PARTS of Medicare vs. Medigap PLANS – Understanding the Difference

One of the most confusing (to most people) things about turning-65 is understanding the terminology. More specifically, there are “parts” (of Medicare) and “plans” (Medigap). Many people get these confused and it can lead to making decisions that are not to your advantage.

Parts of Medicare

There are four parts of Medicare. Medicare Part A is the part that covers hospital and inpatient services. You get this automatically from paying into the Medicare system during your working life. Medicare Part B is the part of Medicare that covers doctor’s office and outpatient services (like labwork, etc.). You must sign up for Part B in order to have this part of Medicare. There is a $110.50/month premium for this that is generally paid through a Social Security deduction.

Medicare Part C is an optional part of Medicare that is also known as Medicare Advantage. If you wish to stay with “original” Medicare (Medicare Parts A & B), you do NOT need to sign up for Part C. In fact, if you sign up for ‘C’, all of your coverage is provided through the private Part C company and Parts A & B no longer provide your benefits.

Medicare Part D is the prescription drugs part of Medicare. This part of Medicare is also optional and provided through private companies. In order to have prescription drug coverage, you must sign up for Part D. You can do this by calling 1-800-MEDICARE or through an independent agent.

Plans – Medigap

Medigap plans are also named by letters, which is the source of most people’s confusion. The plans are standardized and each company is required to offer the plans from the standardized plans chart. This chart goes from “A” to “N”. You should select a plan that meets your needs from a reputable company with low rates. You can view the full chart here that shows what the standardized plans cover: Standardized Plans Chart

If you have any specific questions, or if we can help in any way, please do not hesitate to reply to this email or contact us toll-free at 877.506.3378. Medicare-Supplement-Comparison.com is a leading, independent Medicare Insurance agency. Because we are an independent agency, we work as a centralized place to compare all plan options, ask questions, and make unbiased decisions.

2011 Part D Information – Breaking News About Premiums, Donut Hole Coverage

The Centers for Medicare and Medicaid Services released today the projected average premium for the Part D plans in 2011. Projected numbers for 2011 show that the monthly premiums will increase by approximately $1, from $29 in 2010 to $30 in 2011. This is good news for Medicare Part D policyholders who feared large increases in the Part D premiums next year.

With some of the changes caused by PPACA (i.e. “health insurance reform”), some Medicare enrollees, as well as some in the insurance industry expected the Part D premiums to increase a good bit for next year. So, this news is welcome.

The PPACA, which was signed into law in March, changed some of the benefit structure for Part D. The changes that beneficiaries will see from this include a 50% reduction in brand-name co-pays when they are in the “donut hole” and a 7% reduction in generic co-pays when they are in the “donut hole”. This will greatly help anyone who reaches the “donut hole” to save on their medications while they are in that coverage gap.

To get more information about Medicare Part D or these changes, visit Medicare Supplement Quote. You can also request information on Medicare Supplement plans (Medigap) and/or Medicare Advantage.

Does Medicare Cover Preventive Care?

Here is a bullet-point list of some of the preventive care that Medicare covers (most people think Medicare doesn’t cover preventive care at all – not true):

– “Welcome to Medicare” physical (within 1st 6 mos.)

– Cardiovascular screening (once every 5 years)

– Mammograms (once a year)

– Cervical screening (once every 2 years)

– Prostate screening (once every year)

– Colorectal screening (varies depending on type and history)

– Glaucoma tests (once every year)

– Shots (varies)

– Bone density tests (once every 2 years)
and more!

See Medicare’s booklet on the topic here: www.medicare.gov/
Publications/Pubs/pdf/10110.pdf

Medicare and Medicare Supplement Insurance in 2011 – What We Know & What We Don’t Know

It’s hard to think of Jan. 1 when it’s 95+ degrees outside, like it has been in most parts of the country the last month. However, it is August and 2011 will be here before you know it. I anticipate there to be several changes with Medicare and Medicare insurance in 2011. Some of which were in place before the health insurance reform act, some of which are offshoots of the act itself. Here’s a brief look at what we do know and what we don’t know so far:

What We Do Know

  • Medigap coverage is not changing on 1/1/11. Your coverage will never change, unless you willingly change it. The plans are standardized and the same from company to company.
  • Medicare Advantage plans will be required, in 2011 and on, to have a network in place. In other words, PFFS plans, which is what most of the plans have been in the past, will be extinct. Those companies that do PFFS plans will offer the same plans through a network (PPO or HMO-type plan) OR they will cease offering those plans altogether.
  • Several major Medicare Advantage companies will not be participating any longer in the program (i.e. CIGNA) and others will operate in far fewer counties. People in plans that are not renewing have a special enrollment period that starts October 1. They can choose a Medicare Advantage or Medigap plan without having to qualify medically or worry about pre-existing conditions.
  • As a side result of these non-renewing plans, there will be thousands upon thousands of Medicare-eligible individuals having to find new coverage at one time. I expect this to cause an influx of people onto the more stable Medigap plans, which will in turn cause slow turnaround times for Medicare and the companies themselves. In short, if you are one of these people who is losing a plan or are re-evaluating your drug coverage, getting started in October is highly advisable.
  • Medicare Part D is projected to have a smaller, yet to be determined, ‘donut hole’. Over the next 10 years, this ‘donut hole’ is supposed to be closed completely.

What We Don’t Know

  • We don’t know what the fate will be of all the Medicare Advantage companies yet. They are still in the process of filing plans, getting them approved, etc.
  • We don’t know what Part D plans will cover/not cover for next year. Their plans typically aren’t released until mid-October for the Nov. 15 start date.

Sometimes, new Medigap companies/rates come out around the first of the year; however, the information hasn’t been released yet. We will certainly keep you posted on it, as it is released, however, if/when new plans come out.

Medicare Part D – Annual Enrollment Period is Nearing

The annual enrollment period for Part D runs November 15-December 31. For 2011, that enrollment period is going to change; however, it will stay the same for one more year (2010).

This is the time of year to compare all of the new Part D plans to your current plan to see if there is any savings to be had on a Part D plan. You can do this on the Medicare.gov website, which was recently revised in an effort to be more “senior-friendly” (see for yourselves and let us know what you think?!?!). Or, you can get quotes for the available Part D plans through an agent or broker, particularly an independent agent so you can compare all of the options in a centralized place.

If you have a Medigap (or Medicare Supplement) plan, this is also a good time to re-evaluate it, based on price. The plans are standardized, so price is the primary comparison point. You need to make sure you have the best price possible on your selected plan, so that you can avoid paying more than you should.

Part D plans are NOT standardized. On the contrary, they change each and every year, with new formularies, deductibles and premiums. This makes it more important than ever to re-evaluate each year.

Medicare-Supplement-Comparison.com is a one-stop “shop” for comparing all of your Medicare insurance. You can re-evaluate your coverage, and in 85% of cases, save a good bit of money per month for the same exact plan. Insurance is an  increasingly changing field, and if you don’t change with it, you are at the mercy of what an insurance company wants to charge you. To get Part D information/quotes (starting in October) or Medicare Supplement quotes, visit us at www.medicare-supplement-comparison.com.

What Does Medicare Cost – the Parts of Medicare and Their Cost

Medicare is the Federal program that provides insurance coverage to those over age 65 and/or deemed disabled by the government’s guidelines. Many people are completely uncertain as to how it works and what its costs are for them. Common misconceptions are:

  1. That it is completely free (an unfettered handout)
  2. That it is the same as Medicaid OR that Medicaid is for “older people” and Medicare is for low-income people.
  3. That Medicare, in and of itself, is complete coverage

These misconceptions cause much confusion with Medicare, and this article is going to look, specifically, at one oft-mistaken aspect of Medicare – what it costs.

First of all, there are two parts of “original” Medicare – Part A and Part B. During an individual’s working life, they pay into the Social Security/Medicare system through payroll deductions (in most cases). This entitles you to Medicare Part A at the time you are either qualified for it through disability or reach the month of your 65th birthday. There is no additional cost to Medicare Part A – it is something that the working public contributes to throughout their working years.

For Part B, however, there is an additional cost when you reach age 65 or disability qualification. This cost is now $110.50/month. This is typically done as a deduction from your Social Security check, although you can also pay it quarterly if you prefer. This current (as of 2010) cost of $110.50/month applies to everyone, with the exception of people whose income dictates that they pay a higher amount. Also, there is some assistance available for Part B costs for those with low enough incomes.

Medicare Part C is a relatively new part of Medicare that is called Medicare Advantage. Medicare Advantage plans are offered through private companies. These companies are paid by the Federal Government to “manage” your Medicare benefits. They are required to offer at least as good of coverage as Medicare A & B offer, but some companies go above and beyond this “original” Medicare coverage to different extents. They companies also, typically, pass some relatively small premium on to the customer. This amount varies from company to company and from area to area.

Medicare Part D is the part of Medicare that covers prescription drugs. This is also, like Part B and C, an optional part of Medicare. This is offered through private companies, which extend a premium to the customer in exchange for coverage of your prescription medications. The average Part D cost nationwide (for 2010) is approximately $31, but this premium can vary greatly from area to area and for different levels of coverage.

Medigap plans are not a part of Medicare itself. They are offered through private companies and supplement your “original” Medicare. In some cases, they offer complete coverage so that, between Medicare and the Medigap, you don’t have any out of pocket costs for doctor or hospital care.

For more information about what Medicare covers and what it costs, you can view: Medicare coverage information. Or, to get more information and an idea of what Medicare supplements cost, visit Medicare Supplement quote.