Medicare Open Enrollment Period Nov 15th thru Dec 31st

Hello to all on this fine and dreary day.




As I am sure we all know Medicare Open enrollment period is here again. Who has what? how much does it cost? Drug coverage gap? Which way to go?



I feel really bad for anyone going on medicare this year or any other time as well. Why, you may ask? The over abundance of information sent via email, or thru snail mail, the million and one phone solicitation calls, the calls from different insurance carriers, sales agents, families, friends, associates, everybody has something to say, something to add on.




You know what enough already!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!






I am going to give it to you straight!!!!!!!!!!!!!!!!!!!!!!!!



I am going to start with the basics



This information comes directly from the Medicare.Gov website. If you want to help someone who is on medicare, direct them to the Medicare.gov website or give them the phone number to contact Medicare directly.




Please don't confuse people anymore because they are already confused. Medicare can be complex, to most people it is, so if you don't know the answers reference them to someone that does.






Medicare is run by The Centers for Medicare & Medicaid Services (CMS), it is a Federal Agency that runs Medicare. It is part of the U.S. Department of Health and Human Services




Medicare is a health insurance for people aged 65 or older, under 65 with certain disabilities, and any age with End-Stage Renal Disease ( which means permanent kidney failure requiring dialysis or a kidney transplant)


Medicare can best be described as having four parts to it. I will explain this in laymen's terms for the average person.






Part A is for Hospital Insurance


Part B is for Medical Insurance


Part C is for a Medicare Advantage plan like an HMO or a PPO


Part D is for Medicare Prescription Drug Coverage






but you may be asking do i need to have all four parts, the answer is no!!!




Medicare Part A helps cover inpatient care in hospitals. This includes criticalaccess hospitals and inpatient rehabilitation facilities. It also helps cover hospicecare and home health care, and skilled nursing facilities






What is Medicare Part B?




Medicare Part B helps cover medically-necessary services like doctors’ services,outpatient care, and other medical services. Part B also covers some preventiveservices. These include a one-time “Welcome to Medicare” physical exam, bonemass measurements, flu and pneumococcal shots, cardiovascular screenings,cancer screenings, diabetes screenings

While there is no cost associated with Part A, Part B of Medicare does have a premium that comes out of your pocket The Premium in 2009 is 96.40, this normally comes out of your Social Security check monthly.







So we know what Medicare covers, but do we also know what Medicare does not cover?






Keep in mind that Medicare doesn't cover everything. Medicare does not cover cosmetic surgery, health care you get while traveling outside of the United States, except in limited cases, hearing aids, most hearing exams, long-term care ( like nursing homes), most eyeglasses, most dental care and dentures.






Please remember though that some of these services can be provided for you by a Medicare Advantage Plan like an HMO or a PPO.






And if you read my previous post you would know the difference between a PPO and an HMO






Don't Worry, i will explain that once more.










No for the fun part, and yes i am being a little sarcastic, because if Medicare was confusing before, it became harder to understand when they came with Part D - Medicare Prescription Drug Coverage.






Medicare offers prescription drug coverage ( Part D) for everyone with Medicare. This coverage may help lower your prescription drug costs and help you protect against higher costs in the future.






It can give you greater access to drugs that you can use to prevent complications of diseases and to stay well.






In order to get Medicare drug coverage, you must join a plan run by an insurance company or other private company that is approved by Medicare.






now here is the fun part, which i personally think that this is a field that should be better managed by our government and you will understand why i say that when i tell you the following:






Each plan can vary in cost and drugs covered. If you join a Medicare drug plan, you usually pay a monthly premium. I will say this, please please please check the formulary drug list before you sign up with any plan to make sure that your meds are listed.






If you don't understand how to look up your medications with any formulary list for any prescription drug plan, ask a licensed agent to help you, find someone that is knowledgeable and who will take the time to help you, if you can't find anyone. send me a note, i will find you an agent to help you.






This is a huge pet peeve for me, as an agent, it aggravates me to no end, when insurance companies and other agents don't take the time to help you.






Keep in mind that if you decide not to join a Medicare Prescription plan when you first become eligible, you may pay a penalty if you choose to join at a later date.






If you have limited income and resources, you may qualify for extra help with your drug costs. If that is the case don't worry, I am going to post all the necessary information at the end of this post, where to go to get help.






So what are your Medicare Health plan choices?






You can choose different ways to get your Medicare health coverage. Most people get their coverage through Original Medicare or a Medicare Advantage plan like an HMO or PPO, your costs will vary depending on your coverage and the services you use.






Original Medicare- provides Medicare Part A and Medicare Part B coverage, it is a fee-for-service plan managed by the Federal Government. This means you are usually charged a fee for each health care service or supply you get. in addition to that, for some services, you will pay an amount called a deductible before Medicare pays its part. Then, when you get a medicare covered medical supply or service, Medicare pays its share of the cost of the supply or service and you pay your share.






This is one of the reasons most people on medicare opt to get a Medicare Advantage plan or even a Medigap (Medicare Supplemental Plan) to offset those deductibles, copays and coinsurance costs.






Now keep in mind that with Medicare Advantage plans, or Part C plans, you may be required to stay within a certain network and only see certain doctors and hospitals and would not be allowed to go out of network. You may also need a referral to see a specialist. You may also need Prior Authorization to get certain tests, exams, labs, ultrasounds, surgeries.






This is something you would need to ask your insurance provider or agent before you enroll into a plan.






So when can you make changes to your plan???????????






You can make changes to your MEDICARE health or Prescription drug coverage between NOVEMBER 15- Thru DECEMBER 31ST of each Year. If you are eligible for a Medicare Advantage plan, you can also join a Medicare Advantage plan between January 1st thru March 31st. each year.






Phone numbers and websites





http://www.socialsecurity.gov/






Getting help with prescription drug costs


1-800--772-1213


TTY Users 1-800-325-0778




This is only Part One of 6 of my medicare post

Part 2,3,4, will be in much more detail.

see you soon!!!!!!!!!!

Health Insurance Basics Part 2 - What most people are not aware of

Health Insurance Basics - Part 2 what big companies don't tell you, and you don't know to Ask