MEDICARE FAQ's

Has Health Care Reform Changed Medicare?

Medicare is here for you.  The Patient Protection and Affordable Care Act - better known as Health Care Reform - was passed in March 2010.  This landmark legislation will affect the way some people get health care insurance.  Some of the provisions from Health Care Reform apply to Medicare.

How does Medicare work?

There are four parts to Medicare. They are Part A, Part B, Part C and Part D.  Each serves a different purpose and some of them combine to give you more complete coverage.

Part A - Most people get Part A coverage automatically from the federal government when they turn 65, if they have worked 40 quarters paying into Medicare. Part A covers medically necessary care requiring an overnight hospital stay.  It also covers follow-up nursing care after a hospital stay, hospice care and some home health care for the home-bound.

Part B - Also provided by the federal government, Medical Insurance - or Part B - is optional and combines with Part A.  If you choose to enroll in Part B, which most people do, you will get coverage for some services that don't require a hospital stay.  Part B covers medically necessary services such as doctor's office visits, hospital and clinic care that doesn't include an overnight stay, lab tests and some health screenings.  You cannot be denied Part B coverage, but to receive it, you must enroll and pay the monthly premium. Generally, most people have their Part B premium deducted from their Social Security check.

Part C - Medicare Advantage plans include Preferred Provider Organizations (PPO's) and Health Maintenance Organizations (HMO's). Medicare Advantage plans are offered by private companies that have been approved by Medicare.  These plans provide you with all you Part A and Part B coverage, as well as Part D prescription drug coverage and other benefits Original Medicare doesn't cover.

Part D - Original Medicare Parts A and B do not cover your prescription drugs. If you want coverage for prescription drugs through Medicare, you'll need to enroll in a Part D Prescription Drug Plan.  You can enroll in a Part D Prescription Drug plan from a private insurance company to get prescription drug coverage along with Part A and/or Part B coverage through Medicare Advantage Plans, which generally include Part D Prescription Drug coverage built in. When choosing a prescription drug plan, you'll want to pay special attention to the list of medications it covers, called a formulary. I will cover this with you during your NO COST consultation.

Will Medicare cover all of my health care expenses?

Original Medicare covers some - but not all - health care expenses. For example; Original Medicare does not pay for long-time personal care services at home or in a nursing home. Original Medicare also does not cover prescription drugs, routine eye exams, eyeglasses, hearing aids, routine dental care or non-emergency care provided outside of the United States. Under Original Medicare, you are also responsible for deductibles and share some of the cost (coinsurance) and this could result in thousands of dollars. I will explain this in much greater detail during your "No Cost, No Obligation Consultation".

Private insurance companies offer Medicare Supplement ("Medigap") plans, which fill some of the gaps in the benefits covered by Original Medicare. Private insurance companies also offer Medicare Advantage HMO and PPO plans. Medicare Advantage plans not only cover costs Medicare does not, but they also have more benefits than Part A and B and a Medicare Supplement Plan combined. As a licensed and certified insurance broker for Medigap, HMO and PPO plans, I will guide you through the available choices.

Will you explain Supplemental Coverage (Medigap) for Original Medicare?

Under Original Medicare, you're generally responsible for 20% of all costs.  With the rising costs of health care, use of sophisticated tests and expensive surgery, 20% of a three-day hospital stay can be thousands of dollars in out-of-pocket costs. Private insurance companies offer Medigap plans to help you with these expenses.

There are several plan options to choose from, each with a different combination of benefits and different levels of coverage.  The plans have standardized benefits that follow federal and state laws.  That means all of the plans that private insurance companies offer have the same features and out-of-pocket costs.  The differences can usually be seen in a monthly premiums and value-added benefits and services.  That makes them easy to compare.

There are 11 different Medigap plans.  Each plan is named with a letter (A-N).  Different insurance companies offer different plans - many don't offer all 11. So, although the benefits in any Medigap plan are the same regardless of insurance company, the policies differ. Generally, when you buy a Medigap policy, you must have original Medicare and pay the monthly Medicare Part B premium.  In addition, you will have to pay a monthly Medigap premium.  Remember, Medigap plans don't include Part D Prescription Drug coverage.  If you choose a Medigap plan, you'll need a stand-alone Part D plan as well.