IQ Fifty Plus Guide

Insurance Planning

Medicare Preview

Medicare is a health insurance program provided by the Federal government for people 65 years of age or older, people under 65 with certain disabilities, and people any age with end-stage renal disease (ESRD). There are three parts: A is hospital insurance, B is medical insurance, and D is prescription drug coverage.

Part A Hospital Insurance helps cover inpatient care in hospitals and skilled nursing facilities (not custodial or long-term care). Hospice and some home healthcare are also covered. Most people don't have to pay a monthly premium for part A.

Part B Medical Insurance helps cover doctors' services and outpatient care. It also covers physical and occupational therapists and some home healthcare if these are medically necessary as prescribed by your physician(s). You pay an annual deductible and monthly premium for part B. Medicare deductible and premium rates may change each January.

Part D Prescription Drug Coverage may help lower prescription drug costs. Part D is optional. Medicare drug plans are run by insurance companies and private companies approved by Medicare. If you join a Medicare drug plan, you usually pay a monthly premium.

If you are receiving Social Security benefits when you turn 65, then your Medicare Hospital Benefits start automatically (Medicare Part A). If you are not receiving Social Security, then you should sign up for Medicare close to your 65th birthday, even if you are not retired or planning to retire.

What about “Medigap” insurance? What is it and do you need it? Medicare supplement insurance is also known as “Medigap” insurance because it covers the costs of health care that the “original” Medicare program doesn’t. If you are covered by a health insurance plan (from your workplace or other type of group policy) then you may not need a medigap policy. Medigap insurance only works with the original “fee-for-service” Medicare plan not the Medicare Advantage (formerly Medicare + Choice) plans. If you are enrolled in a Medicare Advantage Plan, it's illegal for anyone to sell you a Medigap policy.

Understanding your Medicare coverage can be confusing. Each person’s situation is different. The following resources should help you make more informed decisions. And most of the resources include phone numbers or other contact information if you need additional help.

Government Resources

Medicare.gov is the official U.S. Government site for people with Medicare. The Frequently Asked Questions section has answers to over 250 questions. Many of the Medicare publications (and the Social Security site) send you to this site for more information. It also has a detailed section on prescription drug coverage.

The following resources are pdf files and need the free Adobe Acrobat Reader to view them. If you don’t have the Reader on your computer you may download it from Adobe.

Medicare and You is the official government handbook published each year. It describes Medicare benefits, changes for this year, privacy rights, and choosing a health plan.

Medicare and Other Health Benefits: Your Guide to Who Pays First provides an explanation of how Medicare pays with other types of insurance.

Your Medicare Benefits provides an explanation of Part A and Part B benefits.

Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare provides information on choosing a Medigap policy to supplement the original Medicare plan.

Other Resources

Medicare Rights Center provides (as the site puts it) “your guide through the Medicare Maze.” Dear Marci, you’ll find a Medicare Q & A. There are also sections with Medicare Answers, Medicare Drug coverage, a glossary of Medicare terms and much more. You can also subscribe to free newsletters: Dear Marci which has basic health tips, Medicare coverage advice, health plan reminder, and links to other resources; Medicare Watch has Medicare Q&As, health care policy news, and changes in Medicare benefits; Asclepios covers Medicare consumer issues.

AARP has sections on Health Insurance and Medicare with articles on Medicare, supplemental plans, managed care, and private insurance.

Center for Medicare Advocacy, Inc. has detailed information and FAQ articles including one on Medigap.

 

 

IQ Fifty Plus Guide is prepared by Remar Sutton and Associates and licensed to Educators Credit Union. Copyright 2007. All rights reserved.