2014 Medicare Insurance Information Guide
What is Medicare? Original Medicare is health insurance coverage that’s managed by the federal government.
Medicare services:
Medicare is a medical health insurance plan which was established by Congress in 1965. Those who have paid 10 years of security taxes can take Medicare at the age of 65 or if you have certain disabilities. Medicare covers medically necessary healthcare services.
- Medicare includes an annual Part A Insurance deductible and an annual Medicare Part B deductible.
- Many Preventive Services.
- Check the “Medicare & You Handbook” for Medicare Insurance Coverage and Benefits
Who is Eligible For Medicare this year?
Medicare is health insurance provided to individuals 65 or older, people under 65 with certain disabilities, and all individuals with End State Renal Disease “ESRD”.
When will I receive Medicare Insurance coverage Part A and Part B?
Individuals under 65 and disabled will automatically receive Medicare insurance coverage after receiving disability payments for 24 months.
If you have ‘ALS’, the month your disability begins is the date you’ll receive Part A and Part B.
Does Medicare Have a Network of Providers?
Original Medicare doesn’t have a specific network of providers, such as an HMO. You can have services at facilities and providers who’re accepting new patients and belong to Medicare. You won’t need to choose a primary care physician (PCP). There’s no need to get a referral to see a specialist.
No need to worry about filing paperwork for covered services, facilities, or equipment. Filing Medicare claims is done by the providers.
Make sure your providers and facilities accept assignment. Most providers, such as doctors, specialist, and hospitals, sign an agreement to accept assignment for all Medicare-covered services.
What are the different parts of Medicare?
- Medicare Part A
- Medicare Part B
- Medicare Part C
- Medicare Part D
Medicare Part A is your hospital insurance coverage.
Part A helps cover:
- Inpatient Hospital Care
- Skilled Nursing (After 3 day inpatient hospital stay)
- Home Health Care
- Hospice Care
Medicare Part B is your medical insurance.
Part B helps cover:
- Doctors, Specialist, and other Health Care Provider Services
- Outpatient Services and Care
- Home Health Care Services
- Durable Medical Equipment
- Preventive Services
The standard 2014 Nebraska Medicare Part B premium is $104.90. Most people have this amount automatically deducted from their Social Security checks.
The 2014 Part B coinsurance hasn’t changed much over the years. The Part B coinsurance is generally 20% of the Medicare-approved amounts. Get Extra Help Paying Health Insurance Cost
What’s Not Covered by Medicare Insurance Part A and Part B?
- Long Term Care (LTC)
- Routine Dental Services
- Eye Care
- Dentures
- Acupuncture
- Hearing Aids and Exams for fitting
Medicare Part C is Medicare Advantage.
Part C (MA &MAPD) helps cover:
- Includes all Part A and Part B Benefits
- Run by Private Medicare-Approved Insurance Companies
- Usually Provides Prescription Drug Coverage (MAPD)
- May Provide Extra Benefits and Services (for an extra cost)
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Medicare Advantage Plans often times include Part D prescription drug coverage. Advantage Plans are available in specific services areas. They’re generally network based such as an HMO or a PPO. MAPD plans sometimes cover services not covered by Part A and B. Enrollment in a Medicare Advantage Plan is generally for an entire year unless you qualify for a Special Election Period.
If you enroll into Part C, the Advantage Plan insurance company pays for your health insurance coverage instead of Medicare. I do stress, that you STILL have Original Medicare and the option leave and return to Part A and Part B during certain times of the year. Enrollment into a Medicare Advantage Plan with Prescription Drug Coverage (MAPD) will automatically end another MAPD plan or Part D stand-alone insurance coverage.
Medicare Part D is Prescription Drug Coverage.
- Helps cover Prescription Drugs
- Run by Private Medicare-Approved Insurance Companies
- May Lower Prescription Drug Cost
Part D insurance coverage can be purchased by Medicare-Approved Private Insurance companies. Depending on your area, there are multiple Part D insurance companies.
Enroll into Part D coverage certain times during the year. Enrollment generally last an entire year. Reviewing Part D insurance coverages and potential changing plans annually prevents seniors from overpaying for their medications. The main time to change Part D plans is “Annual Election Period” now called “OEP”. ‘OEP’ is from October 15-December 7th.
Find Medicare Part D Prescription Drug Plans from multiple insurance companies in your area.
Avoid a Part D Late Enrollment Penalty.
You could be accessed a 1% penalty per month for not purchasing Prescription Drug Coverage, Part D. Find out more on late enrollment penalties at “www.Medicare.gov“.
Medicare Fee-for-service facts you should know before looking at Medicare Supplement plans and applying:
- Some Healthcare providers who accept Medicare patients, accept ‘Assignment’. These providers are accepted to charge according to the Medicare guidelines. Providers who do not accept this assignment can charge up to 12% more than the Medicare-approved amount.
- If a provider accepts assignment, then you will have to pay 20% of approved charges. (Plan G will pay after deductible is met)
- Before provider’s service, you should ask whether they will accept the assignment approved by Medicare.
Call one of Retirement Transitions Specialist if you would like to speak to someone without waiting on hold and pressing multiple extensions. We will answer your Medicare Sign Up questions and concerns.
