KATHY HOPE |
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Insurance Advisors |
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YOUR
CA HEALTH INSURANCE BROKER FOR 22+ YEARS |
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Individual, Child-Only, Family, Entrepreneur, Small Business, Group,
Medicare |
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Serving Northern and Southern California |
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Medicare Health Insurance Basics
Part A, Part B, Part C, Part D
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CLICK HERE FOR MEDICARE ONLINE
QUOTE
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Who
Qualifies For Medicare Health Insurance? |
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People
aged 65 or older. |
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People
under 65 with certain disabilities. |
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Foreign
born residents who have entered the U.S.,
legally and have lived here for at least
5 years. |
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| Do
You Have To Sign-Up For Medicare? |
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If
you are 65 and still working you will have to sign up for medicare.
There are 3 ways you can sign up:
| 1. |
Visiting
a local social security office |
| 2. |
Calling
Social Security:
714-840-0047 |
| 3. |
Go
online to website: www.socialsecurity.gov. |
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Part
A and Part B - Original
or Traditional Medicare |
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Administered
by the federal government and has two
parts: |
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| Part
A - Hospital Insurance |
Covers,
in part, care and services
received during a hospital stay,
at a skilled nursing facility or hospice and
during home health care. Certain
conditions do apply. It is usually free because of
previously paying for it via
payroll taxes. If you don't sign
up when first 65, penalties may be
applied when you do unless you can
use a special *enrollment period. |
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| Part
B - Medical Insurance |
Partially
covers
services like doctors' services, outpatient care, home health services and other medical services.
Also covers some preventive services. There is a monthly premium
averaging from $100 - $119 in
CA. If you don't sign up when
65, is only available, without
penalties, during special
*enrollment periods. |
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Medicare
Enrollment Periods |
| Enrollment,
changes, cancellation, additions to your
Medicare A, B & D can only happen
during certain periods of time during the
year. The ability to enroll or un-enroll
whenever you want is NOT an option. In California
there are 5 different enrollment periods.
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Initial Enrollment Period |
| You can sign up when
you're first eligible for Part B. For example, if
you're eligible for Part B when you turn 65, this is a 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you enroll in Part B during the first 3 months of your Initial Enrollment Period, your coverage start date is the 1st day of your birthday month. If your birthday is the first day of the month, your coverage begins on the 1st day of the prior month. |
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| General Enrollment Period |
| If you did not sign up for Part A and/or Part B (for which you pay monthly premiums) when you were first eligible, you can sign up between January 1
- �March 31 each year. Your coverage will begin July 1. You may have to pay a higher premium for late enrollment. |
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| Annual
Election Period - Open Enrollment |
| The
Annual Election Period is October 15 -
December 7th of every year. During this
time you may join, change or drop an MA or
Part D plan. Changes are effective January
1st. Each year, Medicare health plans and Part D prescription drug plans can change their premiums, deductibles, cost-sharing and some benefits, or discontinue their coverage altogether. You need to be aware of how your plan may change, and prepare accordingly. |
| The
California Birthday Rule! |
| California
has an "open enrollment
period" for MEDIGAP plans
that occurs the 30 days prior and
after your birthday. Note
that Medigap plans can be changed
at any time, but if you use the
"birthday rule" you
don't have to answer any medical
questions. You
must already have a Medigap
plan. You can switch to
another plan as long as it is of
equal or lesser coverage. Contact
me to find out more about this
enrollment period. |
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| Special Enrollment Periods
and Special Election Periods |
| Special
Enrollment Periods (SEP) exist for Part B
and Special Election Periods (SEP) exist
for MA and Part D plans. |
Special
Enrollment Periods:
If you did not sign up for Part B (for which you pay monthly premiums) when you were first eligible because you're covered under a group health plan based on current employment, you can sign up for Part B
during the 8-month period that begins the month after the employment ends or the group health plan coverage ends, whichever happens first. |
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Special
Election Periods:
These may be available for MA and Part D
plans depending upon the situation.
If you move might allow you to have a
special period of time. Qualification for
Medi-Cal benefits, coverage from an
employer, etc. are some possible
justifications. Contact me to discuss if
this applies to you. |
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| Medicare
Advantage Disenrollment Period |
| This
period runs from January 1st - February
14th of each year. It allows
beneficiaries to un-enroll from their MA
plan and return to original medicare.
Because MA plans include prescription
plans, when you un- enroll from a MA plan
you will have a coordinating Special
Election Period to enroll in a stand-alone
Part D prescription plan. You cannot
switch from one MA to another MA during
this period. |
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| Part
C - Medicare Advantage Plans |
These plans are offered by private insurance companies approved by Medicare. You must have both Part A and Part B to join one of these plans. The plans provide all of your Part A and Part B services and generally provide additional services. You usually pay a monthly premium, and co-payments that will likely be less than the coinsurance and deductibles under Original Medicare. In most cases, these plans also offer Part D prescription drug coverage. Costs and benefits vary by plan.
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| The different types of Medicare Advantage Plans are: |
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| Health Maintenance Organization (HMO) Plans |
| A Medicare HMO Plan has a network of primary care doctors, specialists, hospitals and other providers that you must go to. Most plans require referrals to see specialists. |
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Preferred Provider Organization (PPO) Plans |
| A Medicare PPO Plan has a network of primary care doctors, specialists, hospitals and other providers that you may go
to. You have the flexibility to go to any doctors, specialists, or hospitals that are not on the plan’s list, but it will usually cost more. |
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Private Fee-for Service (PFFS) Plans |
| Generally, you get care from any Medicare-approved provider such as a doctor or hospital who, before treating you, agrees to accept the Medicare Private Fee-for-Service
Plan's terms and conditions of payment. If your provider does not agree to the
plan's terms and conditions of payment the provider should not provide services to you except for emergencies, and you will need to find another provider that will accept the plan. |
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Special Needs Plans (SNP) |
| Plans for people with certain chronic diseases and conditions or who have specialized needs (such as people who have both Medicare and Medicaid or people who live in certain institutions). |
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HMO Point of Service (HMOPOS) Plans |
| An HMO plan that
sometimes allows you to go out-of-network
for some services, but when you do it will
cost more. |
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Medical Savings Account (MSA) Plans |
| A plan that combines a high deductible health plan with a bank account.
Deposits from Medicare will be made to an
account you set up. The amount of
money is less than the deductible in most
cases, and you use the money to pay for
you health services as needed throughout
the year. |
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You can enroll in a Medicare Advantage Plan every year during the Annual Election Period (AEP)
beginning on 10/15/2011 thru 12/7/2011. You can also enroll during your Initial Election Period (IEP) or if you qualify for a Special Election Period (SEP). To join a Medicare Advantage Plan, you must have Part A and Part B and live in the plan's service area. |
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| Part
D - Medicare Prescription Drug Plans |
Prescription
drug plans offered by private insurance companies and approved by Medicare.
Drug coverage is available to everyone who has
Medicare, regardless of income or health.
Subscribers pay a monthly premium.
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There are two
types of Medicare Part D prescription drug coverage:
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| Stand-Alone
Medicare Prescription Drug Plans
(PDP's) |
| If
you are enrolled in original /
traditional medicare you may also
enroll in a PDP. California has
over 30 plans available. |
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| Medicare Advantage
Prescription Drug Plans
(MA-PD's) |
| You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans.
The availability of MA plans
varies by CA county. Plus
not "all" MA plans have
drug coverage. |
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To join a Medicare Prescription Drug Plan, you must have Medicare Part A or Part B. You must also live in the service area of the Medicare drug plan you want to join. |
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| Standard
Benefits of Part D |
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Deductible
amount is $310 (may vary
.. call us to inquire) |
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Initial Coverage Limit is $2,840 |
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Out-of-Pocket
Threshold is $4,550 |
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Coverage Gap (donut hole) begins when you pay total drug costs (what you pay + what the plan pays) of $2,840 and ends when you reach $4,550 in total drug costs.
Part D enrollees will receive a 50% discount on the total cost of their brand name drugs while in the donut hole. The full retail cost of the drug will still apply to the catastrophic stage. Enrollees will receive a 7% discount on generic drugs while in the donut hole. |
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Catastrophic Coverage - The enrollee pays the greater of 5% or $2.50 for generic drugs and the greater of 5% or $6.30 for all other drugs, |
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Drug copays and coinsurance vary by plan. |
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| Financial
Prescription Drug Aid: |
| Extra help or low income subsidy (LIS) is a program that helps people with Medicare who have limited income and resources pay for Medicare prescription drug coverage. If you qualify for extra help, you will get help paying for your Medicare drug plan’s monthly premium, and for some of the costs you would normally pay for your prescriptions. The amount of extra help you get will be based on your income and resources. You can apply for extra help by calling Social Security at
or visiting
www.socialsecurity.gov.
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HEALTH INSURANCE PROVIDERS WE WORK WITH INCLUDE:
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