The Benefit Basics

July 2008

 
In This Issue
What is Medicare Part A and Part B?
What is Medigap Insurace?
What is a Medicare Advantage Plan?
What is Medicare Part A and Part B?
Caren Martin
 
woman w/ flowers
Medicare Part A is hospitalization insurance.  You are entitled to Medicare Part A if you have worked at least 40 Medicare approved quarters (approximately 10 years).  Medicare Part B covers medically necessary outpatient care, doctor's services, physical/occupational therapy and limited home health care.  The services are covered as follows in 2008:
  • You pay $135 deductible.
  • You pay 20% of the Medicare approved amount, which is the approved amount for medically necessary services.  Excess charges over the Medicare-approved amount may apply if your doctor does not accept the Medicare assignment.
  • You pay copays for certain outpatient services.  

While Part A is automatic, you must choose to enroll in part B and there is a monthly premium of $96.40 a month, however this can be adjusted based on income.  Part B also has holes in coverage, referred to as "gaps."

What is Medigap Insurace?

Ellen Lewis
 
beachWhen you have Medicare Part A and Part B, you have two choices, Medicare or Medigap.  In order to be eligible for a Medigap plan, you must be enrolled in Part A and Part B.  The Medigap plans supplement what Medicare Part A and Part B do not cover to fill in the coverage "gaps". 
 
 
  • There are 12 plan designs, A through L, which are mandated by the government.  These plans can not be altered by an insurance company.
  • Medigap plans have higher premiums with a lower cost share at the time of service than the Medicare Advantage plans.
  • There is no prescription benefit with the Medigap plan, so you must enroll in Part D as well.
  • Usually there are no networks, making these plans ideal for seniors who have a second home or travel extensively.
  • There is a one time open enrollment available without medical underwriting.  This period begins when Part B becomes active and continues for six months.

These plans do not change often, but the government can release new benefits every year on October 1st.  

What is a Medicare Advantage Plan?

Caren Martin
 elderly man at computer
Medicare Advantage plans have become a popular choice when it comes to Medicare Part C. Medicare Advantage plans are offered through private health insurance companies like Humana, Anthem and United Healthcare.  They also have networks of doctors.  Medicare Advantage plans are lower premium plans with higher cost share at the time of service than Medigap plans.  They may also include prescription coverage, so it is not necessary to sign up for Medicare Part D.  The annual open enrollment period for a Medicare Advantage plan is November 15th through December 31st.  In order to be eligible, you must already be enrolled in Medicare Part A and B.
 
QUESTIONS OR COMMENTS?
 
Do you have a question you would like addressed in our next issue?
Please email Laura Lauber at [email protected] or call (513) 745-0707

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