Medicare Advantage offers its participants coverage that is much like a HMO/PPO. You will receive all your coverage through this plan. In addition to this type of coverage many Medicare Advantage plans also cover prescriptions, private fee-for-service options as well as some special needs coverage.

If you have a Medicare Advantage plan you do not need Medigap insurance. If you have gap insurance while you have Medicare Advantage it will not work or cover any additional expenses. You should immediately cancel any Medigap insurance when you have been accepted into a Medicare Advantage plan.

Medicare Advantage policies are insurance plans that are maintained by private insurers. This means that while each plan is required to offer the same type of coverage, each plan will have different regulations and fees associated with the plan. It is very important that you carefully research your plan prior to committing to one so you are aware of your coverage and requirements.

Medicare Advantage plans are often cheaper than regular Medicare costs because they cover more of your deductibles and co-payments. But, unlike regular Medicare, you may be required to have referrals to see a specialist and stick to the doctors that are authorized within their network. Much like a regular HMO these types of plans can become very tricky in seeking treatment of a specific nature.

You should always review the plan carefully to make sure that you are going to receive the benefits you need to maintain your health. It might be wise to look for a PPO plan that offers a wider range of medical options. PPO plans will allow you to broaden your range of doctors who can treat you as well as many times skip referrals and head to a specialist at the onset of any problems.

Currently the new administration in the government is trying to “overhaul” healthcare in this country. Medicare is one of the programs that is intended for these changes. It is imperative that you become aware of any and all changes that take place in your Medicare Advantage policies due to these congressional rules. It is too early to tell yet if these changes will dramatically affect your policies. Make sure if you receive any correspondence from your insurer that you read it carefully to make sure you are aware of any changes.

The medicare program in the United States is similar to any health care insurance policy for a single individual, that would be provided through an employer, or by those who purchase their own insurance, and pay out of pocket since they are capable of affording their own insurance policy. Prior to medicare being offered, only about 51 percent of people above the age of 65 were able to afford insurance, meaning that many seniors who needed expensive medications, or expensive nursing care, or expensive in home care, were not getting it, due to the fact that they were not able to afford it, and the fact that there was no government assistance administered to these individuals. Additionally, only about 30 percent of these individuals, who were not able to afford their own insurance, were living above the poverty line. This meant that these seniors were uninsured, and were going without a lot more than just insurance, due to the tough economic conditions, and because they were not able to afford better living conditions, due to the expensive treatment they had to pay for care or medication, when they had to purchase it.

The original medicare plan, covers about 80 percent of the approved medicare medical procedure. This means that about 80 percent of nursing care costs, co-pays, medications, and all approved medicare treatments, are going to be paid for by the government, requiring the seniors (or others who are approved for medicare), to pay only 20 percent of the entire cost out of pocket, making an option for care something which is actually much more affordable for all these individuals. There are also ways that these individuals, especially those living below the poverty level, can obtain a medicare supplement plan, which will pay the other 20 percent, or at least a large portion of that 20 percent, meaning that many individuals will not be required to pay anything for their treatment; or, if they do have to pay out of pocket expenses, they are going to be extremely minimal costs, out of the total amount which is due for the treatment, or the medication which they are obtaining.

The supplement insurance is generally offered via a private insurance company, which will require a monthly insurance fee be paid. But, this is going to be a much lower cost than the 20 percent, if an expensive treatment option, or expensive medication is required for these individuals.

Medicare Part D can be obtained in two ways. The first is by adding a prescription drug plan to your existing original Medicare plan.

The second way to get Medicare Part D is to purchase a Medicare Advantage Plan that includes the prescription drug coverage. These plans, which are usually HMOs or PPOs, combine Medicare Part A, Part B and Part D into one plan. To join one of these plans, you must have Medicare Part A and Part B and live in the service area of the plan you choose.

There are limits as to when you can join a Medicare drug plan. Only those receiving Extra Help can join, switch or drop a Medicare drug plan at any time. Others may only join or make changes during specified enrollment periods, except under special circumstances as described by the enrollment plan.

Each plan provides a list of covered drugs, also called a formulary. The formulary is usually divided into tiers, by cost. More expensive drugs will have a higher co-payment than less expensive drugs.

For certain drugs, the plan may require prior authorization prior to having your prescription filled. Your doctor, or other prescriber, may need to satisfy the plan that a particular drug is medically necessary for your condition.

Your plan may insist that you first try one of the less expensive drugs before they will approve the more expensive one. They also may limit how much of the drug you can get at one time. Many times, you or your doctor can ask for an exception to the rules.

When medically necessary to prevent illness, all commercially-available vaccines, such as the shingles vaccine, must be covered, either by Part B or by your Part D provider. However, the drugs you get in places such as an emergency room are not covered by Part B. Many times, you will need to pay out-of-pocket for these drugs and then present a claim to your provider.

If you exceed the annual limit for your plan, you will encounter a coverage gap. If this happens, you will have to pay more for your medications during the gap period.

Medicare Part D requires a monthly premium. In some cases, it is in addition to your Part B premium, and in other cases it is a part of your Medicare Advantage premium. Rates will vary according to provider. A small group of people with higher incomes may be required to pay higher premiums.

In addition to the monthly premium, you may have an annual deductible. Other possible costs include copayments or coinsurance. If you are on a limited budget, you may qualify for Extra Help to pay for your drug coverage.

If you are eligible for Medicare Part D, it is important that you enroll at your first opportunity. Otherwise, you may suffer a penalty.

On average a each state has about 30 different plans to select from. Some states have over 40. Each plan will be different. Each will cover different drugs, pay different percentages and have different deductibles. The main thing you can count on is that each will have different premiums.

People receiving Medicare should take some time to catalog all the prescriptions that they take so they will have a ready list to begin this process. If you set aside the time to compare plans and see which plan covers all your medications, you will save your self a lot of money over the course of the year.

There are also many changes that have taken place this year that will affect Medicare Part D in 2011. if you have an income over $85,000 single or double that for a couple you will see an increase to your premiums this year.

The rules concerning the dounut hole in coverage is also different. Once a person reaches the limit of $2840.00 in prescription costs they enter the gap period where no plan pays for coverage until the medication costs exceed $6440.00. Starting in 2011, people in the gap area will only have to pay 50% of name brand drugs and will receive a 7% discount on generic drugs until the fill the gap requirements. After the gap period recipients will never pay more than 5% of the cost for their drugs. Low income recipients can contact their local Social Security Office and apply for the Extra Help Program to help cover the costs of the gap.

The best thing to do is take the time to review the policies being offered. There have been many changes in the insurance industry over the last year. Many companies have closed as well as many new ones have opened. By taking the time to review these new plans carefully you will guarantee that you will only pay what is necessary for proper coverage.

There are 12 different supplements offered, Plans A-L, and a careful examination of each policy will help you decide which supplement(s) are best for you. As a rule, supplemental insurance covers one individual only. If you are married each spouse will have to purchase their own supplemental insurance.

Medigap plans do not work with any other type of health insurance. This includes the Medicare Advantage Plans, Veteran Benefit Plans or private retirement insurance plans purchased through an employer or union.

Medigap policies cover expenses that Medicare Part A & B do not cover as well as offers additional benefits. Usage of this gap insurance will help with copayments, deductibles and also pay additional costs on some procedures that Medicare does not fully cover. Medigap insurance does not cover vision or dental work, long term care such as nursing homes and will not cover the cost of a private nurse for in home recovery. You can not be denied coverage by an insurer during the open enrollment period each year. Otherwise if you change coverage during any other time of the year you have the chance of being denied due to health reasons.

Usually when you have Medicare part A you will have Medicare Part B. You will be required to pay for the coverage for Medicare part B as well as any Medigap insurance that you purchase. Medigap prices vary from company to company, it is wise to shop for the best deal.

By law, each Medicare supplement plan must offer the same benefits from each company. So, in short, all Part A’s will be the same from each company, all part B’s etc. The difference will be in the pricing that each insurer charges. This also gives the insurance company a chance to only offer specific plans or to offer all the plans.

It is very important that when you choose a medigap coverage policy that you understand what you are paying for. It is crucial that you examine the price and offerings each supplement will offer and base your choice on your specific needs. Again, each company has to offer the exact same coverage within each supplemental plan, but they are free to charge whatever they like for the plan.

Due to the current changes that are taking place in Washington DC regarding health care coverage and Medicare coverage, medigap insurance needs may be expanding. It is too early to tell if there will be major changes in Medicare but you, as a consumer, should be aware of how the new health care reform may affect your coverage.

If you are receiving Social Security checks, your enrollment into the program will be automatic. The Medicare card will come three months before your 65th birthday. The benefits will be on the first day of the first month of the 65th birthday. If you are not automatically enrolled, contact the Social Security Administration office at (800) 772-1213 to receive benefits.

What Should I Expect to Receive When I Become Eligible?

There are four different parts of Medicare. However, the two most common parts include Hospital Insurance (Part A) or Medical Insurance (Part B). Medicare Prescription Drug Plan will also add a drug plan in Part D coverage. Part C combines Part A and Part B in a Medical Advantage Plan. Each portion of the Medicare Benefits will be explained below:

Medicare Part A: Hospital Insurance

Part A of Medicare covers inpatient care and critical access hospitals. Skilled nursing facilities, hospice care and other home health is covered with this particular part of Medicare. Custodial or long-term care is not covered by Part A of Medicare. Part A of Medicare is covered for free if you have worked and paid for through Medicare taxes while working. You can find out your eligibility by contacting the Social Security office.

Medicare Part B: Medical Insurance

Medicare Part A does not cover doctor’s services and outpatient hospital care. Part B will pay for covered services and supplies when they are medically necessary. The costs for Part B will vary depending on the private insurance carrier chosen to cover this portion. If you have an income of $85,000 or less, you will not have an increase in Part B premium for 2011.

In 2011, the standard premium for Medicare Part B is $115.40. This cost is a 4.5% increase over the 2010 costs for Part B. If you do not select Part B when you first become 65, then the premiums may be higher. The cost may be increase by 10% each calendar year after you are 65 and do not sign up, except in special cases.

Medicare Part C:

Medicare Advantage Plans are private Medicare approved health plans for those individuals eligible for Medicare. You are still in Medicare. However, you may receive private coverage with Medicare costs. Each plan will charge different out of pocket costs and have different networks for doctors that you must see to get care.

Medicare Part D:

Medicare Part D is a prescription drug coverage insurance program. Most people coverage by this insurance may have to pay a premium for this coverage. All medically necessary drugs will be covered under this program. The different drug plans will be best suited to your needs. Once the patient reaches a certain amount, the prescription drug insurance will experience a gap until an out-of-pocket amount is met. Then, the insurance will resume coverage after this amount is reached.

Welcome to Medicare Physical Exam

Those that are new to Medicare will need to schedule a Medicare physical exam as a preventative measure. This will also help you determine any other preventative tests that you may need to receive. Each eligible patient will need to take advantage of this exam.

Conclusion

Patients on Medicare may still be required to pay co-insurance, deductibles or co-pays. A medi-gap policy may be necessary to cover these costs. Overall, Medicare can provide coverage necessary to ensure the health needs of the patient are met. Each patient at the age of 65 should make every effort to enroll before the prices of Medicare increases.

The Social Security Administration is the agency that handles the paperwork when applying for benefits. When an individual becomes eligible for Medicare, the first thing they need to know is that the Original Medicare coverage is Part A and Part B. Part A pays for inpatient care and Part B pays for outpatient care and physician visits. Some benefits not covered by Original Medicare are most dental care, routine eye care, cosmetic surgery, chiropractor service, custodial care, routine foot care, acupuncture and most care while traveling out of the United States.

There are several key points worth knowing about Medicare. One point is there are two ways in which to get Original Medicare. A recipient can select Original Medicare on its own, and as an option add prescription drug coverage and include Medigap for coverage for more complete coverage. The other way is to select a Medicare Advantage plan that bundles extra benefits, normally obtained through an insurance company. Another key point is although Original Medicare does not include prescription drug coverage it is available. However, a Part D is available that does cover prescriptions. Everyone contributes to Medicare through paying taxes while working.

However, when an individual starts using Medicare they are responsible for paying a share of covered benefits thorough terms such as monthly premiums, coinsurance, deductibles and copayments. It is necessary to understand what the terms mean. The term premium means the cost paid to participate. The term deductible means the amount one has to pay before the plan pays. The term copayment means the share paid for a medical expense. The term coinsurance means the percentage of health care costs that are split with the plan. Understanding Medicare costs is essential in order to receive the right benefits for each individual situation.

An additional key point is that the share of the Medicare costs may be larger than anticipated. Medicare simply does not cover some expenses. Many individuals prefer to add extra coverage through a supplement plan to help fill in the gaps of coverage. Since, Original Medicare does not cover everything individuals, can enroll in Part C a Medicare Advantage Plan, Part D a Medicare Prescription Plan, and/or Medigap a Medicare Supplement Plan to help defer some of the costs not covered by Original Medicare. Medicare Advantage plans may also include coverage for vision, dental, prescription, preventive and hearing along with all the services associated with Original Medicare coverage. Part D plans help pay for the cost of prescriptions. Supplement plans help with some of the medical costs not covered by Original Medicare. There are also programs available to help individuals with limited incomes with the cost of Medicare.

Many people do not realize that where they reside makes a difference. Although Original Medicare is the same across the U.S., other parts offered are by private insurance companies and may be available only in certain states. Timing is a key point to remember. Enrollment to join begins three months prior to your 65th birthday or the date of eligibility due to a disability. If an individual, who qualifies for coverage waits until after the eligibility period ends, the choices may be more limited and the premium may be higher. Since plan choices do not have to be permanent, it is certainly a great idea to review health care needs at least once per year. Need may change over time. A good tip to remember is that the coverage selected can be change each year, and a new plan selected, but only during the annual enrollment period. Therefore, it is an excellent idea to review health care coverage each year to check that it still meets the required health needs and provides adequate coverage.

Last of all; do not be afraid to ask for help. Understanding the basics, about Medicare and what the plan includes so the selection will be the right plan and coverage needed.

Medicare Part A

In order for insurance companies to sell Medicare supplement insurance, they must also sell Medicare Part A. With Part A, Medicare recipients receive payments for hospitalizations. It will also pay if they need to go into a nursing home or a hospice, and it will pay for the medical professionals who tend to them in their homes.

Medicare Part B

Medicare Part B is the medical insurance policy that people receive when they turn 65. This insurance covers office visits, any outpatient hospital procedures and any care that needs to provided in the home by medical professionals. Some preventative care will also be covered by Medicare Part B coverage. In order to purchase Medicare supplement insurance, people must have either Medicare Part A or Part B.

Medicare Part C or Medicare Part F

Insurance companies that offer Medicare supplement insurance are required to sell Medicare Part C or Medicare Part F. Medicare Part C is Medicare insurance coverage that works with Medicare to administer the insured their Medicare Part A and Part B benefits. It is also called the Medicare Advantage Plan and may be offered through a health maintenance organization (HMO).

Medicare Part F is the Medicare supplement insurance that will pay the portion that Medicare Part B doesn’t cover. Without the supplement, Medicare would pay a portion of the physician’s fee for an office visit, for example. The patient would be required to pay the difference, but those patients who have Medicare Part F will have the difference covered.

What Medicare Supplement Insurance Does Not Cover

Before people decide to purchase a Medicare supplement insurance policy, they must be aware of what they will not receive from any of these policies. Although Part A will cover the costs of a nursing home, Medicare supplement policies don’t cover this type of care for the long term. These plans also won’t be available to cover the costs of vision care, dental care, for hearing aids or glasses.

Guaranteed Coverage by Medicare Supplement Insurance

Insurance companies may be obligated to sell Medicare recipients Medicare supplement insurance under certain conditions; one time when this is true is if it’s the open enrollment period. The open enrollment period allows people to purchase any Medicare supplement insurance from the first month that they become eligible to receive Medicare Part B; the open enrollment period lasts for six months. The second qualifying criterion is that the Medicare recipient is 65 years of age.

How Medicare Supplement Insurance Plans Work

When people have a Medicare supplement insurance plan from a private insurance company, their policies will work much like other private insurance plans. The Medicare supplement will require that these patients pay a premium every month just like they do for their Medicare Part B coverage. They must also remember that spouses aren’t allowed to be on the same policy; if a husband purchases a Medigap policy, his wife will have to purchase her own, too.

An Advantage of Medicare Supplement Insurance

One of the biggest advantages of Medicare supplement insurance is that it can’t be taken away from the person who has purchased it. This means that it must be renewed, even if the patient has health issues. This won’t be true if the patient lied on the application, committed fraud in any other way or ceased to pay the premiums each month.

A Medicare supplement helps to cover the portion of the medical bills that Medicare isn’t obligated to pay, and is insurance that is made easy for Medicare recipients to purchase. It also helps to keep Medicare recipients covered for the gaps because renewal is guaranteed. Insurance companies authorized to sell Medicare supplements can help people choose the right plan for them.

There are two available ways to get Medicare. One way is to choose Part A and Part B, which is the Original Medicare, and the other available option is to choose Part C, which is the Medicare Advantage plan. There are private insurance companies that offer these Medicare plans. Before choosing your plan, you first have to decide which company to go with.

Drug coverage

Drug coverage is now available in Medicare. If you have the Medicare Advantage plan, you will have the option to include Part D, which is the prescription drug coverage. If you have the Original Medicare coverage, you can include it in your plan by enrolling in a standalone Part D.

Unless you qualify for an exception, not signing up for Part D as soon as you become eligible for Medicare could result in a penalty on your premium.

Your share of the cost

Although some of the money you pay for taxes goes to Medicare, you will still have to pay a share of the cost. Reason being, the taxes do not cover the cost of the benefits you are now receiving, so to maintain all benefits you will have to pay a share of the cost.

What can affect your share of the cost

If you have Part A and Part B Medicare, you will notice that Medicare does not cover all expenses. Whenever you need serious help, a gap is created, and these gaps create large bills. To help with this problem, it is best to buy a Medicare Supplement Insurance policy. Another good alternative to consider is to choose the Medicare Advantage plan.

How will where you live affect your Medicare coverage

Across the United States, Part A and Part B Medicare plans will be the same, while Part C and Part D plans will be different. Some Part C and Part D plans will be available in only some areas due to the fact they are offered by private companies. However, there are some Part C and Part D plans that will have coverage nationwide.

In general, Medicare will not cover all of your expenses. You will quickly realize that each Medicare plan will have advantages (expenses that are covered) and disadvantages (expenses that are not covered).

Check your current health coverage

Look at your health coverage and see how Medicare will fit in with it.

Take heed to this

When considering getting Medicare coverage, timing does matter. You will become eligible for Medicare right before you turn 65 or due to disability. For those that decide to wait to join, they may find that waiting is what led to them paying more while having fewer choices.

Reviewing your coverage

You are not stuck with your Medicare coverage. Every year, you are able to change your Medicare coverage.

Do not be shy

Do not be afraid to ask for help. Help is always available for those that need it with making Medicare choices, and for those that have little income and (or) assets.

Remaining the same as in 2010, there are two choices for prescription drug plans; supplemental plans working to fill the gap between Medicare and actual costs. At open enrollment, the consumer can decide which coverage to use, or whether to use a drug plan at all. The choices are the Medicare prescription drug plan or Medicare Advantage (MA). These plans have various premiums amounts based on the retiree’s annual income. With all the changes made to Medicare this year, it is difficult to understand certain areas such as the prescription plan changes; however, the Medicare website (www.medicare.gov) is very helpful when choosing the types of coverage desired.

An aspect that changed, within those two plans in 2011, is how spending affects the donut hole. (The donut hole occurs when deductibles are met and prior to catastrophic insurance kicking in.) This year the pharmaceutical companies will discount brand name drugs by 50%, thereby reducing out of pocket costs to the participant. Lawmakers are hopeful the changes will benefit those who reach the donut hole threshold early in the year. In the past, once the donut hole period began the insured participant paid 25% of drug costs and remained in the donut hole until the catastrophic plan was available. Now with the pharmaceutical’s help, the insured will only pay 50% of the cost. In addition, there is no longer a $10 co-pay and $310 deductible. Sounds like a neat little package all tied up and easy to understand. It would be except there are some confusing caveats that affect how and when costs are reimbursed. The consumer can find helpful Medicare articles and handbooks, blogs, FAQs, toll-free help, and calculators on the Medicare website to decide which plan is best for them and what they might spend on prescriptions in 2011.

There are others ways to save on prescription drugs. The consumer may ask their doctor to prescribe generic drugs or a cheaper drug that will still meet the requirements. For maintenance drugs, try the three-month mail-in plans, which are generally cheaper. And for those who are low income, there are assistance programs such as State Pharmaceutical Assistance Programs (SPAP), community and faith based programs, and some pharmaceutical manufacturers offer deeper discounts to low income families to help with the costs.