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The ABC&D’s of Medicare. What is Medicare?. Medicare is health insurance for: People 65 or older People under 65 with certain disabilities People of any age with End-Stage Renal Disease (ESRD) permanent kidney failure requiring dialysis or a kidney transplant.
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What is Medicare? Medicare is health insurance for: • People 65 or older • People under 65 with certain disabilities • People of any age with End-Stage Renal Disease (ESRD) • permanent kidney failure requiring dialysis or a kidney transplant
What Are The Different Parts of Medicare? • Part A – Hospital Insurance • Part B – Medical Insurance • Part C – Medicare Advantage • Part D –Medicare Prescription Drug Coverage
What Does Medicare Cover? Medicare Part A – Hospital Insurance helps cover: • Inpatient care in hospitals • Skilled nursing facility care • Hospice care • Home healthcare Medicare Part B – Medical Insurance helps cover: • Services from doctors and other health care providers • Outpatient care • Home health care • Durable medical equipment • Some preventive services
What Does Medicare Cover? Medicare Part C – Medicare Advantage helps cover: • Run by Medicare-approved private insurance companies • Includes all benefits and services covered under Part A and Part B • Usually includes Medicare prescription drug coverage (Part D) as part of the plan • May include extra benefits and services for an extra cost
What Does Medicare Cover? Medicare Part D – Medicare Prescription drug coverage helps cover: • Run by Medicare-approved private insurance companies • Helps cover the costs of prescription drugs • May help lower your prescription drug costs and help protect against higher costs in the future
Medicare Advantage Plans Part C • The most common plan types are: • Health Maintenance Organizations (HMO) • Preferred Provider Organizations (PPO) • Private Fee-For-Service (PFFS) • Medicare Advantage plans were designed to provide an alternative to traditional Medicare. • These plans must offer at least the same benefits as Original Medicare, but can have different rules, costs and coverage restrictions. • Enrollees in Medicare Advantage plans continue to pay their Part B of Medicare. • Medicare subsidizes these companies to help pay for the cost of care.
Medicare Supplement Enrollment Period Guaranteed Issue • 6 months before and 6 months after your 65th birthday • Terminated from a group plan Underwritten • After age 65 ½ • Changing plans or carriers • No previous coverage
Medicare Supplemental Insurance or Medigap • Deductibles and co-insurance are referred to as “gaps”. • Medicare supplemental insurance is designed to fill in the “gaps”. • There are 10 different federally regulated supplemental plans to choose from; A-D and F,G,K,L,M,N. • No matter what insurance company you select for your Supplemental Insurance, the plans are all the same.
The chart below shows basic information about different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit. Medicare Benefits Covered Out-of-pocket limit in 2012 for K : $4,660, L: $2,330
When Can I Join, Switch, or Drop A Medicare Drug Plan? When you're first eligible for Medicare: • You can join during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you get Medicare due to disability: • You can join during the 7-month period that begins 3 months before your 25th month of disability benefits and ends 3 months after your 25th month of disability. • You'll have another chance to join during the 7-month period that begins 3 months before the month you turn 65 and ends 3 months after the month you turn 65. Between October 15 - December 7, anyone can join, switch, or drop a Medicare drug plan. • The change will take effect on January 1st as long as the plan gets your request by December 7th. Anytime, if you qualify for Extra Help.
Special Enrollment Periods • Generally, you must stay enrolled for the calendar year. • However, in certain situations like the following, you may be able to join, switch or drop Medicare drug plan's at other times. On the 61st day a new benefit period begins. • If you move out of your plan's service area • If you lose other creditable prescription drug coverage • If you live in an institution (like a nursing home)
5-Star Special Enrollment Period • You can switch to a Medicare Prescription Drug Plan that has 5 stars for its overall plan rating from December 8, 2012 through November 30, 2013. • The overall plan ratings are available at ww.medicare.gov/find-a-plan. These ratings are updated each fall and can change each year. See page 77 for more information. • Days 61 through 90, a co-payment of $283 per day will be billed. • You can only switch to a 5-star Medicare Prescription Drug Plan if one is available in your area. • You can only use this Special Enrollment period once during the above timeframe.
Important Medicare Dates • Annual open enrollment for Medicare Advantage and Part D plans is from October 15th through December 7th. The Plans take effect on January 1, 2013. • You can also disenroll from Medicare Advantage plans between January 1, 2013 and February 14, 2013 and switch to Original Medicare. Any changes take effect the first day of the following month.
