While most people are aware of Medicare, not many people fully understand the different eligibility requirements, or in fact, what Medicare is. We hear phrases like “entitlement programs” and “welfare” tossed about, often in conjunction with Medicare. Those phrases can be mischaracterizations, though, and it is important to fully understand what you are dealing with before you start receiving benefits under this program.
What Is Medicare?
First and foremost, Medicare is a federal program that is run nationally, although some differences in the details vary from state to state. The program is run under the auspices of the Social Security Administration, which means that the benefits administered through the program are often connected with Social Security payments.
Medicare for Medicare Beneficiaries
The typical coverage for Medicare begins after an adult turns sixty-five. It is available as part of a retirement benefit of sorts that the Federal government makes available automatically to most adults.
Medicare for The Disabled
Certain disabled persons are eligible before they turn sixty-five. In order to qualify as disabled, you must go through a strict process of proof. In most cases, there is a requirement that you qualify for social security disability insurance in order to also receive Medicare as a disabled person. If you are applying for disability Medicare, there are several things you should know. For instance, there is a twenty-four month waiting period after qualification before Medicare benefits accrue.
There are other situations where an individual may qualify for Medicare. Two of these scenarios include individuals with Lou Gehrig’s disease and with End State Renal Failure. The delay in Medicare benefit accrual does not apply to those individuals with Lou Gehrig’s disease. People with End State Renal Failure may begin receiving benefits three months after the first dialysis treatment.
Still Have Questions?
When it comes to Medicare, there is a lot of information to take in, so don’t be discouraged if you are confused to start out. There are changes to the policies that affect Medicare every year, so it is important to make sure that you keep track of any changes that will make your coverage change. Stay informed, stay on top of things, and keep educating yourself. You can find out more about Medicare and the various policies you can choose from at www.medicare.gov.
Hearing loss is very common among aging adults. Your hearing loss may stem from several causes, though the most common is sensorineural. That means that the tiny hairs inside your ears have been damaged and are deteriorating, usually because of aging. You losing your hearing if you notice that straining to hear thing clearly makes you tired, or if you watch the mouths of people around you to understand what they are saying. Other troubling signs of hearing loss include having difficulty hearing people in public places where there is a lot of ambient sound, or if you often find yourself asking people to repeat themselves.
Hearing Aid Exams
The signs of hearing loss can be troubling, but you can do something about it. The first step is a hearing exam. You can ask your family doctor to administer this hearing exam, and if your doctor does not do these tests, you can ask for a referral to a hearing aid professional. There are two different kinds of hearing exams, but only one is covered by Medicare. The typical hearing exam, often similar to regular health checkups, is not covered.
If you want your hearing exam to be covered by Medicare, you should opt for a diagnostic hearing aid exam. It is based on medical need, which is often related to illness or surgery. These exams must be prescribed by your doctor.
Hearing Aid Specialists
There are many different healthcare professionals who qualify as hearing aid specialists. You may be able to get a Medicare-covered hearing exam from an audiologist, otolaryngologist, or a certified hearing aid specialist. These professionals can help assess your hearing loss and also if your loss is a good fit for hearing aids. Make sure that your specialist is trained and certified, and is using up-to-date testing equipment in a sound controlled room for accuracy.
Your Hearing Exam
Remember that your hearing exam should be ordered by a doctor in order to get coverage under Medicare Part B. You may also be able to get Medicare coverage for hearing exams following a loss of hearing due to accident, injury.
During a hearing exam, you should expect to have an ordinary conversation with your hearing aid specialist, at least to start. Make sure you have specific details to share about when your hearing loss began and when you have the hardest time hearing. You will also be tested using specialized hearing technology.
When you are deciding which Medicare Supplemental Insurance plan, or Medigap plan, to choose, you may wonder if there is any real difference between the plans. After all, these plans must be substantially the same, and they all must comply with State and Federal laws. Despite substantial similarities, there are differences that you should pay attention to when making your selection.
An Overview of Medigap
The Medigap program is not run by Medicare, but it is Medicare-approved and run by companies that have been approved to sell Medigap policies. When individuals decide to use Original Medicare, they may seek a way to get their policies filled in through the Medigap system. These policies allow you to pay coinsurance, co-pays, and deductibles for Medicare-covered services. Some other policies allow you to get coverage for conditions and treatments that are not covered by Original Medicare.
A Standardized Policy
Every Medigap policy must be clearly defined as Medicare Supplemental Insurance, and from state to state, those policies must be standardized, so that no matter what company you buy them from, you get substantially similar policies. The same basic benefits are available, and cost of the only really difference between the same lettered policy from different companies. For example, a Medicare Supplemental Part F policy from any company provides the same benfits. The only real difference is cost.
Buying Medigap Policies
There are certain times when you are guaranteed the right to buy a Medigap policy. For instance, if you are in a Medigap open enrollment period, you have the absolute right to buy such a policy. You also may buy Medigap at any time you have a guaranteed issue right.
At other times, you may still be able to buy a Medigap policy, but you are subject to denial by the insurance company for health reasons.
You Need To Know
In order to qualify for Medigap, you must have Medicare Parts A and B. If you have a Medicare Advantage Plan, but you want to return to Original Medicare soon, then you may still apply for a Medigap policy before your coverage ends. As long as you are leaving Medicare Advantage, it is legal for an insurance company to sell you Medigap coverage. You will pay a premium every month, and your policy will only cover you, not any other family members. As long as you continue to pay your premiums, your insurance company can’t cancel your policy.
The bottom line is,besides cost and the practioners who may be covered under your Medigap plan, there are no major differences from company to company for a given plan.
Medicare is available to adults ages 65 years old and older in most cases. You may also qualify for Medicare if you have certain disabilities, or if you suffer from Lou Gehrig’s disease or End Stage Renal Failure. Medicare is a nation-wide program that offers healthcare coverage to Medicare beneficiaries and the disabled for certain guaranteed prices. You are automatically enrolled in Medicare Part A and B. If you choose to supplement your Original Medicare coverage with a Medicare Supplemental Insurance plan, you may find that you have a lot to choose from.
Know Your Plans
Medicare Supplemental Insurance, or Medigap, is designed to fill in the gaps in Medicare Parts A and B coverage. These Medigap plans are controlled by federal and state law. They must offer certain standard benefits, and they must be labeled A through N. When you are choosing between the various plans, you must consider what you are being offered.
Plans A and B
In most cases, you will be required to take plans A and B. These plans relate to your Medicare Part A and B coverage. That means you will need to remember the premium payments and deductible for your Part B coverage. Parts A and B cover hospital and medical care.
Plans C through N
The differences between other plans offered to you will vary from state to state, and to some extent from insurance company to insurance company. You should pay particular attention to the deductibles and premium costs from plan to plan. While some coverage options are standard, there will also be some differences between the various plans over what is covered and what is not. For instance, you will see some differences in prescription drug coverage and treatments.
Make a List
The best way to make sure that you get the kind of coverage you need is to first determine what it is you need. Sounds simple, right? Just make a list of the various medications, treatments, and services that you require. Make sure you determine which are already covered by Medicare, and which you will need additional coverage for. You can eliminate the plans that do not provide coverage for the services and medication you require, and then narrow your options based on premium payments and deductibles. Choosing an insurance plan is difficult no matter what, and the best way you can insure you pick the right one is through careful preparation and research.
The Medicare Open Enrollment period is one of the most important times of the year for those who receive benefits under the Medicare program, and it is vital that you don’t let it go by without taking stock of where you are currently. If you are thinking about making changes to your Medicare coverage, or getting additional coverage, the time to do it is during open enrollment.
The Open Enrollment period for 2013 is October 15 through December 7.
Open Enrollment Defined
During the open enrollment period, all individuals who are enrolled in Medicare policies are allowed to make changes and update prescription drug and health plans for the New Year. Open enrollment is also the time for individuals who have not previously elected coverage have the option to do so. This period is usually over the holidays through late fall and early winter, but you should always make sure you know the precise dates for this period because it changes virtually every year. Missing it means that you will have to wait another full year until the next open enrollment period, unless certain qualifying events, which allow an individual to enroll outside of open enrollment, occur. Coverage for the new, adjusted plan would begin on January 1. Remember that your Medicare plan is an insurance plan, and that means that it can be adjusted yearly.
Adjusting Medicare Part D
One thing that many medicare beneficiaries examine when the open enrollment period arrives is their prescription drug coverage. With Medicare Part D, a phenomenon that regularly occurs is called the “donut hole.” This is a gap in coverage between the limit in coverage policy and the next year on the policy where the enrollee must pay all out of pocket costs. Thanks to the Affordable Care Gap, Medicare beneficiaries will be receiving some help on their donut hole spending in the future, including certain discounts and a boost in coverage limits.
Selecting Your Plan Adjustments
There may be many different Medicare options available to you during open enrollment, so don’t feel like you must be committed to the one you are using right now. This is particularly true when it comes to re-examining your Medicare prescription drug coverage. If your costs are too high, then it may be time to invest in a new policy. There are online tools that can help you determine the right plan for you, including a Medicare Plan Finder tool on the Medicare website at www.medicare.gov.
If you are happy with your coverage, that is great. You won’t have to worry about re-enrolling or doing anything at all during the open enrollment period. It is only for those who seek an adjustment to their coverage that the open enrollment period really matters.
If you are new to the Medicare system, you may not be familiar with the many different “Parts”, or plans available to the average consumer. It can be easy to get confused, especially with all the particular insurance terms commonly used. Before you select the kind of coverage you want, you should know what these types are and what kind of coverage each Medicare plan offers.
Medicare Part A
This is hospital insurance, which means it covers inpatient stays, some nursing homes, hospice care and home care. Medicare Part A does not generally have a premium payment associated with it, because most people pay Medicare taxes while they are employed. If you haven’t paid into the system, you may be eligible if you are 65 years old or older, have enrolled in Medicare Part B, and meet citizenship requirements.
Medicare Part B
Medicare Part B is your medical insurance, which means that it covers doctors’ visits and other types of medical care. You will pay a premium for Part B, which is usually set at a standardized amount. In some cases, the Social Security Administration will contact Part B enrollees about paying based on income, but those are special cases. Part B covers medically necessary medical procedures and some preventative care.
Medicare Part C or Medicare Advantage
Medicare Advantage plans are exclusive of Medicare Parts A and B, and generally combine the two in some way. These plans are offered through private, Medicare-approved companies and operate similar to HMO or PPO insurance plans. Medicare will pay a fixed amount for your plan, and you will have premiums to pay. You will also be required to see only in-plan providers, which differ from plan to plan. Medicare Advantage plans are required to cover everything that Original Medicare does, except for hospice care.
Medicare Part D
Medicare offers prescription drug coverage through Part D. Generally speaking, you should enroll in Part D at the same time you enroll in Medicare, or you can be penalized with a late fee. The plans are run by private, Medicare-approved companies, and will vary in cost and coverage depending on the plan.
You will probably have a monthly premium, along with co-pays. The cost to you will depend on your plan and the kinds of medications you are getting. It is possible to get your premium payment deducted from your Social Security checks, but you must work that out with your drug plan coverage. It is against the law for any Medicare drug plan to have a yearly deductible of more than $320 for 2012.
There are many wonderful benefits to the Medicare program, but if you are enrolled in Original Medicare, you may find yourself worrying about the gaps in the policies, like dental treatments, or even paying the deductible, coinsurance, copayments, and other expenses related to your healthcare costs. If you need assistance with filling in those gaps, you may want to consider a Medicare Supplemental Insurance plan, which is also known as Medigap.
What Is Medigap?
The coverage provided through Medigap plans is designed to allow people to deal with the gaps in their Original Medicare coverage. That means that you must be eligible for Medicare in order to get Medigap coverage. Most people over the age of 65 are eligible for Medicare, and certain disabled individuals under the age of 65 also qualify. Because Medigap exists to supplement Original Medicare disqualifies you for the option of enrolling in a Medigap plan.
When Am I Eligible?
There are certain times when you have an absolute right to enroll in a Medigap plan. One such period of time is the six months following your 65th birthday and your enrollment in Medicare Part B. This period of time is an open enrollment period, and you can buy any Medigap policy offered in your state at that time. During that time, you cannot be refused by an insurance company because of your disability or health problems. You also cannot be charged more because you have a pre-existing condition.
You won’t totally miss your chances to enroll if you miss the open enrollment period, however. You may be able to purchase a policy outside the enrollment period, but it can be at a higher expense.
What’s the difference?
There are many different companies that sell Medigap plans, so you may be wondering if there are special traits you should be looking for. Put your mind at ease on this point. By Federal law, Medigap policies must be standardized, which means that they must offer substantially similar benefits, and the plans must be labeled in similar ways. While the way standardization works is different from state to state, it is safe to assume that the policies are very similar inthe benefits each offers.
Put simply, the main difference in Medicare Supplemental Insurance (Medigap) plans is price.
Sleep apnea is a common sleep disorder which may be covered by Medicare. It often results in pauses in breathing while asleep, or even abnormally low breathing. A pause in breathing is called an apnea, which gives this disorder its name. If you have been diagnosed with sleep apnea, there are several treatment options that you can choose from, and one of them is the Continuous Positive Airway Pressure device, or the CPAP.
Does Medicare Cover My CPAP?
There are a few different ways you can get Medicare coverage for your CPAP. One way this can happen is if you have an obstructive sleep apnea, which means that you temporarily stop breathing during sleep. You can be diagnosed with an obstructive sleep apnea by participating in an overnight sleep study.
You can get a CPAP covered for up to three months under Medicare. Accessories that must be used with the CPAP can also be covered. The prescription for this treatment must be on file with the device supplier and must be signed by your doctor.
What Kind Of Benefit Is A CPAP?
Your CPAP will be covered by about eighty percent. Because the CPAP is a capped rental property under Medicare coverage, you have the option to purchase your CPAP outright instead if you want.
If you use your CPAP machine for longer than three months, which is often necessary, then you must get your use recertified by your prescribing doctor. Make sure that you follow the required steps or you won’t get to keep your coverage.
Before you can get your CPAP device, you must be diagnosed with sleep apnea. An apnea poses a very serious risk to your health, so you must take this process seriously. For one thing, your quality of sleep undoubtedly suffers from this disorder. Furthermore, your body is being deprived of oxygen for potentially hundreds of moments throughout a night. Don’t wait to get your diagnosis.
Getting Your CPAP Device
Make sure that the company from which you get your CPAP is participating in the Medicare program. A supplier that participates in the Medicare program is actually required to accept the assignment of your CPAP device. The device supplier will be able to bill Medicare directly. Make sure that you find out exactly what kind of supplier your device company is – if the company is only enrolled in Medicare but not officially participating, then they can choose to bill either Medicare or you directly.
Medicare is a federal program that is nationally run and allows Medicare beneficiaries and people with disabilities to have access to healthcare insurance. This program is not generally understood, though, and many people don’t understand what exactly it takes to become eligible for the program. There is so much misinformation flying around about healthcare programs and Medicare that it can be difficult to separate the fact from the fiction. Luckily, there is also reliable information out there, and you can understand the requirements of Medicare eligibility with a little help from official sources like www.medicare.gov.
The most important information to know about Medicare is that this federal program operates to give health insurance coverage to those who qualify. It is run by the Social Security Administration, and that means that the benefits under this program are often associated with Social Security benefits. In fact, one way that disabled people can become eligible for Medicare is by qualifying for Social Security Disability Insurance.
Senior Health Insurance
The biggest portion of beneficiaries under Medicare are senior citizens ages sixty-five and up. At the age of sixty-five, most people are automatically enrolled in Medicare Parts A and B. Medicare Part A is hospital coverage, which means coverage for in-patient stays, hospice care, some home health care, and similar treatments. Medicare Part A is automatic and free. Medicare Part B is also automatic, but it is not completely free of charge. It offers medical coverage with a monthly premium and a deductible. There are also copayments associated with Medicare Part B coverage.
In the case of disabled persons, an exception is made for those who have not yet reached the age of sixty-five. To qualify as disabled, you must submit an application to the Social Security Administration. This process can be difficult and lengthy. After qualifying, there is a twenty-four month waiting period before Medicare benefits begin.
Exceptions for Certain Individuals
There are two exceptions to the twenty-four month waiting period. If a disabled individual suffers from Lou Gehrig’s disease, then Medicare benefits begin immediately. Likewise, if a person suffers from End State Renal Failure, benefits will begin three months after the first documented dialysis treatment. These exceptions are to ensure that those who are in the most need for immediate medical coverage receive it.
If you still have questions about your eligibility for Medicare, or if you need more details, the Medicare website is a wonderful resource.
One of the most basic questions that many people have about Medicare when they first enroll is the coverage that this program offers. The program can be very confusing at the beginning, but you shouldn’t let it overwhelm you. Once you get started, you will probably feel inundated with deadlines, various “Parts”, co-pays, differing deductibles, and everything else that comes with beginning a new healthcare plan. Of course, you must consider the coverage provided to you by each kind of Medicare plan.
Who Is Covered?
Medicare is a government-run plan which covers most people ages sixty-five and older. This Medicare plan is also available to those people under sixty-five who suffer from certain diseases and disabilities. If you don’t know whether you are eligible for Medicare benefits, find out by visiting the Medicare website at www.medicare.gov.
You will have access to coverage for in-patient hospital care through Medicare Part A. This coverage applies to your nursing care and any in-patient care at a healthcare facility. You can also get coverage for any home health-care and hospice care under Part A. This part of Medicare usually occurs automatically at the age of sixty-five, and it is free.
For other medical coverage, Medicare Part B kicks in. Part B applies to items like doctor’s visits, medical test,home health visits, and also preventative health services. This enrollment is also automatic, but unlike Part A, this Medicare coverage is not free. There are annual deductibles to be paid, as well as a monthly fee.
When you get Medicare Part A and Part B together, it is often referred to as “Original Medicare”.
There is a different option for those who do not want to take Original Medicare. It is available as an alternative through private Medicare-approved companies. These plans are called Medicare Advantage plans, and they are available in place of Original Medicare. Many offer dental, vision, and prescription drugs, and plans will vary.
Prescription Drug Plans
If you elect Part D, you will have some prescription drug coverage. Like Medicare Advantage, Part D is offered through private companies that have been approved by Medicare. Because they are privately run plans, coverage and cost vary.
Filling In the Gaps
You may find that as you explore your Medicare coverage, you run across gaps in your Original Medicare coverage. In that case, you may want to look into Medigap plans, also known as Medicare Supplemental Insurance, which are designed to cover things that your original coverage does not.