A, B, Cs of Medicare

Medicare is health insurance run by the Federal government for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease. The different parts of Medicare help cover specific services. Medicare Part A is hospital insurance, Medicare B is medical insurance, and Medicare D is prescription drug coverage. For 2012, Medicare A covers inpatient care while in a hospital, after a deductible of $1156/hospital stay. Medicare B covers 80% of doctor services, outpatient care and some preventive services, after an annual deductible of $140.

To get help covering the costs that Medicare does not cover, Medicare gives you the option of choosing to use 1) Original Medicare along with a Medigap policy and aMedicare Prescription Drug Plan or 2) a Medicare Health Plan, which may or may not include a prescription drug plan. Medicare Health Plans combine your Medicare Part A and Part B coverage and often provide extra benefits. These plans include:

  • Medicare Preferred Provider Organization (PPO) Plans
  • Medicare Health Maintenance Organization (HMO) Plans
Medigap Policies

Every Medigap policy must follow Federal and state laws designed to protect you and it must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can only sell you a “standardized” Medigap policy identified by letters (Medigap Plans A-N). Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medigap policies sold by different insurance companies. The Medigap policies range in price, depending on which type of policy you choose, your age, and the company you choose. You will need to contact the company to get the pricing for you. Medigap policies do not cover prescription drugs and so you would need to choose a Medicare D Prescription drug plan in addition to the Medigap policy. Medigap policies also do not cover vision or dental benefits, unless it is a benefit covered by Medicare. In choosing to use Original Medicare along with a Medigap policy you are secure in knowing that any provider (doctors, hospitals, nursing homes) will accept your insurance as payment.

Medicare Health Plans

Medicare Health Plans are approved by Medicare and offered by private companies for specific geographic regions. Click here to get the listing of Medicare Health Plans in Berks Co for 2012. When you join a Medicare Health Plan, Medicare pays a fixed amount for your care every month to that company and they are responsible for giving you benefits at least as good as, or better than, Medicare. Each company offers multiple plan options, with varying benefits; ranging in price from $0-$167/month.

The PPO plans contract with specific doctors and hospitals on an annual basis to provide the services at agreed upon prices. You are not limited to only using the network of providers, but you will have to pay an additional cost if you use a provider outside of the network.

The HMO plans require you to use only doctors, specialist, or hospitals on the plan’s list, except in an emergency. Most Medicare Health Plans include prescription drug coverage; if they do not you can choose a stand-alone prescription plan in addition to your health Plan.

You can switch Medicare Health Plans from Oct 15 – Dec 7 of every year. The thing to remember is that you should always contact your providers to determine if they accept a particular Medicare Health Plan before choosing to enroll.

Prescription Drug Plans (Part D)

These plans are run by private insurance companies and other private companies approved by Medicare. These plans range in price from $15.10-$115.60/month. Each plan publishes a new formulary each year, so it is wise to review your drugs and the choice of plans each year to be sure you have the plan that will give you the best coverage.

You can join or switch Medicare Prescription Plans from Oct 15 – Dec 7 of every year. This can easily be done on the Medicare web-site, www.Medicare.gov, or by calling 610-374-3195 x208 for an appointment with a local APPRISE counselor at Berks Encore.