Medicare – What’s it All About?

 Medicare  is a government regulated healthcare program for those 65 and older. You’ll probably be on it, so it’s important to understand how it works.

In this article I summarize the different parts and coverages that come under the  Medicare  program.

 Medicare  is a program with different parts. Only the first – Part A – is free if you contributed enough FICA over the years. The other parts each cost an amount depending on your income and choices of ‘supplemental coverage’ they offer.

Let’s take a look at what each part is about.  Medicare  is divided into components:

Part A – hospital insurance

Part B – medical insurance (this is optional)

Part C – additional insurance coverage

Part D – offers voluntary prescription drug coverage offered via private vendors

Part A is called hospital insurance. It covers most costs of your stay in the hospital as well as some follow-up costs after being in the hospital. It also pays some outpatient medical services, including medically necessary equipment and supplies, home health care, and physical therapy. Under most circumstances (if you’ve paid enough FICA taxes), you don’t have to pay a premium for Part A.

Part B is medical insurance. It’s optional. If you elect it, the monthly premium is deducted from your Social Security check automatically. It provides for certain out-of-hospital treatments and is intended to help pay doctor’s bills for treatment in or out of the hospital. It also covers many other medical expenses you incur when you’re not in the hospital, such as the costs of necessary medical equipment and tests.

 Medicare  Part B has spawned additional insurance coverages to supplement what it and part A don’t cover. The first is the ‘Original  Medicare  Plan’. Here, you pay your Part B monthly premium and then pay for additional services as you use them. With this plan you might also choose to buy  Medicare  Supplement Insurance, or “Medigap” insurance. The term Medigap implies that these insurance policies will cover the gaps in  Medicare  payments. Medigap doesn’t fill all the gaps, but it helps. More types of coverages are relegated to part C.

Part C:  Medicare  Managed Care and Private Fee-for-Service plans are offered by private insurance companies. Managed care plans generally fall into two main varieties:

1) health maintenance organizations (HMOs) and

2) preferred provider organizations (PPOs).

HMOs are generally less expensive than PPOs but usually more restrictive in their services and choice of doctors.

With these latter two plans in Part C, you must still continue to pay your Part B premiums, and you may also have to pay an additional premium to the insurance company as well as any related deductible or co-insurance payments. However, the services you receive may be more comprehensive than those offered through the Original  Medicare  Plan.

 Medicare  Part D requires you to join a Medical Drug Plan (MDP) in either of two categories of such plans:

1. You can join one of the  Medicare  Prescription Drug Plans (called PDPs). These plans add drug coverage to either of your Original  Medicare  Plan, some  Medicare  Cost Plans, some  Medicare  Private Fee-for-Service (PFFS) plans, and  Medicare  Medical Savings Account (MSA) plans. Or

2. Join a Medical Advantage Plan – like a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) or some other Medical health plan that includes prescription drug coverage.

Through these plans, you get all your  Medicare  coverage of Part A and Part B including prescription drugs (Part D). These Plans are called ‘MA-PDs’

In either category you’ll usually pay a separate monthly premium for the drug coverage in addition to your Part B premium.

After joining a specific MDP, the plan mails you membership materials including a card to use when you get your prescriptions filled. When you use the card, you may have to pay a copayment, coinsurance, or a deductible amount depending on your plan

What to consider when comparing which MDP to choose:

Look for the Coverage, Cost and Convenience to you from each plan. These will be different.

Coverage – check if the type of prescription you want comes under that plan.

Cost – see what costs and payment schedule that plan offers you.

Convenience – make sure the plan’s pharmacies include the ones you want to use.

You can switch your plan each your from November 15 to December 31.

Be sure to apply for  Medicare  coverage three months before your 65th birthday so you can start it when you turn 65.

If you’re on Medicaid, they’ll automatically enroll you in a MDP if you don’t join yourself. Under Medicaid, in most cases, you’ll pay from nothing to about $5.60 out-of-pocket for each covered drug.

Winter Health Tips

As winter sets in, we are becoming more prone to infection and fever. It is important that we be extra cautious about what we eat and do this winter. It is mandatory that we follow the winter health tips religiously as certain changes occur in our bodies as the barometers dip. These changes are more pronounced in the temperate zone where the temperatures are in the freezing range.

It is very common to hear parents complaining that their child has yet another runny nose. Others abhor the winter and the allergies they set in. While that may be true, the more important question is, what you can do to prevent in the first place.

Here are some winter health tips to help you brace yourself for the winter:

Strengthen the immune system with a balanced diet. Vegetables and fruits are important all 365 days of theyear.Look for fresh produce and seasonal items, as far as possible. Steam cooks the veggies if you can’t eat them raw due to cold weather. Hot broths and cooked vegetable salads can be a part of a healthy meal. Dry fruits and nuts can be used as a snack. They not only provide energy but are also filled with nutrients. Carbohydrates are needed for energy and strength. So include brown rice, whole wheat bread, rotis or porridge in your meals.

One of the ayurvedic winter health tips is that green tea or herbal tea with or without honey keeps you warm in the mid morning or mid evening. Some spice like pepper, ginger and garlic are believed to give warmth during winter.

Our bodies generate a lot of energy as a protection against the cold weather and chilly nights. Hence one of the most important winter health tips is to stay hydrated. Apart from water, warm soups can be taken during meals or during snack time. Though alcohol can give warmth, don’t go overboard with it. If you must drink alcohol, take it in small quantities occasionally. Don’t use alcohol as a stress buster or to forget your worries.

Exercise is important. It not only burns calories but also keeps you warm and uplifts your mood. You need extra exercise if you have indulged in those tempting hot and high fat comfort foods. An active warm up is essential. The activity needs to be sufficiently energetic and prolonged to ensure that the whole body is warm. The activity can vary from a stretches of the lower limb muscles to a brisk walk or jog for 15 to 20 minutes.

A hot shower is very comforting. Massage of the body has several psychological benefits and is soothing. Finally, dress appropriately. Avoid overheating.

The above winter health tips will ensure that allergies and cold will be kept at bay to help you to remain healthy and trouble free through the winter.

The Real "Advantage" of Medicare Part C Advantage Plans

In the late 1990’s the United States government had a wonderful idea to begin to privatize  Medicare . The Balanced Budget Act of 1997 created new  health  care options for  Medicare  recipients by way of  Medicare  + Choice. This was later renamed  Medicare  Advantage. This  Medicare  + Choice or  Medicare  Advantage was designed to give senior citizens more options on how to receive their hard earned  Medicare  benefits. Having the right to choose is the American way and this bill was pushed through congress on that idea. This gave senior citizens the right to choose Part C Advantage private insurance and opt out of traditional  Medicare  part A and B. The privatization of Social Security benefits has led to a plethora of problems including: greater cost to the U.S. government, limited healthcare options for Part C Advantage recipients, and unscrupulous Part C Advantage companies.

The cost of  Medicare  is on the precipice of bankrupting the social security system of the United States. The United States spends 599 billion or 20% of federal spending on  Medicare , this number will increase as the baby boom generation reaches retirement. The hope that privatizing  Medicare  Part A and B would reduce Social Security Spending has been proven incorrect. In actuality it costs the Social Security system more for an individual with  Medicare  Advantage than traditional  Medicare  Part A and B. According to a study in September 2010 it costs the U.S. government $1,140 more per enrollee than it would cost for the same number of patients under traditional  Medicare . This is the type of spending that must be curtailed to save the  Medicare  system.

Part C Advantage Plans are organized very similar to the major medical health insurance most U.S. citizens have had their entire life. Advantage plans have coverage areas, network doctors, and coverage limits. These healthcare limitations are something most working Americans are expecting and deal with without any complications. Senior citizens are opting out of traditional  Medicare , perhaps the best  health  care in the world, for private insurance that has significant limitations. Most  Medicare  Advantage recipients do not realize that they have been taken off of  Medicare  Part A and B until they become ill and cannot see the doctor or receive the treatment they need. The  Medicare  advantage plans do not offer senior citizens a better form of  health  care.

The  Medicare  insurance part C Advantage program is government funding of private insurance for individuals that opt out of  Medicare  Part A and B. These private insurance companies are in business to make money just like every other company. To do this they must keep costs down and bring in as much revenue as possible. This does not bode well for the Part C recipients, they find themselves fighting private insurance for benefits and having to cut through an endless supply of red tape.  Medicare  Advantage insurance companies also hire very aggressive sales force to sell their wonderful program to senior citizens who need the protection of traditions  Medicare  now more than ever.

The balanced budget act of 1997 attempted to enact a privatization of  Medicare  that has been a complete failure. In reality: it cost the social security system more to administer, provided a lower class of benefits to  Medicare  recipients, and caused corruption in the  Medicare  system.  Medicare  Part A and B is the best healthcare program in the world and should be recognized as such.

What is Covered by Medicare?

In 2007 over 40 million United States citizens used some form of  Medicare  to help them pay for their medical treatment.  Medicare  is a form of heath insurance, created by the federal government, to help those that are disabled or over the age of 65. It offers several different categories of benefits. Part B of  Medicare  covers visits to doctor’s offices and durable home medical equipment.

Durable medical equipment refers to medical equipment that can be re-used and does not have to be discarded. Things such as walkers, crutches, and wheelchairs are examples of durable medical equipment. In order to receive compensation for this type of home medical equipment, it must be deemed medically necessary. This typically involves only a prescription from a doctor, but for certain types of equipment it is necessary to have your doctor fill out a Certificate of Medical Necessity. This is a very simple form that in essence is just a more detailed prescription. Some items that require this form are oxygen equipment and supplies, patient lifts, and bone growth stimulators.

After the patient has met the yearly deductible, $135 in 2008, they are eligible to have their medical equipment covered. There are many different types of durable medical equipment that is covered by  Medicare  and generally they will cover 80% of the cost. The patient is then responsible for the remaining 20%.  Medicare  also covers the rental of durable medical equipment. For some smaller items  Medicare  will only pay the cost of the item in rental fees, so it may be a good idea to go ahead and purchase these types of items. For other larger items like hospital beds or oxygen equipment,  Medicare  will pay rental fees for a certain amount of time, 13 months and 36 months respectively, after which time you will own the device. They will continue to maintain the devices for you in cases where you rented to own. Many times  Medicare  will also cover 80% of the repair cost of your equipment.

Power wheelchairs and mobility scooters are one type of durable medical equipment that is covered by  Medicare . In order to have  Medicare  cover the costs of these devices, it is necessary to have a doctor’s prescription. The device must also be for use in the home. If the device is only needed for use outside of the home, then it will not be covered.

Another type of device that is partially covered by  Medicare  is the lift chair. This falls into the category of a patient lift, so it will require your doctor to fill out a Certificate of Medical Necessity. In addition it is necessary for the lift to allow the person to stand completely on their own without outside assistance. The only part of the lift chair that is covered by  Medicare  is the actual lift mechanism, which usually amounts to at most $300.

A large amount of other products are also covered. This includes things like prosthetics, pneumatic compression devices, and under certain situations glasses. Typically if you have  Medicare  and are covered by Part B benefits, you can purchase the item and then submit the receipt, a doctor’s prescription, and a Certificate of Medical Necessity to  Medicare . They will then mail you a check. For a complete list of what is covered, check out their site.

What Should Be There in the Best Medicare Supplemental Plans?

The best  Medicare  supplemental insurance plans covers up for out of pocket expenses not reimbursed by regular insurance. These out of pocket expenses include co payments, deductibles and coinsurance. Some plans pay for these expenses paid from the pocket, while other provide with a cash benefit paid over a time period or given to the person in lump sum amount.

This lump sum amount can be utilized to cover for lost wages, expenditure in transportation due to medical treatment, or to pay for medication, food and other expenses which one may not expect due to injury or illness.

Best  Medicare  Supplemental Insurance Plans

People who are already enrolled in  Medicare  can also eligible to enroll in supplemental insurance, which are sold and marketed by private companies. Traditional  Medicare  (which includes hospital insurance under Part A and medical insurance under Part B) pays for most, but not all, services related to  health  and medical supplies.

A best  Medicare  supplemental insurance plan must be able to cover for “gaps” left out by traditional  Medicare  such as deductibles, coinsurance and co payments. These expenditures can really add up particularly for people who are hospitalized or require skilled nursing home services. This plan also pays for medical services a person seeks outside the country and preventive services not approved by  Medicare .

People who are enrolled in Part A and B of  Medicare  and also in best  Medicare  supplemental insurance plan, the  Medicare  first pays its share of approved medical services and then Medigap pays its share of the cost.

Types of Supplemental Insurance

Other than Medigap, there are three types of supplemental plans that are widely sold in the country. These policies are either available as voluntary benefit from the employer or one can enroll directly through an insurance company.

Critical Illness Insurance

Disease specific or critical illness insurance is designed to provide financial backup to people with serious illness, like cancer. These plans provide a lump sum amount to help people take care of additional expenditure related to illness but not provided in regular insurance or disability plan. Depending on the plan, it can be utilized to pay for:

  • Specialists not in the network
  • Deductibles
  • House hold help and child care
  • Travel and lodging to get the treatment at far off place
  • Experimental treatment
  • Daily expenses such as utility bills, car payments and groceries

Accidental Death Plan in Best  Medicare  Supplemental Insurance

Accident plans are of two types, including Accident Health Insurance, and Accidental Death and Dismemberment Insurance. They are often sold together. Due to variation in local regulations the benefits differ from one state to another.

Accident health insurance or accident hospital indemnity policy pays for medical expenditure resulting due to an accident which is not approved under regular health plans. These plans also reimburse for extended services in homecare, and lodging and travel expenditure of family members.

An accidental death and dismemberment policy gives a lump sum amount to the beneficiary of the person who died in an accident. The plan also provides benefits, however smaller to people who did not lose their life but lost a limb, suffered permanent paralysis or eyesight. AD&D does not cover for deaths related to suicide, illness or natural death.

Hospital Indemnity Insurance

Hospital confinement or indemnity insurance offers cash benefit to people who are confined to a hospital due to serious injury or illness. The person can receive the benefit as a lump sum amount or as a weekly or daily payment; there is, however, a minimum waiting period for the benefit to start. Just like other best  Medicare  supplemental insurance, the extra benefits are there to pay for services and for services not approved by regular coverage.

Caveat Emptor – Are you enrolling in extra coverage?

Insurance companies spend a huge amount in promoting their insurance products through direct to consumer advertising. Many Americans are aware of a flac duck, an advertising campaign that assisted a flac in becoming the biggest provider for supplement products in the country.

A best  Medicare  supplemental insurance is quite economical, but it is totally unnecessary to have duplicate coverage. People who are at or above 65 years of age and are enrolled in  Medicare , one can get the full coverage by purchasing a regular Medigap plan or by purchasing an advantage plan.

The first step is to ensure that you and your family are protected with a regular coverage. People, who are searching for best  Medicare  supplemental insurance plan, should have answers to the following questions:

  • If you or any of your family members develops serious illness or meet with an accident, will the current coverage sufficient to cover for the treatment?
  • What is the probability that you or one of your family members will develop a major illness or serious accident?
  • Is it of any worth to pay for best  Medicare  supplemental insurance over time?

Apart from this, before you sign a supplement insurance contract, it is crucial to understand the benefits and limitation of such plans. For instance, every supplement plan has its own restrictions, the applicant may be asked to wait for sometime before the coverage starts or may have limit on how much can be reimbursed for how long.

Affordable Senior Health Insurance

Recently affordable senior health Insurance coverage has been a big topic as a saving grace for those who can least afford high medical cost. With the skyrocketing cost of   health  care senior citizens have a way to help pay some of their the costs of  health  care that are not covered by the original  medicare   health  plan with supplemental insurance officially called “Medigap Policies”. The reasons these policies may prove beneficial are that they assist senior citizens who can least afford it from incurring bills they can’t pay or from being denied care when needed.

A Medigap policy is health insurance that’s sold by private insurance companies, each insurance company decides which Medigap policies it chooses to sell. The good thing is that these health plans for seniors are the same from one supplemental health insurance company to the other. You can choose from up to 12 different standardized Medigap policies, letters for Plans A to L are used to identify each policy. The supplemental benefits in any Medigap Plan are the same for any insurance company. These letters A-L also denote basic and extra supplemental benefit levels. Once you decide on a affordable level of insurance that meets your needs the only difference will be the costs not the plan. Also these senior citizen policies must follow Federal and State laws that are mandated to protect you.

This standard was set specifically to prevent confusion and most importantly to make comparison easy. A Medigap policy must be clearly identified on the cover as “ Medicare  Supplement Insurance.” You can effectively do a search online and compare the costs of providers you may consider knowing that the health plans offered by all potential companies are the same and that they offer identical supplemental benefits. This is why to get the most affordable senior citizen supplemental health insurance rates it is critical to compare Medigap insurance policies as rates widely vary.

Basic supplemental benefits are covered by each of the 12 Medigap policies while additional benefits are determined according to the plan you choose. For example supplemental Plan A is the most basic. Everything in Plan A is offered in Plans B through L, with these plans offering even more coverage. You will find cost sharing, depending on the level is different for Plans A to J and Plans K to L but that the services offered are similar.

In the event of serious illness or accident, especially for persons who did not sock away a substantial retirement fund during their working years, having to pay the amount that is left after  Medicare  and Medicaid have paid their share could be catastrophic. For senior citizens a policy that can take care of most of what government insurance plans for seniors do not has many benefits and deserves a look.

Supplemental health insurance for seniors is not too expensive and generally affordable. Just remember it is very important that you compare the policies offered by different insurance companies. Whether you do it locally or easily on line this task should not be skipped, compare. After doing some research you may find that not only is it affordable, senior health insurance is something you can not afford not to have.

South Carolina Medicare Supplements – The 2010 Plans

In March of this year, the Centers for  Medicare  and Medicaid Services announced changes to the current  Medicare  Supplement plans.

This affects new South Carolina  Medicare  Supplement plans in several significant ways. Existing  Medicare  Supplement policyholders will not be affected by the changes, so if you have a  Medicare  Supplement currently, you do not need to be concerned with the upcoming 2010 plans changes.

However, those going on  Medicare  after June of 2010, or those wishing to replace current coverage with new coverage, will fall under the guidelines of the new plans.

A summary of the changes and how they affect the South Carolina  Medicare  plans follows:

  • Plans E, H, I and J will be eliminated completely.
  • A Hospice benefit will be included in all new plans sold after 6/1/2010. This will be a “core” benefit.
  • Preventive Care and At Home Recovery will be removed from all of the plans that included them.
  • Plans M and N will be added and made available for sale. This is, quite possibly, the most significant change that wil occur with the 2010 Medigap plans revisions. Plan M and N will both use cost-sharing – co-pays and deductibles – which will allow them to have lower monthly premiums. With Plan M, the insured will be responsible for 50% of the Part A (hospital) deductible. With Plan N, the insured will have a $20 doctor’s office co-pay and a $50 emergency room co-pay. Both plans project to have premiums 15-30% lower per month than current Plan F premiums.

All companies that offer South Carolina  Medicare  Supplements are required to adhere to the new 2010 plans. Again, existing policyholders will not be affected by the changes. If you are turning 65, or going on  Medicare , after 6/1/2010, however, it is advisable that you investigate the new plans. When you are comparing options, make sure that you are viewing an updated 2010 chart (instead of the old charts that will be outdated as of 6/1/2010).

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How To Get Medicare Supplement Quotes

If you’re reading this article, it means that you are either a senior age 65+ looking to fill the gaps in your current Medicare coverage, or are someone researching for someone who is. Either way, you will find some resources here in this article to help you get the cheapest Medicare Supplement Quotes, and compare them with different companies.

The most easiest way to get a quote is simply by choosing an insurance agency or brokerage you feel comfortable with, and asking them for a quote. If after you receive a quote, you are not satisfied with the premium amount, you can move on to another company of your choosing and asking them for another quote. However, if you think the premium you received is affordable, then you can apply for coverage right then and there depending on your current health status.

Usually when you get a quote, a brokerage will list the top 10 companies with “A” ratings for you, and they will do the shopping for you so you don’t have to. They will list the companies side by side, and give you premiums for each, and give you a background on each insurance company. Some of the companies listed will more than likely include; Mutual of Omaha, Blue Cross Blue Shield, Aetna, Gerber, United of Omaha, Sentinel Life, United Healthcare, and Woodmen of the World. All these companies have “A” ratings, so you should keep that in mind to see if the brokerage you are working with gives you quotes for these companies. United of Omaha typically is always the most affordable, depending on your health.

Allowing a Medicare Supplement Insurance brokerage to help you in your search for the cheapest quotes will not only save you time, but save you from headaches and hassles as well. This is the best route to take, and in the end save you the most money. If you are unsure about which brokerage to call or contact to help you, you can just search on Google for a local one, and see if they can assist you with getting Medicare Supplement Quotes.

Currently, there are certain issues that may increase your initial premium. The funding that Medicare receives, for example, could affect private supplement insurance policies, as well as Medicare expansion (which may reduce or increase premiums). But the brokerage you choose will go over all this with you once you sit down and talk with them.

Medicare Advantage – Part C Basics

 Medicare  Part C, also known as  Medicare  Advantage, is a  health  plan supplied by  Medicare-approved  private companies.  Medicare  Part C is often chosen by people who cannot qualify for premium-free  Medicare  Part A/Part B coverage, or by those who have special needs or want additional coverage. Since the plans are offered by multiple companies, the insured has many choices, and can select the coverage, the benefits, the rules and the costs best for him or her.

 Medicare  Advantage plans have many of the same choices as non-Medicare  health  insurance. Options are available for PPO (Preferred Provider Organization) plans, HMO (Health Maintenance Organization) plans, MSA (Medical Savings Account) plans and more.

Part C is also popularly known as “ Medicare  + choice” because of the advantages this plan provides.  Medicare  Advantage plans must cover everything that original Medicarea covers, with the exception of hospice care. (This is because  Medicare  Part A still covers hospice, even if you elect to participate in a  Medicare  Advantage plan.) With Part C, the  Medicare  Advantage plan also typically covers doctor prescribed medications, some hearing aids, glasses and walking aids like walkers or canes. Some plans offer coverage for dental work, vision testing and glasses, hearing aids, and even preventive health-and-wellness programs. Many Part C plans include prescription drug coverage.

 Medicare  Part C, paired with private  health  insurance companies, can help provide much greater coverage than Part A and Part B alone would offer. The only difference is that it usually costs more to enroll with some of the health insurance companies to get the additional benefits and coverage. Also, because  Medicare  Part C works with private insurance companies, the plans and fees are subject to change annually. There is always the chance that your plan provider could decide to stop participating in  Medicare . If this occurs, you will have to rejoin a different  Medicare   health  plan or return to being covered by original  Medicare  only.

Because  Medicare  Part C/Advantage plans must be approved by  Medicare , and work in conjunction with Part A and Part B, the rules for eligibility are very similar to Part A and Part B. You can enroll in  Medicare  three months before your 65th birthday through three months after the 65th birthday. With a few exceptions, you can join a  Medicare  Advantage plan even if you have pre-existing conditions. You are able to join a plan only during certain times of the year. Almost always, once you’ve enrolled, you are enrolled for a year until the next enrollment period.

Remember, while these plans have great benefits, they can be more costly. If you are interested in a  Medicare  Advantage/Part C plan, you should gather as much information as you can and weigh the monthly costs against the benefits carefully. When looking at the costs, you should be sure to ask whether the  Medicare  Part B premiums are included or must be paid separately. Every company and every plan offered can be different, so make sure you understand clearly all of the costs and rules that you are agreeing to. alicevbheatherta alicevbheatherta aliceananabinar aliceananabinar katherinehjjudith katherinehjjudith Agustus stable Edu