Health Insurance

Medicare Open Enrollment Period for 2018 – October 15, 2017 through December 7, 2017

Medicare is a Federal Health Insurance Program. To be eligible for Medicare you must be a US Citizen or Legal Resident and one of the following.

  • Age 65
  • Been disabled for 24 months or more
  • Have End Stage Renal Disease or ALS

Medicare has four parts: Part A, Part B, Part C and Part D

Part A and Part B are known as Original Medicare. This means Medicare is the primary provider for your health insurance payments. Part C (Medicare Advantage), Part D, and Medicare Supplements are insurance plans offered by independent insurance companies. These plans cover some of the costs associated with original Medicare.

Part A covers Hospitalization. This includes inpatient  hospitalizations, skilled nursing, home health care and hospice care. If  you, or your spouse, have worked 40 quarters in your lifetime, Part A  is no cost to you. If you do not meet these requirements, you may  purchase Part A. For 2017 the deducible for Part A is $1,316 per 60 day  benefit period.
Part B covers Medical. This includes doctor visits,  screenings, lab work, x-rays, outpatient services, etc. Unlike Part A,  Part B has a monthly premium. The standard premium in 2017 for most  Americans is $134/month and is taken directly out of your Social  Security check. If your income is greater than $85,000 as an individual  or $170,000 as a couple your premium could be more than the standard  rate. The annual deductible for Part B is $183 for 2017. After the  deductible has been met, Medicare will pay 80% of your Part B charges  and you will be responsible for the remaining 20%. If you do not enroll  into Part B when you are first eligible, you may be assessed a Late Enrollment Penalty.
Part C or Medicare Advantage plans  are offered through independent insurance companies that contract with  Medicare which becomes the primary provider for your health insurance  payments. These plans combine Part A & Part B coverage, as well as  offering additional benefits such as; hearing, vision, dental &  fitness memberships, and may also include coverage for Part D  Prescription Drugs. These plans have low premiums and deductibles along  with Co-Pays and Co-Insurance. To be enrolled into a Medicare Advantage  Plan you must: be enrolled in Original Medicare Part A & B, reside  in the plan’s service area (Networks), and cannot be diagnosed with End Stage Renal Disease. Enrollments Periods.
Part D is Prescription Drug Coverage offered through  independent insurance companies. Part D Prescription Drug plans differ  between insurance companies and are required to be the same or better  than Medicare Guidelines.For 2017, the Part D Prescription Drug Guidelines are:                

  • Deductible is $400.
  • Initial Coverage Stage: You pay copays until your total drug cost reaches $3,700.
  • Coverage Gap: You pay a coinsurance (51% of Generics and 40% of Brands) of the prescription until your reaches $4,950.
  • Catastrophic Coverage: Generics are $3.30, Brands are $8.25, or 5% whichever is greater.

If not enrolled into a Part D Prescription Drug Plan or have other creditable drug coverage when first eligible, you may have a Late Enrollment Penalty.

Medicare Supplements aka “MediGap” plans are offered  by independent insurance companies and help cover some of the costs  that Original Medicare does not.

  • Medicare is the primary provider with a Medicare  Supplement being secondary. You may purchase a Medicare Supplement to  cover Medicare deductibles and coinsurance amounts.
  • Medicare Supplements do not cover Part D Prescription Drugs, so a Part D Prescription Drug Plan may be necessary.
  • When first eligible for Medicare Part B, you can  purchase a Medicare Supplement without any Medical Questions asked. This  is called Open Enrollment. If you lose other coverage, you may be able to enroll into a Medicare Supplement through Guarantee Issue.
  • If you are outside the Open Enrollment/Guarantee Issue Period, the insurance company will require medical questions to be completed.

Late Enrollment Penalty

Networks

Enrollments Periods

TROOP

(True Out of Pocket Costs)

TROOP = Deductibles + Copays + Co-insurance + Drug Company payments

Open Enrollment

Open Enrollment for Medicare Supplements is the month Part B becomes effective and the 5 months that follow.

Guarantee Issue Period

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