first $1,132 for a hospital admission. This plus what Medicare pays will cover most expenses for the first 60 days of an admission.

If your stay lasts more than 60 days you will be responsible for $283 per day for days 61 through 90. These costs will be paid by a Medicare supplement plan A. Medicare will pay the rest.

If your hospital admission lasts more than 90 days, you will start using your lifetime reserve days. Medicare gives you 150 lifetime reserve days. For each of these days that you use, you will be responsible for $566 per day.

If you use all of your lifetime reserve days, Medicare stops paying entirely. However, a Medicare supplement plan A will pay the cost for another 365 days once in your lifetime.

In the Doctor’s Office

A Medicare supplement plan A will pay for doctors’ coinsurance unless a doctor charges more than the Medicare approved amount. The current coinsurance amount is 20%.

This plan will not, however, pay for your Medicare Part B deductible. This deductible is $162 in 2011. Medicare does not pay towards your deductible. It pays 80% of the approved amount of your expenses in excess of your annual deductible.

Hospice

Without a Medicare supplement you will be responsible for $5.00 for each prescription drug given to you for hospice care. You will also pay 5% of the cost of inpatient care. A Medicare supplement plan A will pay these costs for you.

Medicare Supplemental insurance for the Disabled

Filed under: Senior Health Insurance — Tags: — Alston @ 9:19 pm September 27, 2011

Many people who are under age 65 qualify for Medicare. Although parts of their situation may be different than that of a retired individual, many of the same plans are available to both groups.

The majority of people covered by Medicare are over the age of 65. However, many younger people qualify because of a major health condition or a disability.

Individuals who are deemed to be disabled by Social Security’s definition are automatically enrolled in Medicare. This, however, takes place after a wait of 24 months. You will need to receive Social Security disability benefits for two years before you will qualify for Medicare. Individuals receiving disability benefits from the Railroad Retirement Board may also qualify after 24 months.

Individuals with End Stage Renal Disease will generally qualify for Medicare once they start receiving disability benefits from the Social Security Administration. They will not have to wait 24 months. This is also the case with individuals with Amyotrophic Lateral Sclerosis. This condition is also known ALS and Lou Gehrig’s disease.

If a Medicare beneficiary under age 65 chooses Original Medicare, their Medicare benefits will be the same as they are for older beneficiaries. Original Medicare consists of Medicare Part A and Medicare Part B.

Medicare Part A pays primarily for hospital services. Medicare Part B pays primarily for doctors services. These benefits will not equal the cost of most services. For this reason many will choose to purchase a Medicare Supplement insurance policy or switch to Medicare Part C.

Some of the Medicare Supplemental policies will not be available to those under the age of 65. Insurers are mandated to make some of their policies available to disabled beneficiaries, but these are often the policies with the poorest benefits. They are usually priced higher than other senior health insurance policies with similar benefits.

Younger Medicare Beneficiaries will qualify for most Medicare Advantage policies. Medicare Advantage is also known as Medicare Part C. These policies are offered by private insurers and often offer benefits similar to a combination of Original Medicare plus a supplemental policy.

For this reason, disabled Medicare beneficiaries should investigate Medicare Advantage policies. Agents who sell Medicare Supplement policies will often also sell Medicare Advantage policies as well.

Dental Coverage under Medicare

Filed under: Senior Health Insurance — Alston @ 8:53 pm September 20, 2011

Original Medicare specifically excludes coverage for routine dental care. However, there are cost-effective ways to get this important coverage.

One of the ways to get coverage for dental expenses is to choose Medicare Part C instead of Medicare Parts A and B. Part C is also known as Medicare Advantage.

Medicare Advantage policies sometimes, but not always, will cover dental care. There are both pros and cons to Medicare Advantage policies when compared to Original Medicare.

Should you choose to get your health insurance through Original Medicare, you can still get coverage for your teeth. You can supplement your coverage with a private dental insurance policy. Before purchasing one of these policies you should be sure that you understand the limits of the coverage.

Many dental policies limit what they will pay for in several ways. There may be waiting periods before certain services. There may be upper limits on the amount they will pay for your dental care during your lifetime and/or during a policy year.

Although you cannot get dental coverage under Original Medicare, there are other options. These options include Medicare Part C and private dental insurance plans.

Medigap Advantage Coverage Costs

Filed under: Senior Health Insurance — Alston @ 3:49 pm September 13, 2011

One curious thing about certain Medicare Advantage policies is that they do not require premiums. This, to say the least, is unusual.

You can get quotes from our website. Click here if you want to determine Medigap Advantage coverage costs for your area.

The answer to this mystery is that he insurance company does receive payment for insuring you on their health insurance plan, even though it is not from the insured. The payments for enrollment in a zero premium Medigap Advantage policies comes from the Federal Government.

The various Medicare Advantage plans require that you no longer receive reimbursement for healthcare services and benefits from Medicare Part A or Part B. This means that the Federal Government is no longer responsible for any medical expenses you might incur once you sign up for a plan through a MA company. The insurer will cover your covered health-related expenses. When you enroll in a Medicare Advantage policy, the insurer you chose will receive some of the money the government saves by no longer having to pay for your care.

Medicare Advantage policies are considered Medicare Part C. Unlike Part A (which primarily covers care received in hospitals) and Part B (which primarily covers services received in doctors’ offices), the benefits come from private insurance companies. Another difference is that the coverage can include prescription drug benefits.

(Prescription drug benefits can also be received from Medicare Part D. Medicare Part D benefits are also provided by insurance companies like Blue Cross Blue Shield and Aetna and not Medicare.)

With most of these types of policies, you will still need to pay a premium after enrollment; you will need to subsidize the money the insurance company receives from the Fed. However, with certain policies this is not the case.

These policies tend to have high deductibles. You pay more toward any hospital services and other benefits you might receive. They provide less in the way of benefits and therefore do not require that you subsidize the payments they receive from the Fed.

Medicare Premiums for 2011

Filed under: Senior Health Insurance — Tags: — Alston @ 5:52 pm April 30, 2011

Original Medicare is composed of Medicare Part A and Medicare Part B. Part A pays primarily for hospital expenses. Part B pays for other medical expenses. Neither pays for prescriptions received out of the hospital.

Medicare Part A Premiums for 2011

The premium for Medicare Part A is usually paid for by the time a person becomes eligible for Medicare. If you have worked 40 quarters or ten years, you have probably paid for Medicare Part A.

Some potential Medicare beneficiaries have met the citizenry and residency requirements but haven’t paid into the system for enough quarters to be eligible for premium-free coverage. These people can pay a monthly premium for Medicare Part A. The monthly premium for Medicare Part A is $450 for 2011.

Medicare Part A Late Enrollment Penalty

If you don’t sign up for Medicare Part A when you are first eligible, you may be subject to a 10% penalty should you decide to sign up in the future. You will pay this penalty for two years for every year you were eligible but did not sign up.

This penalty is likely to be waived if you were covered by a group health insurance policy during the period between when you first become eligible Medicare Part A and the time you sign up for Medicare Part A.

Medicare Part B Premiums for 2011

The premium for Medicare Part B is different for different beneficiaries. Medicare will cost 96.40 per month for most people who were beneficiaries in 2009. Those who became Medicare beneficiaries in 2010 are likely to pay $110.50. Those who start Medicare in 2011 can pay as low as $115.40 and as high as $369.10 each month. Those with higher incomes can pay more than those with lower incomes. (These figures assume that no penalty is in effect.)

Medicare Part B Late Enrollment Penalty

If you don’t sign up for Medicare Part B when you are first eligible, you may have to pay a penalty if you decide to sign up for Part B at a later date. You will pay an extra 10% for every 12 month period that you are eligible for Part B but do not sign up. This penalty is permanent unlike the Medicare Part A penalty.

This penalty is likely to be waived if you are covered by a group health insurance policy during the time period in questions. This is similar to the rules regarding the penalty for late enrollment in Medicare Part A.

Medicare Part C and Part D Premiums for 2011

These policies are purchased through private carriers. To get premium amounts for Medicare Part C, D or Medigap you can complete our questionnaire and have quotes sent to you.

Who is Responsible for Costs during the Medicare Donut Hole?

Filed under: Senior Health Insurance — Tags: — Alston @ 4:14 pm April 27, 2011

Medicare beneficiaries who are insured by a standard Part D prescription drug plan (PDP) and who have large prescription drug expenses will have to pay 100%* of their prescription drug expenses that exceed $2,840 until their expenses reach $6,440. This is called the donut hole.

(The figures in this post apply to those who have the standard Medicare prescription drug benefit plan. There are other variations.)

One can purchase a Part D plan as a standalone policy that can be purchased with or without a Medicare supplement plan. The benefits can also be a part of a Medicare Advantage policy that provides both medical and prescription benefits.

Medicare Prescription Drug Donut Hole
A person who is insured by a standard Part D Prescription Drug plan will pay (in 2011) the first $310 of their prescription expenses. This is the Part D deductible. If their expenses exceed the $310 deductible, they will be responsible for $25% of the expenses that exceed $310 until their expenses reach $2,840.
If their expenses for prescription drugs exceed $2,840 they will enter what is referred to as the “Donut Hole.” The insured is responsible for 100%* of prescription drug expenses in the donut hole.
The donut hole ends when costs exceed $6440.

*During 2011 enrollees in Medicare Part D will be given a 50% discount on brand name drugs and a 7% discount on generic drugs for prescriptions received while in the donut hole. This discount is paid for by the drug companies.

This discount does not affect how quickly one moves through the donut hole as only the undiscounted costs are considered True Out of Pocket (TrOOP) expenses.

The 2010 affordable care act affects both Medicare and Medicaid. The health care reform law includes a provision that will reduce the donut hole each year until it is eliminated in 2020.

When prescription costs exceed $6,440 the insured pays either a co-pay or 5% of the cost of the drug. The co-pay can be $2.50 or $6.30.

Medicare Part D Prescription Rebates

During 2010 Part D enrollees who were not eligible or Extra Help received a one-time rebate of $250 if they reached the donut hole. (Extra Help is a low income subsidy available to those who qualify for both Medicare and Medicaid.)

Medicare Budget Cut Proposal to Hurt Those 55 and Younger

Filed under: Senior Health Insurance — Tags: — Alston @ 6:12 am April 23, 2011

Apparently our politicians don’t know the difference between cost saving and cost shifting. I’m not averse to lower taxes, but when lower taxes results in lower essential benefits we aren’t left with much of a bargain.

Apparently if I’m like the average American I’m on track to put $150,000 into Medicare and could expect to receive $400,000 in benefits if no changes are made to Medicare. I can certainly understand that when you add to my personal deficit the deficit of a few hundred million other Americans you wind up with a large and ugly number.

Although I know that pointing fingers and looking at the past isn’t going to help… Why was this allowed to happen? Why weren’t the taxes set at a level where the tax revenues assigned to Medicare would cover not only the current expenses but the future ones as well? Did all these baby boomers just show up out of the blue in the last few years? Was there no one in Washington that had both a calendar and a calculator?

I’ve got to end the rhetorical questions there. Otherwise this would cease to be a G-rated blog.

The Republicans want to cut spending.  That OK with me, but this proposal is like me proudly announcing to my wife that I was going to save us $2,400 a year by not paying our $200-a-month light bill. If we assume that the most likely scenario doesn’t happen, (This scenario involves my wife didn’t kicking me in the head and making me pay the bill.) we are left with only a few possible choices. My wife pays the bill and then files for a divorce. We go without lights and then my wife files for a divorce.

If our Medicare benefits are cut dramatically the health care costs for seniors do not go away. Either we or they (and we are they) find other ways to pay for health care or our lights go out prematurely.

In another words, these… (Fill in the blank with your favorite curse word.) morons want to balance the budget by shortening my life expectancy.

What the Fred Flintstone are these people smoking?

Medicare Payment Schedule

Filed under: Senior Health Insurance — Tags: — Alston @ 1:49 pm February 27, 2011

Medicare pays doctors and other providers based on a predetermined schedule. The Medicare payment schedule determines what a physician or other provider receives for services. The schedule is based on both the service rendered and the zip code of the provider.

This schedule generally underpays medical providers. It often causes them to charge more to their patients who are not Medicare Beneficiaries to make up for the underpayment.

For this reason the Medicare system does not pay its way. Doctors, hospitals and other providers are bullied by the federal government in to accepting lower payment than they deserve. This of course, forces them to increases cost for others.

Although, I see no problem with non Medicare Beneficiaries subsidizing the cost of our older and less healthy citizens, I do have a problem with the lack of transparency. The fact that the Medicare payment schedule underpays providers and thereby raises my cost for health care is a hidden tax.

The way that Medicare is subsidized is not only a hidden tax, it is a regressive tax. A regressive tax is a tax that has more impact on the poor than the rich.

Many people who are sick or hurt are unable to work due to their illness or injury. These people obviously have lower average incomes than the population in general. They pay more to subsidize Medicare through their deductibles, copays and in some cases, a higher cost for health insurance than do many others.

The amounts that Medicare pays health care providers will continue to cause strain on an already nearly overwhelmed health care system. It is a significant factor that raises health insurance premiums for those who are NOT Medicare beneficiaries.

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