Posted by Tom Carolan on Fri, Feb 26, 2010 @ 04:37 PM
Medicare beneficiaries fill in Medicare's coverage gaps in a number of different
ways, including:
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Government Programs (Medicaid/QMB/SLMB);
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Group Retirement Policies (Non-Standardized);
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Non-Standardized Individual Medigap Policies (Issued Prior to July 31, 1992);
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Standardized Individual Medigap Policies (Issued After July 31, 1992).
Medicare beneficiaries who are also eligible for Medicaid (Title 19) do not need Medigap insurance since Medicaid will cover the cost of their health care expenses. People who do not qualify for Medicaid but are within 100% of the federal poverty level are eligible for coverage under a program known as the Qualified Medicare Beneficiary Program (QMB). QMB program benefits include:
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Payment of Medicare premiums.
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Payment of Medicare annual deductibles.
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Payment of Medicare coinsurance amounts.
Thus individuals who qualify for the QMB program generally also do not need, and should not pay for, Medicare Supplement Insurance. The qualifying income figures change in April each year. Contact the Department of Social Services office in your area to find out more about Title 19 and QMB eligibility and enrollment.
Individuals who do not qualify for QMB because of excess income may qualify for the Specified Low-Income Medicare Beneficiary Program (SLMB) or Qualified Individual Program (QI). People who have incomes within 120% - 135% of the federal poverty level are eligible for SLMB or QI coverage. However, SLMB and QI only pay for the Medicare Part B monthly premium. Therefore, SLMB and QI individuals may still want to purchase Medigap insurance if they can afford to do so. Like QMB, the qualifying income figures change in April each year and the programs are administered by the Department of Social Services.
Some employers offer health insurance coverage to their retirees. Retirees who are covered by such group plans may not need to purchase an individual policy. While a retiree may choose to switch to an individual plan, this may not be a good choice because group retiree plans usually do not cost anything to the individual and the group coverage is often as good or better than most individual Medigap policies. Thus the individual should compare his company's policy costs and coverage with the ten Medigap policies. The retiree should also consider the stability of his company. If it is conceivable that the company will falter, that his costs will rise, or that coverage will diminish, the individual may wish to purchase an independent policy. Remember, however, that if a new policy is purchased the old policy must be dropped.
Most Medicare beneficiaries are not eligible for Medicaid or QMB, however, and may want to obtain Medigap insurance. Approximately two-thirds purchase Medigap policies. As of July 31, 1992, Medigap policies were standardized throughout the United States. This mandatory standardization was a result of legislation passed by Congress through the Omnibus Budget Reconciliation Act of 1990. There are ten specific benefit plans which federal law permits to be sold as Medigap policies. Two new plans were added in 2006. States may allow all or some of these plans to be marketed. Insurance companies may sell all or some of the plans which the individual state allows them to market. However, there is a basic benefit package, known as the "core benefit" plan, which must be allowed in all states and which must be offered by any company which sells Medigap insurance.
Although individual Medigap policies have been standardized since 1992, some seniors are still covered by previously issued non-standardized plans. These policies are no longer available for purchase. However, individuals may continue to keep their old policies and many people have chosen to do so. Individuals covered by an old policy should consider changing to a new "standardized" plan, and should compare the benefits and costs of each of the policies. Then an informed decision can be made. An individual who purchases a new standardized policy can only have one Medigap policy and must therefore drop the old, non-standardized plan. This protects people from the unnecessary costs of duplicate coverage.
Posted by Tom Carolan on Fri, Nov 20, 2009 @ 04:35 PM
If you are close to the age of 65 then you have probably been researching all of 
the benefits associated with Medicare health insurance. Because there are so many different plans with many advantages, it may be very difficult to decide what plan best fits your needs.
The Medicare Advantage Plan (Part C) is one of four different parts of the Medicare health care system. This plan allows those with Medicare parts A and B to receive coverage from a private insurance company that is government-approved. Medicare Advantage Plans consist of plans such as Preferred Provider Organization (PPO) plans and Health Maintenance Organization (HMO) plans. The largest and most well-known weakness of the original Medicare plan is that is does not cover the cost of prescription drugs. So, if you would like coverage for prescription drugs then you have a few options to choose from.
The Medicare Part D plan is obtainable to anyone who has original Medicare (Parts A and B). This plan is designed to provide coverage for the costs of prescription drugs. This plan is available through private insurance companies that have been approved by Medicare. If you have a supplemental Medicare insurance policy (Medigap), it may actually cover prescription drug costs. If it does not, then you can obtain a Medicare Prescription Drug Plan with Medicare Part D, but you must notify your insurance company if you choose to do so. It is also important to know what benefits your plan covers because supplemental Medicare plans will not always cover prescription drug costs.
Consider Medicare Part C (Medicare Advantage Plan) if you decide not to use Medicare Part D, or supplemental Medicare insurance. At an additional cost, these plans may offer prescription drug coverage through private insurance companies. So, if you obtain one of these plans then supplemental Medicare insurance will only be an alternative. Remember to check for additional coverage choices in your coverage history from past employers. You may have more options if your current or previous employer provided you with prescription drug coverage.
If you already own a Medicare Advantage Plan then it is not necessary to purchase a supplemental Medicare plan. Unless you completely drop the Medigap plan and use the original Medicare, it is illegal to purchase a supplemental plan. In addition, it is very difficult to get a supplemental plan in the future if you ever drop it, so be very careful. Before you ever make a decision that could affect your long-term health coverage, always discuss these issues with your insurance company or your State Health Insurance Assistance Program.
As you age, getting prescription drug coverage is always going to be an important component in any health coverage plan. Because you never know what health situations may arise, it is very important to choose a plan that covers prescription drug costs. So, if you choose Medicare insurance or a Medicare Advantage Plan, make sure to have some form of prescription drug coverage so you will be prepared for any medical situation.
Posted by Tom Carolan on Fri, Nov 20, 2009 @ 11:15 AM
There are two choices available to individuals seeking Medicare coverage as well as the federal health care program. They are known as Medicare Supplement plans and Medicare Advantage plans. Although these plans are somewhat similar, overall, their benefits differ greatly. You must individually consider each plan and determine which has the best options in your situation. In most instances, when you qualify medically and can afford a supplement, or Medigap plan, it is to your advantage to purchase the plan.
The best rule to follow when trying to understand the differences is to remember that Advantage plans pay as a replacement for Medicare coverage, while Supplement plans pay after Medicare coverage. Advantage plans are known as the privatized form of the federal Medicare program, and they replace it altogether. However, you must still be enrolled in the government program, but they do not pay you benefits. Conversely, Supplement plans are available to fill in the "gaps" of coverage that are not paid by the government's program because they are designed to supplement.
There are several reasons why Supplement plans are generally more useful than the Advantage plans. Here are a few good reasons:
- You can use supplements at any doctor that accepts the federal Medicare program; however, most Advantage plans require that you stay in the network of doctors/hospitals that they are affiliated with. Also, these networks are not fully developed in some areas, so some people may have to drive a ridiculous distance just too see a doctor or go to a hospital in their network. This situation can be very irritating.
- Medicare supplements generally do not make use of cost-sharing, or deductibles and co-pays. Most supplement plans cover 20% of costs not provided through the federal program, in addition to one (or both) of the deductibles. On the other hand, Advantage plans make use of cost-sharing with deductibles and co-pays as a component in their plans. A great number of the Advantage plans require a co-pay of $15-$40 when you visit the doctor's office. Also, there is a daily co-pay for hospital stays for the first 5-10 days, plus deductibles and/or co-pays for hospital admission.
- Medicare supplements will not annually modify coverage because they have not changed and they have been federally standardized since 1992. However, Advantage plans are always modified each year, and in recent years, every change has been against the favor of the insured person.
For those over 65, the two insurance choices are Supplements and Advantage plans and there are specific benefits offered in each plan. However, if you are medically qualified and can afford a supplement plan, it is in your favor to choose the supplement for comprehensive insurance coverage for those over 65. Make sure to examine each plan and recognize what coverage you will need in your current situation before you finalize your decision. Insurance coverage is a necessity, so why not make the best choice for your health coverage?
Posted by Tom Carolan on Thu, Nov 19, 2009 @ 10:26 AM
Medicare supplemental insurance has been available for awhile but many people in the White House believe it is time for some health care changes. In 2010, there are many new changes being made to Medicare supplements. It is obvious that not everyone will want to accept the new changes, but hopefully these changes will benefit a large portion of those with Medicare health care coverage.
There are a few changes that have already been discussed. One of these changes is that plans A through G are being phased out into new plans also labeled A through G. However, the old plans will not be totally phased out because those currently under the old plans will be grandfathered in and they will still be covered under those plans.
You must know that those that are just signing up for plans A through G will not necessarily receive the "new" Medicare supplement plans. This is due to the fact that they will be the same as the "old" plans. As you can see, this process is quite confusing, so make sure to have your questions answered before the new changes go into effect. Do your best to keep up to date with reports if you are currently under a Medicare supplement plan by researching on the Internet and reading medical news publications.
Another confusing aspect of the new changes to Medicare supplements is that those currently enrolled in plans A through G by June 1, 2010 will be placed in "closed risk pools." A closed risk pool means that people in the group will probably have to pay higher costs for Medicare supplement insurance.
Obviously, having rates go up may be very difficult for some people-especially those on a fixed income. In any case, after May 31, 2010, the insurance rates will be reset and the new plans will be available. For those that receive the "new" versions of the plans after June 1, 2010, there will be strong competition among insurance companies bidding for Medicare supplement business.
With increased competition, it generally means lower rates, and these lower rates have the possibility to stay in effect longer than we may expect. Frankly, it is difficult to predict how well the Medicare supplement insurance market will do in relation to premium costs. But, we can assume that in order to attract more customers, the rates will be lower in the beginning of these Medicare supplement changes.
Because of the radical policy changes occurring in the White House, we have no idea what else may change in Medicare health insurance. Just remember to stay up to date with policy and rate changes in the Medicare health care system and know that the medical news publications and Internet articles are a quick and easy way to obtain information about new Medicare changes. To avoid the confusion, just stay well-informed and educated on the subject of new Medicare supplement changes.
More Information:
Medicare Supplemental Insurance Quotes
Medicare Advantage Quotes
Posted by Tom Carolan on Wed, Nov 04, 2009 @ 12:28 PM
Retiring from work often results in living on a fixed income, which wasn't the case in years past. The adjustment isn't always easy and it can mean that every day is spent pinching pennies. But when it comes to necessities like health care coverage, you want to feel confident that your health coverage will be there when you need it.
Also, you want to ensure that you know where to get the most cost-effective health care insurance and know that you'll be covered for all emergencies. The process of finding health coverage doesn't have to be as complicated as it sounds because you can benefit from health care plans that are provided by the government under Medicare and Medicare supplements. The supplements are intended to fill in the gaps that the original Medicare plan was meant to provide for.
Although you may know and hear a lot about Medicare, because it's in the news more when U.S. debt is discussed, you may not know very much about Parts A - L. These are supplement choices to add to your existing Medicare coverage. With this, not only can you budget your money in advance, but you can save plenty of money on health care coverage.
Another tool to help you save money on health care coverage is available on the internet. It's a little-known resource that will help you save money on prescription drugs by showing which pharmacies in your area are offering the best rates for the prescription drugs you are taking. By using this tool, you can save a great deal of money over the course of a year if you must buy prescription drugs every month. You can find this helpful tool at: http://www.medicare.gov/pdphome.asp. On the webpage, look for the title that says "Medicare Prescription Drug Plan Finder." Make sure you have your red, white and blue Medicare card. Also, the best option to choose is Personalized Plan Search.
When you know where to find the best price for your prescription drugs, you have more room to enjoy the rest of your life. For many, prescription drugs are essential for living because there is no option to live without them. So whether you receive your prescriptions through a mail-order drug company or an approved pharmacy, it makes cost-effective sense to know where the best prices are. This is also a way to discover the other choices you may have in terms of generic, less expensive drugs that will work just as effectively for your health condition.
In addition, knowing as much as possible about your Medicare options will always save you money and time. So many Medicare recipients spend extra money on options that they really don't need. The best way to get the most out of Medicare and Supplement plans is to choose a health insurance representative who understands your situation and will assist you in choosing the plan that works best for you.
Posted by Tom Carolan on Tue, Nov 03, 2009 @ 03:45 PM
Insurance company health plans that have a contract with CMS (Center for Medicare and Medicaid) are known as Medicare Advantage Plans. Anyone with Medicare Part A and B is eligible to receive a Medicare Advantage plan. For people with certain health conditions, Medicare also offers specialized plans; but the general plans are not allowed to reject a person based on a health condition except for very specific reasons.
If an individual is enrolled in a Medicare Advantage plan, they will not lose their Medicare. If they want to end their Medicare Advantage plan then they can re-apply for original Medicare after a month has passed. Instead of using a Medicare card, they must use the insurance card that is provided by the Medicare Advantage plan while they are enrolled.
Having a Medicare Advantage plan may cost recipients nothing, or a small fee; although many require the Part B participation amount. Instead of having a portion of tax money go to original Medicare, the plans receive a payment from CMS every month. This tax money pays for a high percentage of the Medicare Advantage Plans.
By tradition, Medicare Advantage Plans were believed to be like HMO plans, where an insured person could only use certain doctors, hospitals, and other medical providers under the plan in order for expenses to be covered. Surprisingly, many Medicare Advantage Plans are actually HMO plans; however, PPO plans are also available with Medicare Advantage. Often, Fee for Service Medicare Advantage Plans are marketed aggressively because these plans will cover any medical providers that accept the insurance.
To figure out which plan works best for you, you must assess your own medical needs and preferences. If your current medical providers have a contract with a Medicare Advantage Plan's HMO, then you may be very pleased with comprehensive coverage that has few extra payments. If you would like to have more choices, and doctors in your area will accept a Fee for Service plan, then an "Any Doctor" plan would be a good fit for you. Keep in mind that not all doctor's offices will work with the Fee for Service plans, although many insurance companies claim that all offices accept the plan. With PPO plans, you can receive the greatest coverage at a low price inside your insurance network, and you will still be covered even if you use a different medical provider.
The Part D plan of Medicare (prescription drug coverage) is included in most, but not all, Medicare Advantage plans. Also, beyond their normal Part B premium, most Medicare Advantage plan recipients may have a minimal, or nonexistent, monthly premium. Some Advantage plans will even refund the Part B premium altogether. If you are an applicant in poor health, you must know that Medicare Advantage Plans are not permitted to do a lot of risk selection based on health condition, so one of these plans may be the best choice for you.
Medicare Supplement Plans
The traditional Medicare Supplement plans are very different from Medicare Advantage plans. With Medicare Supplements you are able to still use your original Medicare card, in addition to the health card provided by the Medicare Supplement plan. Also, these plans are provided through insurance companies, but the insurance companies only supplement the coverage "gaps" and deductibles that original Medicare Part A and B do not cover.
If you already have Medicare Part A and B, then by having a Medicare supplement plan you will be able to pay any portion of your medical bill that is not covered by Medicare. Obviously, each Medicare supplement plan will differ from one another so you need to understand exactly what a Medicare Supplement plan will cover before you sign up. For example, Medicare may pay 80% of your hospital bill and the supplement plan will cover the remaining 20%. Medicare supplements generally provide the widest access to health care.
Choosing a Medicare health plan can be one of the most important decisions anyone eligible for Medicare can make. Because this decision is so important, choose someone skilled to help you find the right plan to fit your needs, lifestyle, and budget.
Posted by Tom Carolan on Fri, Oct 30, 2009 @ 04:14 PM
Having a Medicare supplement can help fill the gaps in your Part A and B Medicare coverage!
Medicare: it's a wonderful program, and has saved senior and disabled citizens untold billions of dollars for health care. But the fact is that Medicare alone was never designed to pay 100% of health care expenses for the elderly.
Why do You Need a Medicare Supplement?
You need a supplement to Medicare in order to pay all of your medical expenses.
You might incur expenses in several areas that would not be covered by Medicare. For example, your deductible for a hospital stay in 2009 is $1068, and Medicare would not pay this amount. There is also a $135 deductible for Part B of your Medicare coverage.
Generally, you must pay twenty percent of your doctor and other medical expenses out of pocket.
As you can see, if you don't have supplemental insurance, your out-of-pocket costs could amount to almost $52,000 in just one year!
Many private insurance companies have these kinds of insurance policies available to pay what isn't covered by Medicare for your medical expenses.
This kind of insurance is legally standardized into twelve plans: Plan A through Plan L. This means that Plan G from one company must have the same benefits as Plan G from a different company. But although the benefits are required by law to be the same; different insurers may be vary according to cost and coverage.
So, it pays to shop wisely for a Medicare Supplement policy!
Which Medicare Supplement is Best for You?
Which Medicare Supplement is best for you depends on your needs. Again, there are many different insurers to choose from, so just shop around and select the plan that seems best suited to your individual needs. Many people have supplemental insurance coverage included in their retirement package, so take this into consideration before choosing a plan.
Can You See Your Own Doctor?
Most major insurers do allow you to see and choose your own doctor.
When Can You Apply for Medicare Supplement Insurance?
It is best to buy a Medigap, or Medicare Supplement, policy during your open enrollment period. This open enrollment period is the period that begins after you reach age 65, on the first day of the month in which you were born. It lasts for six months. During your open enrollment period, you cannot be denied any Medicare Supplement coverage that an insurance company sells, or made to wait for coverage to start, or be charged more for a supplemental Medicare policy because of poor health.
Do You and Your Spouse Need Separate Medicare Supplements?
Yes, you will each need your own individual Medigap policy, just as you each have your own Medicare coverage.
Can You Switch Medicare Supplements?
Yes. In fact, even if you are happy with your policy, it's a good idea to compare rates and benefits of other plans from time to time. If you find a plan that seems better than what you have, check with the insurer for Medicare Supplement quotes. You might be able to save a considerable amount of money by switching to a different Medicare Supplement!
Get a quote for Medicare Supplemental Insurance.
Posted by Tom Carolan on Fri, Oct 30, 2009 @ 03:28 PM
A Medigap policy is health insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn't cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.
Insurance companies can only sell you a "standardized" Medigap policy. These Medigap policies must all have specific benefits so you can compare them easily.
You may be able to choose up to 12 different standardized Medigap policies (Medigap Plans A through L). Medigap policies must follow Federal and State laws. These laws protect you. A Medigap policy must be clearly identified on the cover as "Medicare Supplement Insurance." Each plan, A through L, has a different set of basic and extra benefits.
It's important to compare Medigap policies because costs can vary. The benefits in any Medigap Plan A through L are the same for any insurance company. Each insurance company decides which Medigap policies it wants to sell.
Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company.
You and your spouse must each buy separate Medigap policies. Your Medigap policy won't cover any health care costs for your spouse.
For additional information on Medigap policies, including why you would want to buy a Medigap policy and information about what Medigap policies cover, please read our publication, Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.
Posted by Tom Carolan on Fri, Oct 16, 2009 @ 04:18 PM
If a facility is to receive payment for procedures covered by Medicare, the facility must enroll in the Medicare program. Medicare was created and is issued by the federal government and it is a form of medical insurance for citizens age 65 or older. In order to receive payments from Medicare, the facility is required to complete a form titled "Medicare Enrollment Application for Institutional Providers" (CMS-855A). There are several ways that the facility can submit their application once they choose to enroll in the Medicare program.
There is information titled the "Provider Enrollment Packet" that the facility can request. This packet provides the step by step instructions needed to complete and submit the CMS-855A application. By logging on to the Centers for Medicare & Medicaid Services (CMS) website, the facility can also electronically submit the application. On the website they can download the application to print, or just electronically submit it.
If the facility is not a Medicare provider yet, and has not yet received Medicare payments directly into a bank account, then an electronic funds transfer (EFT) must be submitted with the CMS-855A application. Information about submitting funds electronically is given in the electronic data interchange (EDI). In order for the application to be processed, this form must be submitted with the CMS-855A application.
In addition to the enrollment application, the CMS-855A is required for any changes. These changes include any changes in billing or telephone information, any additional locations, change of ownership, stock transfer, or reactivation of an old Medicare provider number. This also includes changes of address, business name, financial information; as well as changes in management or facility directors.
Any facility that chooses to accept patients with Medicare insurance will receive a National Provider Identifier (NPI). This is a number that must be submitted on each application so the review process can be as quick and efficient as possible. Before submitting the CMS-855A forms, the NPI number should be requested. Any forms without the NPI number will not be processed until the NPI is submitted.
Upon submission of all information and applications, the forms are reviewed for approval. To ensure that providers receive prompt payment for services rendered under Medicare, all information on file must be kept up-to-date. The person that reviews the CMS-855A form is an audit intermediary (AI). They also review the Medicare provider's cost reports to decide what the final settlement of the cost report will be. This review helps to provide payment only to facilities that are operating within Medicare's guidelines and costs. To ensure that facilities are only billing for services rendered, and that patients are receiving Medicare-approved services, any payments for services provided under Medicare are closely scrutinized.
The detailed application process for Medicare ensures that facilities who apply for Medicare payments have high standards. So, they are eligible to be a Medicare provider. These standards allow for Medicare recipients to receive the best care possible when a medical situation arises.
Medicare Supplemental Insurance Quotes
Posted by Tom Carolan on Fri, Oct 16, 2009 @ 01:27 PM
Many insurance companies offer additional benefits known as Medicare supplemental health insurance plans. All of these plans are to provide coverage for health insurance costs that are not covered by Medical. When Medicare changed the way of coverage and payment that was in place for a number of years, Medicare supplemental health insurance plans were created.
Some of the differences between the old insurance and the new are the new Medicare insurance does not cover as much of the costs for prescription drugs as the old. It also does not cover many of the preventive health measures required for older Americans. Medicare insurance can be considered a "back up" insurance policy for any item that Medicare will not pay for.
Currently, Medicare has 12 standard Medicare supplemental health coverage plans that are available to senior citizens. Each of these plans must cover the same areas of healthcare for seniors and the plans are strictly regulated by the government. If you are planning to buy a Medicare insurance plan, the best time to purchase is within six months of applying for Medicare.
Oftentimes, insurance companies will tell individuals that their company's Medicare insurance plan is better than all the others and they will attempt to charge a higher price. It is imperative to remember that each one of these plans offer the same services. So, when looking for a Medicare supplemental health insurance plan, it is best to shop around for the lowest price because the services the plan covers stay the same and all of the plans are not different from one another.
Once you qualify for Medicare, many insurance companies have a Medicare supplemental health plan if you have a health policy with your retirement benefits. You generally will not even recognize any changes to your insurance benefits. Unfortunately, many Americans do not have any health coverage. If you are one of these people, then you will need to search for a Medicare supplemental health insurance plan on your own upon qualifying for Medicare benefits. Most of the major health insurance agencies offer a Medicare supplemental health plan. To calculate premiums for Medicare supplemental health insurance, you must consider: Age at the time of issuance; Attained age; and Community rate. And keep in mind that inflation will always increase insurance rates throughout your lifetime.
As you search for the right Medicare supplemental health insurance plan, take into account the fact that the services provided by the plan will not be modified. All plans are government regulated and provide the same healthcare services to everyone. So, if you find a great price that is affordable for you your main focus should be on the cost of the Medicare insurance and what the rate of increase will be during your lifetime. If you find that some plans seem to be more expensive in the beginning, you should remember that there will be a slow or nonexistent increase in the plan's rate over the life of your policy.
Medicare Supplemental Insurance Quotes