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.
Medicare is a government run health insurance system available to most people over the age of sixty-five. It is also available in other circumstances to people who are younger if they have certain disabilities. Medicare serves about forty-four million Americans, and about seven million of those people are younger and have a disability that qualifies them for Medicare coverage. Medicare coverage can apply to those who qualify through Social Security Disability Insurance, or because they suffer from either Lou Gehrig’s disease or End State Renal Disease.
Social Security Disability
If you are receiving SSDI, then you are likely eligible for Medicare. Your SSDI benefits are determined through what you have earned via work credits. In many cases, people with disabilities aren’t eligible for SSDI benefits because they don’t have enough work credits.
If this is your situation, and you don’t have access to SSDI through other means, like a family member who qualifies, then you may want to look into Supplemental Security Income benefits instead. This may qualify you for other insurance coverage.
Qualifying for SSDI involves a very strict test, and there are medical evidentiary requirements and a host of proof that the government requires. If you are between the ages of eighteen and sixty-two, then you have to show your disability has stopped you from working for at least a year meaning you have a qualifying physical or mental impairment, or that you have a fatal impairment.
Medicare Benefits With SSDI
Before you can receive Medicare, you must get SSDI. After you officially qualify, you will wait for five months before you start to receive your cash benefits from SSDI. There will be another twenty-four month wait before you receive your first Medicare benefits. If you qualify for SSDI because you have Lou Gehrig’s disease, then you will begin receiving Medicare benefits from your first month of SSDI. For End Stage Renal Disease qualifiers, you may begin to receive Medicare benefits within three months of your first dialysis treatment.
The End Of Medicare
Because your Medicare insurance is based on your disability, if your condition gets better and you stop being disabled, then you will no longer be eligible for Medicare benefits. The Social Security Administration has a review process for beneficiaries, and periodically your file will be reviewed to determine if you are still disabled. If you lose your SSDI benefits, then you will also lose your Medicare coverage.
Medicare is available to most people ages sixty-five years and older. It is also available to people younger than sixty-five with certain illnesses and disabilities. If you have high risk factors for diabetes and are eligible for Medicare benefits, then you may be eligible for Fasting Blood Glucose tests.
High Risk Factors
There are signs that you may be at risk for diabetes, and some are more severe than others.
If you have any of the following high risk factors, then you will be eligible for Medicare-covered testing:
- a history of high blood sugar
- a history of high or abnormal cholesterol and triglyceride levels
Medicare also has a list of questions that may indicate that testing is covered. If you answer yes to two or more of these questions, then you are likely to qualify qualify:
1. Are you sixty-five years of age or older?
2. Are you are overweight?
3. Do you have a family history of diabetes?
4. Do you have a history of gestational diabetes
Diabetes Testing Equipment
There are many different items that you will need to buy regularly if you have diabetes. For example, you will need to have a glucose monitor, testing strips, and lancets. In certain cituations, other equipment like insulin pumps and blood sugar control solutions, and even special therapeutic shoes are necessary.
If you aren’t sure if Medicare covers some of your diabetes equipment, you should check because Medicare may not cover everything. For example, insulin is only covered if you use an external insulin pump. On the other hand, if you have Medicare Part D, you may be able to get some insulin and other medical supplies covered, as well as other oral diabetic drugs. If you aren’t sure if your medication is coverage, check with the Medicare guidelines, or on the Medicare website.
Your Cost and Other Details
Because diabetes treatment is covered under your Part B coverage, you will be able to get your diabetes coverage at twenty percent of the Medicare-approved amount. Of course, that kicks in after you’ve paid your yearly deductible under Part B.
Medicare also covers self-management training, which is available to people at risk for complications involved with diabetes. In order to get this training, you must have an order from a doctor or healthcare provider. Just like your other diabetes treatment, you will pay twenty percent after your yearly deductible.
There are many choices when it comes to your Medicare plan, and you may not understand all of them at first. That’s okay. This is complicated stuff, and understanding won’t come overnight. What you need to know are some basic details about the types of Medicare plans available to you, and what kinds of basic coverage each plan can provide for you.
The Original Medicare plan is provided by Medicare, and comes in two parts — Part A and Part B. Part A covers hospital insurance, while Part B is medical insurance. There is a difference between the two! Generally speaking, you will have your choice of doctors, hospitals, and health care providers, as long as they accept Medicare. In most cases, you or your supplemental coverage, if you have it, will pay deductibles and coinsurance. Most Part B coverage requires the payment of a premium.
You also have the option of Part D coverage with Original Medicare, which covers prescription drugs. These plans are run through Medicare-approved private companies, and you will pay a monthly premium.
If you go with a Medicare Advantage plan, you’ll have Part C insurance, which is a combination of Part A and Part B. Medicare-approved private companies offer these plans, however you will have to abide by plan coverage rules. That means that you are restricted to the health care providers listed in your individual plan. A monthly premium is typical, and so are co-pays and coinsurance for covered services. Read your plan carefully for additional details.
There are gaps in the Original Medicare coverage that you may choose to fill in with the use of Medicare Supplemental, sometimes referred to as Medigap. These policies are purchased through private companies, and costs and details vary by plan. Medigap policies are not available to those who elect Medicare Advantage.
There are important differences between these two government healthcare programs, and it is important for anyone who may take advantage of these programs to understand the differences. On the most basic level, Medicare is a social security program that is run nationally, while Medicaid is a governmental program that operates on the state level. Medicare benefits are given to most people at the age of sixty-five, although certain disabled individuals can qualify for Medicare benefits earlier. Your ability to receive Medicaid is also influenced by your income and assets.
Medicaid: The Basics
The Medicaid program is for low-income families, children, and adults who need health coverage. It is offered at no charge to beneficiaries, and is run by your state. Because this program is income-based, qualifying for it is very strict. You must give the Medicaid program proof of all your income and assets, and that includes anything you own. If you don’t report something, you may be denied coverage. Children may be covered under Medicaid even if their parents are not. In fact, children are the biggest recipients of Medicaid benefits, because they are able to receive coverage for vision, dental, hearing, and other health coverage that is not available to adults.
Medicare: The Basics
Unlike Medicaid, Medicare is a more open program, at least if you are receiving it because of age. Most people are automatically enrolled in Medicare at the age of sixty-five, although some people receive Medicare benefits because of disability or certain illnesses. If you are disabled, you may receive up to twenty-four months of disability coverage under Medicare. Medicare is not a free program. Part A is offered at no cost, and covers your hospital care. Part B is also an automatic enrollment, but it includes a deductible and monthly fees.
Can The Two Combine?
Many Medicare beneficiaries are curious about receiving a combination of Medicare and Medicaid benefits. It can be done, and many elderly individuals receive benefits under both plans. If you receive Medicare, you may still apply and qualify for Medicaid. Medicare doesn’t cover 100% of all costs, because you will still have copayments and a deductible in many cases. If you need the assistance, you can use Medicaid to help you make ends meet. This is an option that many elderly patients pursue, especially because Medicaid is free for qualified enrollees, unlike Medicare Supplemental Insurance plans, which may fill in gaps and pay for fees that Medicare doesn’t cover.
When you enroll in Original Medicare, you may notice that there are still some expenses to you. While Medicare Part A is free and automatic, there are monthly expenses and a yearly deductible involved in Medicare Part B. You must also be aware that there are healthcare procedures that Medicare doesn’t cover. What then? The answer is simple. When you buy a Medigap policy, you are buying an insurance plan that aims to cover the gaps left in your healthcare coverage provided by Medicare Parts A and B.
What Exactly Is Medigap?
Medigap, which is also known as Medicare Supplemental Insurance or Med Sup, is a policy that you can buy through private insurance companies to help cover the things that your Original Medicare plan just doesn’t cover. The goal is to give you the most complete coverage possible. While this plan doesn’t come directly through the Medicare system, it is offered only by Medicare-approved insurance companies, and there are federal and state laws that must be complied with in every Medigap policy, including the basic coverage that must be offered.
Who Can Buy Medigap Policies?
This may sound obvious, but the only people who are eligible for Medigap policies are those who are first eligible for Medicare. Medicare covers most people over the age of sixty-five, and some people under the age of sixty-five who are disabled or suffer from certain illnesses. If you are covered under Medicare, and you receive Original Medicare, then you can purchase a Medigap policy. Medigap is not available to those people who elect to receive Medicare Advantage coverage.
When Can I Enroll?
There is an open enrollment period during the first six months following your sixty-fifth birthday and your enrollment in Medicare Part B that an insurance company must sell you a Medigap policy without using medical underwriting. This means an insurance company must sell you a policy and can’t charge you more than someone in perfect health. In most cases you can purchase a Medigap policy outside of the open enrollment period, but you will be subject to medical underwriting and there is no guarantee that you will be offered a policy.
Medigap or Medicare Advantage?
There are two distinct options that Medicare enrollees have to choose from, and you will have to evaluate your options and choose the best coverage and cost for you. You may elect to choose Original Medicare, which is comprised of Medicare Parts A and B, and then fill in the blank spots of coverage with a Medigap policy. Your second choice is Medicare Advantage, which combines the types of coverage for a hybrid policy that is designed for more complete coverage overall.