Posts Tagged ‘original medicare’

Do You Qualify For Original Medicare Coverage? Key Tips To Help You Know For Sure

Sunday, November 14th, 2010

If you are nearing the age of 65, you may be asking yourself, “What is Original Medicare Coverage and am I eligible?” These are important questions because for most people nearing retirement age, the Medicare program will take over as the primary source of health insurance.

Although the Medicare program has evolved since it first started in 1965, Original Medicare is the single payer, Federal health insurance program for U.S. citizens and legal residents age 65 or older. It now also includes coverage for individuals eligible for Social Security Disability benefits, those who have kidney failure, or ALS (Lou Gehrig’s disease). There is one other Federal insurance payer, the Federal Employees Health Benefits program that covers Federal employees.

Although Medicare is now considered to have 4 parts, Original Medicare is most often associated with what is called Part A and Part B. Part A covers hospital inpatient, skilled nursing facility, and home health care benefits. Part B covers doctors’ services, medical supplies and equipment, and hospital outpatient care. Part B also covers many other services such as clinical laboratory services, imaging, ambulatory surgery, cancer treatments, preventive services, and much more.

Generally speaking, eligibility is not complicated. If you are a U.S. Citizen or naturalized citizen nearing the age of 65, or disabled or have End Stage Renal Disease, you are probably eligible. Eligibility questions, however, can be addressed to the Social Security Administration at 1-800-772-1213.

Enrollment into Medicare Part A and B is automatic if you are receiving Social Security benefits at the time you turn age 65. If you have been receiving Social Security Disability Insurance for 24 months, you enrollment is also automatic at the end of the 24 month. Generally speaking, you should receive your red, white and blue Medicare card about 3 months prior to the month of your enrollment.

Those nearing 65 but not yet receiving Social Security benefits must submit an application to the Social Security Administration. All Medicare applicants have a 7 month, initial enrollment period that begins 3 months before the sixty-fifth birthday and ends on the last day of the third month following the month of your sixty-fifth birthday.

The one stable piece of information to hold onto is that Medicare enrollment is always done through the Social Security Administration. If you are already receiving benefits, your enrollment will be automatic and you won’t need to do anything at all. If you are not receiving SSA benefits by your sixty-fifth birthday, you will need to submit an application through the Social Security Administration. As this is quite an important change in your life, you should not hesitate to seek answers to your questions through the Social Security Administration toll free number, 1-800-772-1213.

Get free information about private management of your Medicare benefits. Learn more about Medicare Advantage PPO Plans. Need drug coverage? Medicare Part D in 2010 may be right for you!

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Medicare Advantage 2010 Or Original Medicare: Making The Right Choice For You

Friday, September 3rd, 2010

What will it be for 2010, Original Medicare or an Advantage plan? Typically, the average person turning 65 and about to be enrolled into Medicare is unclear on just how to receive his or her benefits. Do you choose Original Medicare or one of the many private, Medicare Advantage plans? 2010 is a year of great financial change for many Medicare insurance companies due to the recent health insurance reform of the Obama administration. However, this will not affect the actual working of either traditional Medicare or the privately managed Advantage plans.

Medicare Advantage plans in 2010

The essential working of the plans, whether they are Medicare Advantage PPO plans, HMO plans, or private fee for service plans, remains largely the same as the Advantage plans in 2009. One significant difference for 2010 is that the costs premium and out-of-pocket costs appear to have generally increased from 2009, and that there are far few plans offering zero premium options, and more plans whose cost sharing more closely mirrors that of Original Medicare.

What are you getting when you join a 2010 Medicare Advantage plan? The Medicare program requires that the Advantage plans offer you the same core services that you receive in Original Medicare. However, the Advantage plans deliver your benefits according to their own policies and procedures. When you join an Advantage plan, that plan takes over management of all of your Medicare health benefits and become the only and single payer on your medical expenses. You are still in the Medicare program, but instead of the Federal government managing your benefits, the private, Advantage insurance takes over. The Advantage plans are not supplemental insurance and will never pay after Medicare. They pay instead of Medicare, and Original Medicare will never pay on charges while you are enrolled in a private plan.

Medicare Advantage PPO Plans and HMOs

Medicare Advantage PPO and HMO plans are in charge of all of your benefits. As mentioned above, that remains true for as long as you remain enrolled in such a plan. The health maintenance organization (HMO) is made up of a network of health care providers, and when you become a member, you are generally required to receive all of your care from within the network. Normally, if you go out of the network, you would pay the charges out of your own pocket. The only exception to that rule is if you need emergency or urgent care services. A PPO, or preferred provider organization, also includes a network of providers. However, the PPO allows you to receive services out-of-network from providers of your choosing as long as they agree to submit claims to the insurance company.

If you join a Medicare Advantage plan, can you still get drug coverage? The answer to that is a solid yes. In fact, most advantage plans include drug coverage, also generally known as Medicare Part D. In 2010, just as in 2009, if you need drug coverage and want to join an HMO or PPO, you must accept the drug coverage offered by the plan. However, if you join a private fee for service plan that does not include Part D, then you would be allowed to join a separate, stand-along prescription drug plan.

How do you know which kind of plan is best for you? That is tough question. In large part that depends on your understanding of your medical needs and knowing what would make you feel secure. Those able to afford the more expensive, private coverage may prefer to join the Advantage program. Generally speaking, Medicare beneficiaries requiring light to moderate health care are likely to have a better experience in an Advantage plan than those whose health care needs are more extreme. If you are thinking of joining a private plan, we advise giving careful consideration to your health care needs, your cost expectations, and then speaking with plan representatives to determine what is best for you.

Is a Medicare Advantage PPO plan the right choice? Find out today. Learn more about how health insurance works today!

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Key Tips To Help You Know If You Qualify For Original Medicare Coverage

Thursday, August 12th, 2010

If you are nearing the age of 65, you may be asking yourself, “What is Original Medicare Coverage and am I eligible?” These are important questions because for most people nearing retirement age, the Medicare program will take over as the primary source of health insurance.

In the United States, health insurance might be broken down into two general categories–Medicare and non-Medicare private health coverage. Medicare is the government run, Federal health insurance program for people 65 years or older, disabled people who have worked the minimum number of years to qualify for Social Security Benefits, and people of any age who have End Stage Renal Disease (ESRD). All other insurance, with the exception of the Federal Employees Health Benefits program and Mail Handlers is private insurance.

What does Original Medicare coverage include? In short, the program provides a broad range of services through Part A and Part B. Part A helps cover inpatient services such as hospital inpatient stays, skilled nursing facility services, and home health care. Part B is your Medical insurance covering doctor visits, hospital outpatient services and surgery, medical supplies and equipment, and physical therapy.

So, how do you know if you eligible for Medicare? If you are a U.S. citizen or naturalized citizen and you fall into one of the categories above (65 or over, disabled, or have ESRD), you may be eligible for Medicare benefits. If you are unsure, the most certain way to determine your eligibility is to call the Social Security Administration (SSA) at 1-800-772-1213 between the hours of 7am and 7pm (in any time zone).

However, if you are already receiving Social Security Benefits prior to your 65th birthday, then you will be enrolled into Medicare Part A and Part B automatically. The way this works is that approximately 3 months before you turn 65, you will receive you initial enrollment packet that will include your Medicare card. If you want to enroll into both A and B, sign your card and keep it in a safe place. If you want to refuse Part B, simply sign the back of the card form that you receive, put an “x” in the box that says you are refusing Part B, and send the card back using the return envelope. After the SSA receives and notes your decision, you will receive a new card listing your enrollment into Part A, only.

Those of you nearing 65 and still working or simply choosing to put off receiving Social Security benefits will need to apply directly with the Social Security Administration. The time to do this is during the Initial Open Enrollment Period, which begins 3 months before your sixty-fifth birth day, and ends 3 months after the month of the sixty-fifth birthday.

The one stable piece of information to hold onto is that Medicare enrollment is always done through the Social Security Administration. If you are already receiving benefits, your enrollment will be automatic and you won’t need to do anything at all. If you are not receiving SSA benefits by your sixty-fifth birthday, you will need to submit an application through the Social Security Administration. As this is quite an important change in your life, you should not hesitate to seek answers to your questions through the Social Security Administration toll free number, 1-800-772-1213.

More on Medicare, find out about Medicare Part D in 2010 and the truth about Medicare Advantage PPO plans.

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Medicare Supplements 101: What you Need to Know about Original Medicare First

Friday, February 5th, 2010

In the case of obtaining a Medicare supplement, there are numerous things that you need to know. However, the most important thing that you need to comprehend is Original Medicare itself and how it functions before you can become involved in getting your own Medicare supplement policy.

Medicare started in 1965 as a government-sponsored healthcare program for seniors over age 65 and those who are disabled under certain circumstances. The policies are administered and regulated by the Centers for Medicare and Medicaid Services, or CMS.

Anyone who has reached age 65 and is eligible for social security or railroad benefits can get Medicare, as can anyone who is disabled and has been on social security or railroad benefit plans for more than two years.

Additionally, people who have end-stage renal disease and require dialysis are eligible for Medicare on condition that they qualify for social security. The objective of Medicare is to behave as health insurance for individuals who need it. The coverage is the same for everyone, and includes two parts:

Medicare Part A covers hospitalization expenses, home health care and hospice care.

Medicare Part B covers doctor visits, surgical services, diagnostic testing, therapies of certain kinds, medical supplies and equipment, ambulance services, plus some preventative care.

However, since these insurance programs are all uniform, some people miss out on critical services they need because they aren’t covered.

Enter the Medicare supplement. When an individual has a Medicare plan of healthcare and it doesn’t cover all of their medical needs, he or she will likely look for the coverage they need in other places. However, those who are retired or disabled are generally living on a fixed income, which makes it difficult to afford the insurance and/or medical services that they need.

Often known as Medigap, this is a government-regulated supplement plan that can be obtained by anyone with Medicare insurance to cover the expenses that aren’t covered by their Medicare plan. There are different plans to pick from, and each one has different benefits and coverage types.

It is easy to consult with many resources online or an actual Medicare supplement insurance agent to figure out which plans are best for your specific needs. The supplement works by paying the leftover expenses that Medicare didn’t cover for any health services that you need performed.

It doesn’t matter how much or how little supplemental coverage you may need, because there’s something for virtually everyone. As soon as you understand Medicare and what it is lacking, it is easy to then go on the hunt for a Medicare supplement that should complete the puzzle.

Learn more about Medicare supplements. Stop by Richard Cantu’s site where you can find out all about Medigap and what it can do for you.

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