September 11, 2015 lhisinsadmin

About Medicare

To assist you with the Medications piece, please find the form here to list your medications.  After we have your permission to talk about Part D, then we will need this information  to assist you.

Medication List LHISINS

 

Looking for a Quote for Medicare Advantage or Part D?

 

Road To Retirement

How to APPLY for Medicare

You can APPLY and learn about Original Medicare at medicare.gov.

Medicare Part A

is Hospital insurance, for things like Hospital Stays (not including the doctor's fees), Skilled Nursing Facilities and Hospice.  Keep in mind it does not cover Long Term Care (custodial Care).

Hospital Room

What can you expect to pay under Part A under Original Medicare?  This is if you have ONLY original Medicare, and on Medicare Approved charges.

Hospital Stay

In 2019, once Medicare Approves the charge, you would be responsible for:

  • First 60 Days: $1,364 deductible  (per Hospital Stay)

  • Days 61 - 90: $341 per day

  • Days 91 and After: $682 per "lifetime reserve day" after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)

Skilled Nursing Facility Stay (100 days per benefit Period), you would be responsible for

  • The First 20 days: $0 (Medicare covers the first 20 days of approved stays)

  • Days 21 - 100: $170.50 per day

  • Days 101 and On: All costs for each day after day 100

Medicare Part D

is for Prescription Drug coverage. Medications

  • It is offered by private insurance companies approved by Medicare.

 The plans vary in their

  • monthly premium costs

    deductibles

    copayments

    lists of medications that they cover (formularies).

    The limits they may place on certain medications through "Prior Authorization", "Quantity Limits" or  "Step Therapy"

 It is important to consider what medications you are taking, and the limits of the plans available, as these plans can change each year.

  • It is also important to know about things like the Part D Late Enrollment Penalty, the Donut Hole (Coverage gap) and Extra Help.

    • The Late Enrollment Penalty is addressing any gaps you have had in your prescription drug coverage:
      • (From Medicare.gov)  The late enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these: A Medicare Prescription Drug Plan (Part D)
      • The national base beneficiary premium for 2019 is $33.19. The monthly penalty is rounded to the nearest $0.10 and added to the monthly Part D premium
      • 10% of The National Base Beneficiary Premium  x the number of months in the gap = the Late Enrollment Penalty (monthly)
    • The Donut Hole/Coverage Gap
      • There are a three basic phases of Part D, the Initial, the Coverage Gap and Catastrophic
      • In the Initial phase, you will pay the agreed upon amounts (after any applicable deductible) for your medications
      • The Donut Hole/Coverage Gap hits once the COSTS of your medications reach $3820 in 2019 then you will pay no more than 25% of the cost of Brand Name drugs, and 37% of the cost of Generics (reduced to 25% in 2020), until your Out Of Pocket costs have reached $5100
      • Once you have passed the $5100, then you are in catastrophic coverage, where you pay $3.35, $8.35 or 5%, whichever is greater for your medications for the remainder of the year.

To Learn how to navigate Medicare.gov for Part D plans:  Helpful sheet on navigating Medicare.gov for Part D plans

Medicare Part B

is for Doctors and Out Patient services, for things like doctor visits, out patient surgeries, lab tests.  It also has coverage for Ambulance, Durable Medical Equipment like Wheelchairs, Oxygen equipment and more.

FL83674

 What can you expect to pay under Part B, if you only have Original Medicare (A&B)?

In 2020, you pay

  • Your Part B Premium

  • $198 Part B Deductible per year

  • 20% of the Medicare Approved Part B charges (Medicare pays 80% of the approved charges, leaving you 20% after the deductible)

  • Part B Excess Charges (An amount a doctor may be permitted to charge YOU, OVER what Medicare normally approves, is called an Excess Charge)

Medicare Supplements (MediGap)

 If you wish to learn more about Medicare Supplements (Medigap)

If you are a Medicare Supplement Client, then please join my mailing list.

  • Medigap (Medicare Supplements) work with "Original Medicare" (Medicare parts A&B).  So they address things that Medicare leaves to you, once Medicare "approves" the charges.
    • If Medicare does not "approve" then the supplement won't either.
    • Keep in mind, "Original Medicare" does not address Part D drugs.

  • Medigap policies are standardized.   Which basically means Plan F with Company A, functions the same as it does with Company Z

  • Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as "Medicare Supplement Insurance." 

  • Insurance companies can sell you only a "standardized" policy identified in most states by letters.  According to Medicare.gov, the current plans (for California in 2017) are A, B, C, D, F, G, K, L, M, N.  There's also a High Deductable Plan F (called HDF).

How these plans work with Medicare is the same for each company.  What's the difference?  Cost, rate increase history, the ability to make changes while a member, and sometimes some added benefits like health club benefits or access to a nurse line.

For more information about Medicare Supplements (also known as Medi-Gap plans), please see the Medicare website, OR Call me: 408-982-7358 or Email

Medicare Part C

is also known as Medicare Advantage.  

  • It is offered by private companies approved by Medicare.  

  • If you join a Medicare Advantage plan, then you still have Original Medicare, but will be getting your Part A coverage and Part B coverage from the Medicare Advantage plan, and not from Medicare.  You must continue to maintain your Medicare Part A & B, but you will be getting your services through the Medicare Advantage plan.

  • Medicare Advantage plans can sometimes include coverage for things not included in original Medicare, such as; Part D medication coverage, Dental, Vision, gym memberships etc.

  • Why do people consider Medicare Advantage (Part C)?
    • Medicare Advantage plans often include benefits beyond Original A&B.  Such as including coverage for Prescription Drugs or Vision/Hearing benefits.  There may even be Dental or even some have health club membership components.
    • What you will want to know?  
      • Are your Doctors part of the plan
      • How are your medications addressed by the plan
      • do you live in the service area?
      • What copays/coinsurance costs are you exposed to, and is there an "Out Of Pocket" max, for the medical part?  Keep in mind that Part D Medications are not subject to the Out Of Pocket Max. 

Helpful Info from Medicare.gov

Medicare.gov is filled with information, helpful in understanding options. It is an incredible resource for finding out:

  • Does my Doctor Accept Original Medicare?  CHECK HERE

  • How about my medical supplies like Wheelchairs/walkers, CPAP, Diabetic Supplies, Oxygen and many other supplies?  CHECK HERE

  • How can I save money on Medicare?

  • Are you looking for information on Medi-Cal in Santa Clara County? CHECK HERE