Answers To Your Questions About : Medicaid

For most seniors over 65 Medicare and provides their health insurance coverage. There are four individual parts of Medicare, they work independently of each other or in tandem depending on the type of treatment and options selected. Basic Medicare consists of the primary coverages provided in Part A and Part B.

Provides for facility based care, most commonly referred to as hospital care, however, there are other facilities also covered in Medicare Part A. The first level of care is Hospital care, Medicare provides up to 90 days of hospital coverage no matter how many times you need it. When you first enroll into Part A there are an additional 60 days of care beyond the original 90 days, however, these days once used are gone forever. These days can be used all at once if you have a hospital stay lasting 150 days, or can be divided out in multiple stays, 120 days in one stay and 120 days of care in another. Hospital stays have deductibles and co-pays associated with them as well as a three pint blood deductible. Part A for most recipients is available for no additional monthly premium; it is primarily funded by a Medicare payroll tax. There is also coverage for Skilled Nursing facility, up to a 100 day coverage per admittance; Home Health care; Hospice care and Psychiatric hospital coverage.

Physician based care or commonly referred to as medical care. This level of Medicare coverage is optional (kind of) since it requires a monthly premium. The premium is deducted for most from their social security check and is based on the recipient’s income. Besides the monthly premium there is a $183 annual deductible, once met coverage is split on an 80%/20% basis with Medicare. The recipient is responsible for 20% of the approved Medicare costs with no stop loss. Part B also has a three pint blood deductible for out patient services. If you already have health coverage through an employer or group plan, Part B may not be needed (optional), however, once you lose this coverage you have a time frame requirement to add Medicare Part B or face a penalty later on when you do enroll into Medicare Part B.

Provides for prescription drug coverage and was added to the Medicare program in 2006. Prescription drug coverage is divided into four phases. They consist of the deductible phase, cost sharing phase (split 75%/25%), the coverage gap phase (commonly referred to as the donut hole) and finally the catastrophic phase. Prescription drug coverage (Part D) is provided by independent insurance carriers for a monthly premium and is also considered optional coverage. However, if the recipient did not have drug coverage before enrolling into a Part D prescription drug plan there could be a penalty assessed.

Medicare Part C (Advantage Plan) combines in most cases all of your Medicare services Part A, Part B and Part D into one coverage plan which eliminates some of the out of pocket costs for the enrollees. All Medicare Advantage plans have a maximum out of pocket expense per year for their enrollees, regardless of their health conditions or illnesses. These plans are evaluated by CMS on an annual basis through a Star rating system, one through five, with five star being the highest rating. A five star rated plan can be enrolled into anytime throughout the year, otherwise you must have a qualifying event to enroll. Medicare Advantage plans also provide some services that Medicare does not cover; such as vision, dental or hearing. These additional benefits vary depending on which carrier is providing the coverage.

Medicare Supplement Insurance policies are sold by individual insurance companies to supplement Medicare coverage or fill-in the gaps (lapses) of coverages provided by Medicare. To be eligible for a supplement plan you must be enrolled into Medicare Parts A & B. These plans have guaranteed issues periods, where regardless of your health condition they must be issued to you. These periods are typically the first six month after enrolling into Medicare Part B, or if you were enrolled in Medicare Part B before age 65 due to a disability or illness upon turning 65 you will have another guaranteed issue period. You can purchase a supplement plan any time after turning age 65, however, unless during a guaranteed issue period you will have to go through medical underwriting. Premiums for these plans are based primarily on age and rate band (zip codes). There are 14 different Medicare Supplement Plans available. Plan F and Plan G are the most purchased plans today.