Tag: Medicare
Medicare is divided into parts, which are differentiated by letters of the alphabet. If you will be turning 65 shortly, take some time to understand Medicare Part A and B what it covers, and the costs involved.
Part A
Part A provides hospitalization coverage, including hospital stays, skilled nursing facility care, home health care (skilled nursing, physical therapy), and hospice care. For most individuals, Part A is free, there is no charge for coverage as long as you meet a few requirements. As long as you are a permanent resident of the United States and you or your spouse paid Social Security taxes while employed, enrollment is automatic. There are deductibles and co-insurance that you are responsible for.
Not Covered
Private room
Personal care items (shampoos, toothpaste, etc.)
Television, phone charges
First three pints of blood
24-hour home care
Meals and homemaker services not related to treatment
In-home personal care (bathing, dressing, etc.)Â
Part B
Part B covers expenses that are necessary to treat or prevent a disease or condition. Fees that occur outside of room and board while in the hospital are those related to diagnostic testing, preventative care, and supplies needed to diagnose or treat. Fees for visiting the doctor are also included. Part B also provides coverage for many tests and screenings. The standard monthly premium for 2024 is $174.70 (or higher depending on your income). Most people who get Social Security benefits pay this amount.
Not Covered
Elective and cosmetic surgery
Alternative medicine â acupuncture, homeopathy
Vaccinations and immunizations
Prescription and Non-Prescription drugs
General dental work, dentures
Long term care
Hearing aids and exams for fitting
Eye examinations for prescribing glasses
Out-of-Pocket
There are out-of-pocket costs associated with Medicare, deductibles, coinsurance, and copays. Many seniors choose to supplement coverage to cover costs. You do not have to accept Part B, and you may opt-out by signing the back of your card and returning it by mail. If you are still working and receiving coverage from your spouse or through an employer, accepting Part A, but delaying Part B may make sense.
Enrollment
Typically, the best time to enroll in Part A and B Is when you are first eligible, during your Initial Enrollment Period. Unfortunately, Â If you do not qualify for Part A and need to enroll for Part B and miss your enrollment, you may have to wait until the General Enrollment Period, Jan 1-Mar 31, with coverage starting on July 1.Â
Penalty
if you donât enroll in Part B at this time, you will be responsible for a penalty for each 12-month period you were eligible for but didnât enroll. A 10 percent penalty will be reflected in your premium and will continue for as long as you receive benefits. If you have coverage through your spouse, you may delay enrollment without a penalty. You may be eligible for a Special Enrollment where you won’t be charged a penalty. If you are subject to the penalty, in addition to a premium increase, you may have to wait until January (General Enrollment Period) to enroll for coverage that begins in July. The monthly rate for Part B is based on your income.
Effective Dates
In the event you have not enrolled automatically and choose to enroll in Medicare yourself, effective coverage dates vary based on the month you sign up. If you sign up during your Initial Enrollment Period (the 7 months beginning 3 months before your 65th birthday and ending 3 months after your 65th birthday) effective start dates are shown below.
The same month you turn 65, coverage begins 1 month after you enroll.
1 month after you turn 65, coverage begins 2 months after you enroll.
2 months after you turn 65, coverage begins 3 months after you enroll.
3 months after you turn 65, coverage begins 3 months after you enroll.
References:
https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-how-to-sign-up-for-part-a-and-part-b.html
MUC55-2017-BCBS
Tag: Medicare
If youâre turning 65 in Illinois soon, you will be able to enroll in Medicare, a federally funded program that provides hospital and medical insurance to seniors. For most, enrollment is automatic. Transitioning to Medicare can be confusing. Take a few minutes to become familiar with the coverage and cost of Medicare.
Part A
Part A is free for most people as long as you receive Social Security or Railroad Retirement benefits, you donât need to do anything and your Medicare card will be sent to you by mail.
Part B
A Part B premium will be deducted from your Social Security payments each month. In 2024, the standard premium is $174.70
Enrollment
When you first become eligible, you enter what is called your Initial Enrollment Period. This is a 7-month period of time beginning 3 months before your birthday month, and extending 3 months after your birthday month. This is the time to enroll in Medicare or enhance coverage with additional benefits. If you delay, you may have to wait until the General Enrollment Period (Jan 1- Mar 31) of the following year and may also be charged a Part B late enrollment penalty.
Additional Benefits
Medicare covers much of your health care, but it doesnât cover everything. Itâs up to you to decide if you want to supplement coverage with additional benefits. Understanding your options will make it easier. Medicare Advantage (Part C)Â enhances Medicare by delivering all of your Parts A, and B, coverage and extra benefits. You are responsible for paying a monthly premium as well as the Part B premium. Medicare does not provide coverage for prescription drugs. Two ways to get benefits, join a Part D plan, or a Part C plan that already includes prescription coverage.
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References:
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html
https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html
Cost of Part B: https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html
MUC47-2017-BCBS
Tag: Medicare
Medicare Part B provides services including tests, shots, and screenings. These preventive measures provide a snapshot of your health and well-being. Coverage also includes counseling that helps seniors make more informed decisions with lifestyle choices.
Tests
One-time âWelcome to Medicareâ preventive visit
Glaucoma
Prostate and colorectal cancer screenings
Pelvic Exams
Bone mass measurements
Sexually transmitted infection testing
Yearly wellness visit
Flu, Hepatitis B, and Pneumococcal shots
Screenings
Multiple cancers
Hepatitis C
Diabetes
Depression
Obesity
Alcohol
Cardiovascular
HIV
Counseling
Alcohol
Obesity
Sexually transmitted infections
Tobacco use cessation
Nutrition therapy
References:
https://www.medicare.gov/coverage/preventive-and-screening-services.html
MUC17-2016-BCBS
Tag: Medicare
There are financial resources available to help seniors with the costs of Medicare. Out-of-pocket costs, premiums, and copayments strain many financially to cover the costs.
Medicare Costs
The exact amount you pay for coverage is based on several factors, including your income. There are five different income tiers used to calculate costs, Part A is typically free for most people, and Part B carries a monthly premium. If you receive Social Security benefits, Railroad Retirement benefits, or Office of Personnel Management benefits, your Part B premium will be deducted each month from your benefit.
Financial Help
There are several programs available to help people with limited income get the coverage they need. Medicaid helps pay for medical costs for people with limited income and resources. In many cases, it offers additional benefits not provided by Medicare, such as nursing home care and prescription drug coverage. Eligibility rules differ by state. Be sure to call your state Medicaid program to see if you qualify.
State Medicare Savings
Created to help seniors pay for premiums and out-of-pocket costs like deductibles, coinsurance, copays, and even prescription drug coverage costs. Eligibility is based on income.
PACE Program
The PACE Program was created to help the elderly in need of nursing home-level care receive services at home or in a center rather than at a nursing home or elder care facility. To qualify, you must be at least 55 years old, live in the service area of a PACE organization, and need nursing home-level care. PACE often covers dental care, prescription drugs, meals, preventive care, emergency services, and more. If you qualify for Medicaid, you pay nothing for PACE coverage. If you do not qualify for Medicaid, you pay a monthly premium for prescription drugs along with a monthly premium to cover the costs of long-term care. However, there is no deductible or copayment.
Extra Help
The Extra Help Program helps pay for prescription coverage, available for those who meet certain income and resource limits. If you qualify, you may pay a reduced amount for your prescription drug plan premium and deductible. Seniors who have full Medicaid or get Supplemental Security Income (SSI) benefits, automatically qualify. Of course, using generic drugs over brand names, using mail-order services, and choosing the right plan can help keep drug costs low.
References:
Medicaid:
https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicaid/medicaid.html
Medicare Savings Program
https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-savings-program/medicare-savings-programs.htmlÂ
PACE
https://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.htmlÂ
Extra Help with Part D
https://www.medicare.gov/your-medicare-costs/help-paying-costs/save-on-drug-costs/save-on-drug-costs.htmlÂ
https://www.medicare.gov/your-medicare-costs/Â
https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.htmlÂ
https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html
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MUC68-2017-BCBS
Tag: Medicare
Many seniors carry group insurance through an employer or a spouseâs employer. If you need medical services, which pays first? Different group plans are called payers. You will have a primary payer and a secondary one. Which pays first and which pays second depends on how many employees an employer has, retired or still working, and whether or not you are covered under a spouseâs plan.Â
20 or More Employees
For companies with over 20 employees, group coverage typically pays before Medicare. If you are over 65, have Medicare, and are enrolled in coverage through work, your group plan usually pays first. When employer benefits do not cover the entire cost of care, the balance is sent to Medicare. Your out-of-pocket costs will vary based on how much of the remaining balance Medicare pays.Â
20 or Fewer Employees
If you receive your benefits through an employer with less than 20 employees, Medicare typically pays first. However, there are instances where your group coverage might pay first if your employer joined with other employers to form a multi-employer plan, and at least one in the group has 20 or more employees, then group coverage pays first.Â
Former Employer
if you are retired and receiving coverage through a former employer, Medicare pays first and the group pays second. However, if you are retired, but your spouse is not retired and you are covered under that policy with 20 or more employees, the group pays first and Medicare pays second.
Primary vs Secondary
Receiving care outside an employer planâs network can be tricky. In many cases, receiving care outside of the planâs network can cause both group and Medicare not to pay. Be careful when considering out-of-network. Check with your employer to ensure they will still pay. If you do not take your employerâs coverage, coverage through a spouse will pay before Medicare. If you choose not to take employer coverage through work, Medicare will pay for approved services. If you have coverage through a spouse, or if your spouseâs employer has over 20 employees, Medicare will not pay first. If you are receiving COBRA, Medicare typically pays first. Even if you had benefits before being enrolled in Medicare. If you have Medicare and are 65 or older, and receive COBRA benefits after enrolling in Medicare, Medicare pays first. Even with a secondary payer, you may have out-of-pocket expenses. The primary payer (whether itâs Medicare or group coverage) doesnât always pay the full balance owed from care. The secondary payer may not cover all of the remaining costs. If you chose to delay Part B, group coverage may not pay until you join Part B. The secondary payer only pays if there are costs the primary doesnât cover. If you donât have a primary because you chose to delay Part B, group coverage may not pay until you enroll.
References:
https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/which-insurance-pays.html
https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/how-medicare-works-with-other-insurance.html
MUC67-2017-BCBS
