Posts Tagged ‘Medicare’

Important Links

Wednesday, May 26th, 2010


Medicare & You

yourmedicarebenefits An Explanation of Part A and Part B Benefits

Important Contacts


With your questions about:

24 hours a day
TTY users should call

  • Medicare (in general)
  • Medicare health plans
  • Ordering Medicare booklets
  • Medigap policies
  • Assistance Programs for Medicare Part B (limited income – ask about the Medicare Savings Programs)
  • Telephone numbers for local organizations who work with medicare, including TTY numbers

Social Security Administration
TTY users should call

  • Address/name changes
  • Death notification
  • Enrolling in Medicare
  • Medicare card (replacement)
  • Social Security benefits
  • Limited Income – you may be eligible for help paying for Prescription Drug Coverage under Medicare Part D

Medigap Policies

Wednesday, May 26th, 2010

365.118 - family recognitionA Medigap policy is a health insurance policy sold by private insurance companies to fill “gaps” in Original Medicare Plan coverage. Medigap policies must follow federal and state laws. These laws protect you. The front of the Medigap policy must clearly identify it as “Medicare Supplement Insurance.”

In all states, except Massachusetts, Minnesota, and Wisconsin, a Medigap policy must be one of twelve standardized policies so you can compare them easily. Each policy has a different set of benefits. Two of the standardized policies may have a high deductible option. In addition, any standardized policy may be sold as a “Medicare SELECT” policy. Medicare SELECT policies usually cost less because you must use specific hospitals and, in some cases, specific doctors to get full insurance benefits from the policy. In an emergency, you may use any doctor or hospital.

Click image to view guide to Medigap Policies

Outline of Medicare Supplement Coverage

(Benefit Plans A-L)

Medicare Supplement Insurance can be sold in only twelve standard plans. This chart shows the benefits included in each plan. Every company must make available Plan “A”. Some plans may not be available in your state as indicated below.

A B C D E F* G H I J* K L
Medicare Part A Coinsurance & Medigap Coverage for Hospital Benefits
Medicare Part B Coinsurance or Copayment 50%* 75%*
Blood (First 3 pints) 50%* 75%*
Hospice Care Coinsurance or Copayment 50%* 75%*
Medicare Part A Deductible 50%* 75%*
Skilled Nursing Facility Care Coinsurance 50%* 75%*
Medicare Part B Deductible
Medicare Part B Excess Charges 80%
Foreign Travel Emergency (Up to Plan Limits)
At Home Recovery (Up to Plan Limits)
Preventive Care Coinsurance (Included in the Part B Coinsurance)
Preventive Care not Covered by Medicare (up to $120)
**Out-of-Pocket Limit $4,620** $2,310**

Plans A-L are standardized by the federal government. Not all plans may be available in your area. Consider the benefits offered by each plan and look for one that best meets your individual needs.

*Medigap Plans F and J also offer a high-deductible plan. You must pay the high-deductible ($2,000 in 2010) amount before your Medigap-covered costs before pays anything..

**After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($155 in 2010), the plan pays 100% of covered services for the rest of the calendar year. Out-of-pocket limit is the maximum amount you would pay for coinsurance and copayments

Medicare Part D

Wednesday, May 26th, 2010

Medicare started offering insurance coverage for prescription drugs through Medicare prescriptions drug plans and other health plan options. Medicare’s prescription drug coverage will typically pay over half of your drug costs, for a monthly premium. It will also provide peace of mind because it protects you once you have spent your plan’s out-of-pocket drug spending limit, you pay 5% of the costs and Medicare pays 95% of the costs for the rest of the year. Even if you don’t use a lot of prescription drugs now, you should consider joining.

Important points you need to know:

  • Medicare prescription drug coverage helps you pay for the prescriptions you need.
  • Medicare prescription drug coverage is available to all people with Medicare.
  • There is additional help for those who need it most.
  • Medicare prescription drug coverage pays for brand name as well as generic drugs.

Your Medicare Prescription Drug CoveragePrescribed

Basic Information

What is Medicare prescription drug coverage?

Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future.

Who can get Medicare prescription drug coverage?

Everyone with Medicare is eligible for this coverage, regardless of income and resources,health status, or current prescription expenses.

When can I get Medicare prescription drug coverage?

You may sign up when you first become eligible for Medicare (three months before the month you turn age 65 until three months after you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. If you don’t sign up when you are first eligible, you may pay a penalty. If you didn’t join when you were first eligible, your next opportunity to enroll will be from November 15 to December 31.

How does Medicare prescription drug coverage work?

Your decision about Medicare prescription drug coverage depends on the kind of health care coverage you have now. There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage.

Whatever plan you choose, Medicare drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you.

Like other insurance, if you join, generally you will pay a monthly premium, which varies by plan, and a yearly deductible. You will also pay a part of the cost of your prescription, including a copayment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible. You can apply or get more information about the extra help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visiting

Why should I get Medicare prescription drug coverage?

Medicare prescription drug coverage provides greater peace of mind by protecting you from unexpected drug expenses. Even if you don’t use a lot of prescription drugs now, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means protection from unexpected prescription drug bills in the future.

What if I have a limited income and resources?

There is extra help for people with limited income and resources. Almost 1 in 3 people with Medicare will qualify for extra help. If you qualify for extra help, Medicare will pay for almost all of your prescription drug costs. You can apply or get more information about the extra help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visiting

Things to Consider



There is a monthly cost you pay to join a Medicare drug plan. Premiums vary by plan.


This is the amount you pay for your prescriptions before your plan starts to share in the costs. Deductibles vary by plans. Some plans may not have any deductible.


This is the amount you pay for your prescriptions after you have paid the deductible. In some plans, you pay the same copayment (a set amount) or coinsurance (a percentage of the cost) for any prescription. In other plans, there might be different levels or “tiers,” with different costs. (For example, you might have to pay less for generic drugs than brand names. Or, some brand names might have a lower copayment than other brand names.) Also, in some plans your share of the cost can increase when your prescription drug costs reach a certain limit.



A list of drugs that a Medicare drug plan covers is called a formulary. Formularies include generic drugs and brand-name drugs. Most prescription drugs used by people with Medicare will be on a plan’s formulary. The formulary must include at least two drugs in categories and classes of most commonly prescribed drugs to people with Medicare. This makes sure that people with different medical conditions can get the treatment they need.

Prior Authorization

Some drugs are more expensive than others even though some less expensive drugs work just as well. Other drugs may have more side effects, or have restrictions ono how long they can be taken. To be sure certain drugs are used correctly and only when truly necessary, plans may require a “prior authorization.” This means before the plan will cover these prescriptions, your doctor must first contact the plan and show there is a medically-necessary reason why you must use that particular drug for it to be covered. Plans might have other rules like this to ensure that your drug use is effective.

Coverage Gap

If you have high drug costs, you may consider which plans offer additional coverage until you spend $4,050 (in 2008) out-of-pocket. In some plans, if your costs reach an initial coverage limit, then you pay 100% of your prescription costs. This is called the coverage gap. Some plans might offer some coverage during the gap. Even in plans where you pay 100% of covered drug costs after a certain limit, you would still pay less for your prescriptions than you would without this drug coverage.


Drug plans must contract with pharmacies in your area. Check with the plan to make sure your pharmacy or a pharmacy in the plan is convenient to you. Also, some plans may offer a mail-order program that will allow you to have drugs send directly to your home. You should consider all of your options in determining what is the most cost-effective and convenient way to have your prescriptions filled.

Peace of mind now and in the future

Even if you don’t take a lot of prescription drugs now, you still should consider joining a drug plan. As we age, most people need prescription drugs to stay healthy. For most people, joining now means you will pay a lower monthly premium in the future since you may have to pay a penalty if you choose to join later. You will have to pay this penalty as long as you have a Medicare drug plan. If you reach the point where you have spent your plan’s out-of-pocket drug costs during the year, the plan will pay most of your remaining drug costs. This protection could start even sooner in some plans.

Medicare Healthcare Plans Quote

Wednesday, May 26th, 2010

Complete the following information if you would like to obtain a quote. Please understand this is not an application. An application will be sent to you if coverage is desired.

All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.

Part I – Applicant Information

Social Security Number
Birth Date
Medicare #
Have you used tobacco within the last 12 months?
Spouse Information
Social Security Number
Birth Date
Medicare #
Have you used tobacco within the last 12 months?
Applicant Address
Street Address
Zip Code
Phone Number
Alternate Telephone
Email Address
Part II - Medical & General questions - Please give details to "yes". Include insured or spouse name.
A. Do you have a (or pending applications for) Medicare Supplement policy or certificate in force?
If yes, please describe
2. If so, do you intend to replace your current Medicare Supplement policy with this policy?
If yes, please describe
B. Do you have any other health insurance coverage that provides Medicare benefits?
If so, with which company?
What kind of policy?
C. Are you covered for medical assistance through the state Medicaid program:
1. As a Specified Low-Income Medicare Beneficiary (SLMB)
2. As a Qualified Medicare Beneficiary (QMB)
3. For other Medicaid medical benefits?
D. Are you covered or will you be covered under:
Medicare Part A (Hospitalization)
Effective Date Insured:
Effective Date Spouse:
Medicare Part B (Medical Expenses)
Effective Date Insured:
Effective Date Spouse:
Health Questions (Answer for all Insured)
Within the past two (2) years have you had, or had a medical diagnosis of:
a. Cirrhosis; Hemophilia; Multiple Sclerosis; Leukemia; Amputations due to Diabetes?
b. Renal Dialysis; Kidney Dialysis; X-Ray Therapy; Radium or Chemotherapy; Degenerative (Crippling) Arthritis; Internal Cancer; Stroke?
c. Emphysema (under treatment); Hodgkins Disease; Disease or Disorder of Lungs or Respiratory Syustem which requires the outside assistance of a Mechanical Breathing Device?
d. Heart attack; angina; transient ischemic attack (TIA); heart failure; heart surgery; angioplasty or coronary by-pass surgery?
e. Parkinson's disease; Alzheimer's disease; senile dementia; organic brain disease or other senility disorders?
2. Are you an insulin dependent diabetic taking more than 50 units per day?
3. Have you been confined to a nursing home or a wheelchair within the past two years or has such care been medically advised?
4. Are you currently hospitalized, or receiving Medicare approved home health care; or have you been hospitalized or received Medicare approved home health care three or more times in the past two years?
5. Within the past year have you been medically advised to have surgery but not had such surgery?

Medicare Part A (2010)

Friday, May 21st, 2010

Part A is Hospital Insurance and covers cost associated with confinement in a hospital or skilled nursing facility.

When you are hospitalized for: Medicare Covers You Pay
1-60 Days Most confinement costs after the required Medicare Deductible $1,100 Part A Deductible
61-90 Days All eligible expenses, after the patient pays a per-day copayment. $275/Day
91-150 Days All eligible expenses, after patient pays per-day copayment.

(These Are Liftetime Reserve Days Which may never be used again.)

151 days or more Nothing You Pay All Cost
Skilled Nursing
When you are hospitalized for at least 3 days and enter a Medicare Approved skilled nursing facility within 30 days after a hospital discharge and are receiving skilled nursing care.
All eligible expenses for the first 20 days; then all eligible expenses, (if you qualify), for days 21-100, after patient pays a per day copayment. After 20 days



Friday, May 21st, 2010

Medicare Terms Defined

For Complete Glossary click here

Lifetime Reserve Days

are limited to 60 days during your life. After these reserve days are used, Medicare provides no hospital coverage after 90 days of a benefit period.

Medicare Eligible Expenses

are expenses which are recognized as reasonable and medically necessary by Medicare. Physicians under Medicare may accept Medicare’s Eligible Expense as their fee amount. Your physician may also charge you more.

Skilled Nursing Facility

provides skilled nursing care and is approved for payment by Medicare or may qualify to receive such approval. Custodial care is not an eligible expense.

Excess Charges

is the difference between the actual charge as billed, and the Medicare approved Part B charge.

Medicare (Part A)

Hospital Services for semiprivate room and board, general nursing and miscellaneous services and supplies. Benefit period applies.

Medicare (Part B)

Medical services in or out of the hospital and outpatient hospital treatment, such as physician services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, and durable medical equipment.

Benefit Period

defines the limit of a stay at a hospital or nursing facility and what benefits you receive for that stay.

Special Notes:

The sale of duplicate Medicare Supplement coverage is prohibited.
Your coverage can never be canceled because of your age, your health, or the number of claims you make as long as you make payments when due.
Consult your local insurance professional for specific information.