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Medicare Program

Monday, Mar 25 2013

What is Medicare?

Medicare is a federal health insurance program created in 1965 to help pay medical costs incurred by people over the age of 65, people with certain disabilities, and people with end-stage renal disease. Under the original Medicare plan (sometimes called fee-for-service), coverage consisted of two parts:

Wednesday, Oct 30 2013
  • Monthly premium: If you buy Part A, you'll pay up to $441 each month in 2013 ($426 in 2014).  Most people get premium-free Part A.
  • Late enrollment penalty: If you don't buy it when you're first eligible, your monthly premium may go up 10%. (You'll have to pay the higher premium for twice the number of years you could have had Part A, but didn't sign up.) Learn more about the Part A late enrollment penalty.

Part A costs if you have Original Medicare

  • Home health care
    • $0 for home health care services.
    • 20% of the Medicare-approved amount for durable medical equipment.

  • Hospice care
    • $0 for hospice care.
    • You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control.
    • You may need to pay 5% of the Medicare-approved amount for inpatient respite care. 
    • Medicare doesn't cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).

  • Hospital inpatient stay
    • $1,184 deductible for each benefit period in 2013. ($1,216 in 2014)
    • Days 1–60: $0 coinsurance for each benefit period in 2013. ($1,216 in 2014)
    • Days 61–90: $296 coinsurance per day of each benefit period in 2013. ($304 in 2014)
    • Days 91 and beyond: $592 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime) in 2013. ($608 in 2014)
    • Beyond lifetime reserve days: all costs.
  • Mental health inpatient stay
    • Days 1–60: $1,184 deductible for each benefit period in 2013. ($1,216 in 2014)
    • Days 61–90: $296 coinsurance per day of each benefit period in 2013. ($304 in 2014)
    • Days 91 and beyond: $592 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime) in 2013. ($608 in 2014)
    • Beyond lifetime reserve days: all costs.
    • 20% of the Medicare-approved amount for mental health services you get from doctors and other providers while you're a hospital inpatient.
  • Skilled nursing facility stay
    • Days 1–20: $0 for each benefit period in 2013 and 2014.
    • Days 21–100: $148 coinsurance per day of each benefit period in 2013. ($152.00 in 2014)
    • Days 101 and beyond: all costs.

    - Information provided by the Centers for Medicare & Medicaid Services -

Monday, Mar 25 2013

What is it?

Medicare Part A is the portion of Medicare that is available premium free to all eligible individuals. Medicare Part A provides services associated with hospital, hospice, skilled nursing care, and home health care.

Monday, Mar 25 2013

What is it?

Medicare Part B is the medical insurance portion of Medicare, which covers physician services, outpatient hospital care, and many other services typically covered under health insurance plans. Part B is financed through monthly premiums paid by enrollees and by contributions from the federal government.

Monday, Mar 25 2013

What is Medicare Part C (Medicare Advantage)?

The Medicare program, which is a federal program that helps senior citizens and certain other individuals pay for health care, is divided into parts; Part A, Part B, Part C, and Part D. Part C is an alternative to Parts A and B.

Monday, Mar 25 2013

What is Medicare Part D prescription drug coverage?

The Medicare program, which is a federal program that helps senior citizens and certain other individuals pay for health care, is divided into four parts. Part A covers hospital and inpatient services and Part B covers doctor visits and other outpatient services.

Monday, Mar 25 2013

What is Medigap?

Because original Medicare coverage has limitations, many people purchase supplemental insurance policies that are specifically designed to cover some of the gaps. These supplemental insurance policies, called "Medigap" policies, are sold by private health insurance companies, not the federal government.

Monday, Mar 25 2013

What is it?

Under certain conditions, disabled individuals are eligible to enroll in Medicare, the federal health insurance program that currently consists of premium-free hospital insurance (Part A) protection, premium-paid medical insurance (Part B) protection, Part C, which allows private companies to offer Medicare benefits as well as benefits not offered by Medicare, and Part D, which covers the costs of prescription drugs.

Monday, Mar 25 2013

What is a Qualified Medicare Beneficiary (QMB) program?

If you are entitled to Medicare Part A coverage, are elderly or disabled, and have limited income, you may be eligible for the QMB program. If you are eligible, your state's Medicaid program may pay for your Medicare Part B premium, Part A and Part B deductibles, and coinsurance requirements.

Wednesday, Sep 25 2013

What is the Medicare open enrollment period?

The Medicare open enrollment period is the time during which people with Medicare can make new choices and pick plans that work best for them. Each year Medicare plans typically change what they cost and cover. In addition, your health-care needs may have changed over the past year. The open enrollment period is your opportunity to switch Medicare health and prescription drug plans to better suit your needs.


When does the open enrollment period start?

The Medicare open enrollment period begins on October 15 and runs through December 7. Any changes made during open enrollment are effective as of January 1, 2014.

During the open enrollment period you can:

  • Join a Medicare Prescription Drug Plan
  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan
  • Drop your Medicare prescription drug coverage altogether
  • Switch from Original Medicare to a Medicare Advantage Plan
  • Switch from a Medicare Advantage Plan to Original Medicare
  • Change from one Medicare Advantage Plan to a different Medicare Advantage Plan
  • Change from a Medicare Advantage Plan that offers prescription drug coverage to a Medicare Advantage Plan that doesn't offer prescription drug coverage
  • Switch from a Medicare Advantage Plan that doesn't offer prescription drug coverage to a Medicare Advantage Plan that does offer prescription drug coverage


What should you do?

Now is a good time to review your current Medicare plan. There are some factors you may want to consider as part of that evaluation. For instance, are you satisfied with the coverage and level of care you're getting with your current plan? Are your premium costs or out-of-pocket expenses too high?

Has your health changed, or do you anticipate needing medical care or treatment? Now is the time to determine if your current plan will cover your treatment and what your potential out-of-pocket costs may be. If your current plan doesn't meet your health-care needs or fit within your budget, you can switch to a plan that may work better for you.


What's new in 2014?

Most Medicare Prescription Drug Plans have a temporary limit on what a particular plan will cover for prescription drugs. In 2014, this gap in coverage (also called the "donut hole") begins after you and your drug plan have spent $2,850. It ends after you have spent $4,550 out-of-pocket, after which catastrophic coverage begins. However, part of the Affordable Care Act (ACA) gradually closes this gap by reducing your out-of-pocket costs for prescriptions purchased within the coverage gap. In 2014, you'll pay 47.5% of the cost for brand-name drugs in the coverage gap and 72% of the cost for generic drugs in the coverage gap. Each succeeding year, out-of-pocket prescription drug costs within the coverage gap continue to decrease until 2020, when you'll pay 25% for covered brand-name and generic drugs within the gap.


Health Exchanges (Marketplaces)

Health Exchanges, or Marketplaces, which are part of the ACA, are available for people to shop for health insurance coverage. The Exchanges are scheduled to open October 1, 2013. The ACA also includes an insurance mandate, which requires most individuals to have health insurance or face a penalty. However, if you have Medicare, neither provision applies to you. As a Medicare recipient, you won't face penalties for being uninsured. Also, Exchanges do not provide information on Medicare plans, and you can't purchase Medicare coverage through an Exchange.


Where can you get more information?

Determining what coverage you have now and comparing it to other Medicare plans can be confusing and complicated. Pay attention to notices you receive from Medicare and from your plan, and take advantage of help available by calling 1-800-MEDICARE or by visiting the Medicare website, www.medicare.gov. Your financial professional can also help you find the information you need to make decisions about Medicare.

 

Copyright 2006-2013 Broadridge Investor Communication Solutions, Inc. All rights reserved.

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