Question: What are Part A and Part B of Medicare? Medicare Part A (Hospital Insurance) helps pay for inpatient hospital care, some skilled nursing facility care, hospice care, and some home health care.   Your exposure with Medicare Part A includes a fairly hefty deductible per benefit period and co-pays for days 61+ in the hospital.  The part A benefit period is your stay in the hospital and 60 days after your release.  So, you could conceivably have to meet multiple part A deductibles within a calendar year.  The co-pays for days 61-90 is $267/day and the co-pays for days 91+ is $512/day.  So, as you can see it can get rather expensive if you have multiple hospital stays or extended stays in the hospital. Medicare Part B (Medical Insurance) helps pay for doctors’ services, outpatient hospital care, and some other medical services that Part A doesn’t cover. Part B helps pay for such covered services and supplies when they are medically necessary.  The part B deductible is relatively inexpensive compared to the Part A deductible and is a calendar year deductible.  However, once the deductible is met you will be responsible for 20% of your Medicare Part B-related expenses.  This can also get rather expensive if you are having to undergo major medical treatment. Question: How do I enroll in Medicare? 
  • If you already get Social Security Benefits, then you’ll be automatically enrolled in Medicare Parts A and B effective the first day of the month you turn age 65. Your Medicare Card will be mailed to you about 3 months before your 65th birthday. Enrollment in Part B is optional.
  • If you do NOT yet get the Social Security benefits, then you’ll need to apply for Medicare through Social Security three months before you turn 65 – at the start of Initial Enrollment Period.  An Initial Enrollment Period  is a 7-month period that begins 3 months before you turn 65, or, in the case of disability, 3 months before your 25th month of disability.  You can sign up anytime during the Initial Enrollment Period.   However, by waiting until you are 65 or later, your Medicare coverage will be delayed.  Enrollment in Part B is optional.
  • If you didn’t sign up for Medicare Part A or Part B during the Initial Enrollment Period, you may sign up during the next General Enrollment Period. This period runs from January 1 through March 31 of each year. The coverage will start on July 1 of the year you sign up.  If you aren’t eligible for premium-free Part A and didn’t buy Part A when you were first eligible, your monthly premium may go up 10%. You will have to pay the higher premium for twice the number of years you could have had Part A, but didn’t join. You will have to pay a higher Medicare Part B premium because you could have Medicare Part B and didn’t take it.  Actual increase is 10% for each full 12-month period that you were entitled for the Part B, and the penalty is as long as you have Part B.  You may avoid paying higher premium, if you are entitled for Special Enrollment Period (see below).
  Question: What is a Medicare Supplement plan?Medicare supplement insurance plan is a health insurance policy sold by private insurance companies. These Medicare supplement plans must follow federal and state laws. These laws protect you. The front of the Medicare supplement insurance plan material must clearly identify it as a “Medicare supplement insurance” plan. You might want to consider buying a Medicare Supplement Plan to cover the above described gaps in Original Medicare coverage. Some Medicare supplemental plans also cover benefits that the Original Medicare Plan doesn’t cover, like emergency health care while traveling outside the United States, At Home Recovery Services, and Preventive services that might not otherwise be covered by Medicare. A Medicare Supplement insurance plan may help you save on out of pocket costs. If you buy a Medicare supplemental insurance plan, you will pay a monthly premium to the private Medicare supplement insurance company that sells you the policy.  Medicare supplement plans do not have an open enrollment period.  This allows you to switch another Medicare supplement plan at any point throughout the year as long as you qualify medically. Question: Why do I Need a Medicare supplement or “Medigap” policy?   You may need to supplement Medicare Coverage for one or more of the following reasons:
  • Medicare was never designed to pay all the health care costs of the elderly.
  • Medicare coverage has many gaps.  For example, there are the hospital deductible is $1,132-per hospital stay.  For Part B expenses, you are responsible for 20% of the bills.
  • Medicare deductibles increase every year.
Question: What is Medicare drug coverage (Part D)? Starting January 1, 2006, new Medicare Part D drug coverage was available to all Medicare recipients. All Medicare recipients can get this coverage that can help lower drug costs and help protect against higher costs in the future. Medicare Part D drug coverage is a Medicare program run through private insurance companies. You choose the drug plan and pay a monthly premium.  Like Medicare Part B, if you decide not to enroll in a drug plan when you are first eligible, you will pay a penalty if you choose to join later. If you delay taking and don’t take Medicare part D when you are initially eligible your premium cost will go up at least 1% per month for every month that you wait to join.  You will have to pay this penalty as long as you have Medicare drug coverage. If you join by December 31 in any year your coverage will begin January 1 of the next year. Question: When is Medicare’s Initial Enrollment Period?  The Initial Enrollment Period begins 3 months before the month a beneficiary turns 65 and ends 3 months after the month the beneficiary turns 65. If beneficiaries wait until they are 65 or sign up during the last 3 months of the Initial Enrollment Period, their Medicare Part B start date will be delayed. Question: What are “open enrollment” and “guaranteed issue” in Medicare?  Open enrollment allows the applicant to be guaranteed a Medicare supplement insurance plan regardless of their current or past health history. Otherwise, the applicant must meet medical underwriting standards to qualify if required by the insurance company. Open enrollment includes a six-month period from the date you enrolled in Medicare Part B if age 65 or older, or a six-month period when you turn 65 if you were eligible for Part B benefits before age 65. Question: Do I have to wait to switch to a different Medicare supplement policy? No.  You are able to switch from one Medicare Supplement plan or company to another plan or company at any time during the year!   However, there maybe health questions that you might have to answer, depending on the carrier, how long you have had your previous Medigap policy, and your age. Question: Which type of Medigap plan is best for me? This depends on your personal preferences, needs and requirements. Consideration should be given to benefits, cost, your economic situation, and current health.  Which plan might best suite your individual needs?  Just call (215) 658-1776 and Allen can answer your questions and provide you with the information you need to make a wise healthcare choice