Medicare 101 Archives - Medicare Life Health

Medicare and You 2020 & 2021

Carly H. Cummings — Fri, 25 Oct 2019 16:22:36 +0000

Medicare and You 2020 & 2021 Guidebook – Read This First

Your Introduction to the Medicare and You 2020 & 2021 Book, and where to get a copy.

The Medicare and You 2021 Guidebook details what you need to know about Medicare benefits for the current year. In it you will find the basics of Medicare, how to get it, and what changes the program is implementing in the calendar year.

However, it is 120 pages long and very detailed. It is also very dry and technical.

So, if you are trying to learn more about Medicare – without falling asleep in the process – we have on-topic website article suggestions for you here that follow the elements of the Medicare and You 2020 Guide.

Where to find the guide

If you would like to follow along with the Guide itself, you can find it online here: Medicare & You Handbook 2021

If you need a physical copy of the Medicare and You 2020 guide, you can request one here: 1-800-MEDICARE (1-800-633-4227)

What is included in the Medicare and You 2021 Guidebook?

Here we will outline the sections of the guidebook and give you relevant articles that discuss the various Medicare elements and benefits.

What are the Parts of Medicare?

Intro Section (page 5)

The Medicare and You book starts out with summarizing parts A, B, and D and what they include.

Medicare Part A – Hospital Insurance
Part B – Medicare Insurance
Part D – Drug Coverage

Medicare Part C is discussed in the next section.

Related Article: For an illustrated overview of the four parts of Medicare, visit our medicare parts infographic and article “Medicare Parts A B C D.”

What are my Medicare options?

Intro Section on Original vs Medicare Advantage (pages 6-8)

Many online comparisons are between Medicare Supplements and Medicare Advantage plans as those are the additions that are in your hands to choose.

However, all these comparisons are in their simplest form between having Original Medicare vs Medicare Advantage. This section does a side-by-side comparison of the two (with or without a supplement).

Related Article: For a more in-depth discussion to help you decide what Medicare options are right for you, please read the “Medicare Advantage vs Medicare Supplements” article here.

How do I get Medicare?

“Section 1: Signing up for Medicare” (pages 15-24)

People get Medicare in different ways. Some are signed-up for it automatically if you are already receiving Social Security or Railroad Retirement. Some people must sign up for it when they turn 65 (or delay it if they are not ready at 65).

This section gives you people to call (Social Security at 1-800-772-1213) and places to visit (online at ssa.gov/benefits/medicare) if you need to sign yourself up.

Other topics covered include, when to sign-up, what to sign-up for, and what does each part cost?

Related Articles:

Read this article to discover what Medicare will cost you.
Also, read this article to learn more about any Medicare Late Fees and Penalties.
If you need help in deciding what to sign-up for, we suggest this article on speaking with a licensed insurance professional.
Finally, if you want to learn more about the Annual Enrollment Period, please see this article.

Hey, Medicare and You 2021, Will Medicare Cover My…?

“Section 2: Find out if Medicare covers your test, service or item” (pages 25-50)

This section lists all Medicare Benefits you will receive if you are signed-up for both Medicare Parts A and B. These benefits are universal, meaning they are the standards of care you will receive whether you are receiving Medicare from the federal government or through a private carrier with a Medicare Advantage Plan.

If you are looking to see if a specific benefit is included in Medicare, this is the section to search for it.

This section also reminds you of what is not included in Medicare, such as Long-Term Care insurance. In addition, Original Medicare does NOT include many services that ARE covered by Medicare Advantage Plans. These include dental care, eye exams, hearing benefits, and fitness programs.

2020 New Offering Alert: One interesting change noted in the Medicare and You 2020 book is that many Medicare Advantage programs are now offering “telehealth” benefits where you can see a provider at home instead of at their facility. The guidebook notes that this is typically beyond what Original Medicare can offer.

Related Article: To see the basics of what Medicare Covers, please see our article “Medicare Parts A B C D.”

What exactly is Original Medicare?

“Section 3: Original Medicare” (pages 51-54)

The Original Medicare section explains how our Federal Health Insurance for Seniors works. If you have Original Medicare, with or without a supplement, you are a beneficiary of a nationalized health care system and the government is the primary payer of your health benefits.

Read this section to learn how that works and how to use your benefits once you are on Medicare.

Related Article: Read “What is Medicare?“

What is Medicare Advantage?

“Section 4: Medicare Advantage Plans & other options”

The other option than being on Original Medicare is to be on a Medicare Advantage Plan. In this case, a private insurance company becomes your primary payer and main contact. Medicare Advantage (MA/MAPD) Plans are called “bundled plans” because they combine parts A, B and D to form one “Plan C.”

They often have reduced costs for premium payments, with some of them even offering “$0” monthly premiums. In addition, they often include extra benefits, not included by government Medicare, such as dental, hearing and eye care. ““Silver Sneakers” and similar fitness/wellness programs are also often an included benefit.

Related Articles:

To read more: “What is Medicare Advantage?”
Plus, to read about when you can join an MA/MAPD plan, please read here about AEP.
Finally, if you would like to compare Original Medicare + Medigap and MA, please read this.

What is a Medicare Supplement / Medigap Plan?

“Section 5: Medicare Supplement Insurance (Medigap) policies” (pages 69-72)

CLICK HERE to see more about the various Medigap plans and what they offer.

When you opt for keeping Original Medicare (instead of a Medicare Advantage Plan) you will most likely want to pair that with not just a stand-alone drug plan, but also with a Medigap Plan. These plans are also called Medicare Supplement Plans.

They are supplemental insurance plans that pick up paying where Original Medicare leaves off – such as with the 20% coinsurance, co-pays and deductibles.

The government sets the requirements for each supplement plan and then the private insurance companies decide what price they can offer for each plan in each market they are in. These plans are labeled with letters, and offer the exact same benefits no matter what private insurance company you choose.

Related Article: For more information, please read this article on Medicare Supplement Insurance.

What is Part D?

“Section 6: Medicare Prescription Drug Coverage (Part D)” (pages 73-82)

Read this section to learn how Medicare Drug Plans work, where to get one, and when you can get one / switch them.

Remember, that if you opt for a Medicare Advantage Plan, you will most likely have your drug plan included (which is called a MAPD plan).

Related Articles:

Please visit this article on Part D Prescription Drug Insurance.
Or to learn about the various costs, click here.
Finally, if you are worried about Part D late enrollment penalties, please read this.

Can I get help paying for medical costs?

“Section 7: Get help paying your health & prescription drug costs” (pages 83-88)

The government has set up several ways for Medicare Beneficiaries to get help in paying for their health insurance. Read this section to see if you qualify for the various tiers of assistance.

How can I protect myself?

“Section 8: Know your rights & protect yourself from fraud” (pages 89-100)

The U.S. government understands that health insurance can be confusing, and there are people out there that will try to take advantage of this confusion. Read this section to know how to protect yourself from health care and insurance fraud.

In addition, Section 8 also explains your rights under Medicare and how to make an appeal if you decide your rights have been violated. The Medicare and You 2020 book defines an appeal as “…the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan.”

How do I get my questions answered?

“Section 9: Get more information” (pages 101-112)

Next, if you have questions related to Original Medicare, the handbook offers you the following numbers to call:

1-800-MEDICARE (1-800-633-4227)
TTY users call 1-877-486-2048
Get information 24 hours a day, including weekends
Medicare and You 2021

Additionally, for questions regarding insurance plans like Supplement (Medigap) or Medicare Advantage (MA/MAPD) then we suggested talking to a licensed insurance professional.

If you are lucky enough to live in our headquarters of Nebraska or our neighboring state of Iowa, you can contact us here.

Related Article: Please see our Frequently Asked Questions page, and if you have a question, please leave it in the comments section or email us. Thanks!

What does this word mean?

“Section 10: Definitions” (pages 113-116)

Do you just live to read a good glossary? Well, here you go. You will find here definitions to all the health care and insurance lingo you need to know to navigate your health care effectively.

Related Article: Feel free to look through all our Medicare Articles. They are all listed on this page.

Medicare and You 2020/2021 Handbook Review

We hope our review of the 2020 & 2021 Medicare and You Book has been helpful.

Our one hope for next year is that the book might be more helpful in pointing beneficiaries towards ways to find LICENSED independent insurance professionals that can help them in making decisions. These agents are the only ones required to stay licensed, tested and up to date on the plans that are out there. Moreover, this applies especially for the Medicare Advantage approved agents as they have to be re-tested every year on changes.

Finally, we are MedicareLifeHealth.com just don’t understand how people can be offering advice on plans – that change yearly – they have not be certified to explain.

Our advice? Find yourself a good agent, and make them work for you.

Further Medicare and You 2021 Topic Relevant Reading

How to Dispose of Old Medications

How to Dispose of Old Medications Do you have a stash of old or expired medications? Are you concerned about ...

Does Medicare Pay for Dentures

Does Medicare Pay for Dentures? One frequently asked question we get is "Does Medicare pay for dentures?" The short answer ...

Is Acupuncture Covered by Medicare

Is Acupuncture Covered by Medicare Is acupuncture covered by Medicare? Only if you have chronic low back pain as defined ...

What Does Medicare Cover?

What Does Medicare Cover? The Most Frequently Asked Medicare Coverage Questions This is a quick directory answering what Medicare will ...

Does Medicare Cover Chiropractic Care?

Does Medicare Cover Chiropractic Care / Services? Yes, when deemed medically necessary, Medicare does cover chiropractic services. Original Medicare Part ...

Does Medicare Cover Cataract Surgery

Does Medicare Cover Cataract Surgery? Yes, Medicare covers cataract surgery. Medicare Part B covers the costs associated with cataract surgery ...

Medicare Part B Premium 2021 Changes

Medicare Part B Premium 2021 The Center for Medicare Services has announced the costs of Medicare Part B Premium 2021 ...

Does Medicare Cover Ambulance Services?

Does Medicare Cover Ambulance Services? Yes, Medicare covers ambulance services in approved emergency situations. As with all Medicare covered costs, ...

Best Hearing Aid Alternatives

Best Hearing Aid Alternatives Hearing aids are expensive. We are talking thousands of dollars, sometimes even with insurance. In addition, ...

HMO vs PPO Which is Better?

HMO vs PPO Which is Better? Insurance has changed a lot over the last 20 years, and there is no ...

How Long Does Medicare Pay for Rehab?

How Long Does Medicare Pay for Rehab? How Long Does Medicare Pay for Rehab? It depends on what Medicare Plan ...

Does Medicare Pay for Stem Cell Therapy?

Does Medicare Pay for Stem Cell Therapy? When does Medicare pay for stem cell therapy? The answer is: in a ...

What is MAPD?

What is MAPD? There are a lot of acronyms in Medicare, and even more in insurance. We know, it can ...

Attained Age vs Issue Age

Attained Age vs Issue Age Medicare Supplement Insurance Companies all price their plans differently. One of the biggest differences between ...

What is Medicare Plan G?

What is Medicare Plan G? When people talk about Medicare Plan G, they are referring to the Medicare Supplement Plan ...

What are Part B Excess Charges?

What are Part B Excess Charges? Medicare Part B Excess Charges are important to understand when you are deciding what ...

How to Apply for Medicare

How to Apply for Medicare (An Ultimate Guide) With so many rules, regulations, exceptions and unique situations, Medicare enrollment can ...

How Much Does an MRI Cost?

How Much Does an MRI Cost? There is nothing worse than getting a hospital bill with an unexpected number on ...

The post Medicare and You 2020 & 2021 appeared first on Medicare Life Health.

What is Medicare?

Carly H. Cummings — Thu, 11 Jul 2019 01:09:28 +0000

What is Medicare?

Medicare is the U.S. national health care program that provides seniors age 65 and older, and some disabled people, with health insurance.

The U.S. government started the program in 1966. The Centers for Medicare and Medicaid Services runs these programs. Medicare also covers people with end stage renal disease and amyotrophic lateral sclerosis. (Visit the government’s website, if you want more info on these situations).

A Simple Guide to the Basics

To start, we will assume you know very little. This article breaks down the basics of our national health care system and its various parts. We will cover:

Eligibility
Signing-Up
What is Provided – Parts, A, B, C & D
Prescription Drug Coverage
Medigap vs Med Advantage Plans
Associated Costs
Guides and Further Information

Who is Eligible for Medicare?

You are eligible if:

First, you are 65 years old or older.
Second, you have End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant) at any age
Finally, you are classified as disabled by the Federal Government, at any age.

When do I sign-up?

If you are mentioned in the above paragraph, you might be ready to sign-up. We are going to assume that you are in the senior category for simplicity’s sake. Turning 65 is the catalyst for many people to join the program, but if you are still working and covered by an employer’s program, you may opt to defer this start date. (Just remember to tell the government if you are opting to defer.)

Open enrollment starts 3 months before your 65^th birthday and ends 7 months after that start (so 3 months after your 65^th birthday month). If you do not have “credible coverage,” such as an employer plan, in place after this window, you could incur penalties from the government.

How do I Sign-up for Medicare?

Please read our full article on how to apply for Medicare – all parts and additions.

First, you may be automatically signed-up if you are already receiving Social Security (SS) or Railroad Retirement (RRB).
Second, if you are not already receiving SS or RRB benefits, you must sign up for it when you turn 65 years old.
Conversely, if you are not ready for Medicare when you turn 65, you must notify the government that you want to delay your benefits. If you do delay, it must be because you have credible coverage in place. An example of this would be an employer plan.

Where do I Sign-Up?

BY PHONE: If you need to sign-up for Medicare, you can call Social Security at 1-800-772-1213.
ONLINE: Additionally, you can also visit CMS online at ssa.gov/benefits/medicare if you need to sign yourself up.
IN PERSON: Please read our article on How to Apply for Medicare to learn about the in person sign-up process including finding a location.
RAILROAD: Finally, if you are on Railroad Retirement Benefits, you will need to notify the local Railroad Board (RRB) office before you turn 65 that you would like to sign-up for Medicare. You can sign-up 3 months before you turn 65 even if you are not planning on retiring at 65. You can read more about Railroad requirements in our article here.

Medicare Easy Pay Information can be found here.

What am I getting with Original Medicare?

Original Medicare, the national health care program sponsored by the US government, provides you with two points of coverage: Part A Hospital Insurance and Part B Medical Insurance.

In addition to these two basic parts, you have to option of adding on a Part D Prescription Drug Plan. These drug plans are not administered by the Federal government, but instead by private insurance companies, and you must sign-up for them individually.

The last part is Part C or Medicare Advantage. This is a second route you can take to manage your health care that replaces Original Medicare with a “bundled” program that rolls your Parts A, B and D all into one plan. These plans (also called MA or MAPD plans) are provided by private insurance companies. We will discuss how this works more after we look at the basic parts.

Let’s look at each part:

Click here for our infographic on the 4 parts of Medicare.

Part A

First, Part A, also known as “Hospital Insurance,” helps with coverage regarding:

Inpatient care
Skill nursing facility care
Hospice care
Home health care

Part B

Second, there is Part B, also known as “Medical Insurance.” Part B helps with coverage related to doctor and other provider services, including:

Outpatient
Home health
Doctors
Health care providers
Durable medical equipment
Prevention

What Part A & B Don’t Cover

When you visit the hospital, Part A pays for most of the costs associated with these services. In addition, your doctor and medical costs will mostly be covered by Part B. However, Part A and Part B do not pay for all of it. There are co-payments, coinsurance, or deductibles that may apply to covered services.

Typically, Medicare pays for about 80% of the costs. Most beneficiaries will supplement Original Medicare with either a Medigap plan or choose a Med Advantage Plan instead. Very few people just have the Original Parts A & B alone.

Finally, there is no part that covers Long-Term Care costs such as Nursing Home or Assisted Living Expenses. Skilled nursing, yes, but nursing homes no.

Next, there is a third part called…

Prescription Drug Coverage

Part D

Finally, you need Part D, also known as “Prescription Drug Coverage.” Private insurance companies provide Part D coverage rather than the government.

Consequently, if you decide not to take on Part D coverage right away, you might incur a penalty if you try to join later. This is if you do not have “credible coverage” (such as with an employer or union). Therefore, please make sure you are signed-up for a drug plan, not just Parts A and B. This is important if you ever suspect you will need this benefit in the future.

Part D plans are regulated by the US government and have many parts in common across the board, including the infamous “Donut Hole” in coverage. You can read more about that here.

The Two Paths of Coverage

You can be covered one of two ways: Original Medicare / Medicare Advantage.

Original Medicare

Path One – Enroll and keep Original Medicare Part A and Part B, sign-up for a Part D or drug plan with a private insurance company, and then you can add on top of that a Supplemental Coverage Plan that picks-up the tab where Medicare leaves off.

There are different kinds of Supplement plans (Medigap Policies) that cover different benefits and they all cost different prices with different insurance companies. To learn more about Medigap or Supplements click here.

Medicare Advantage

Path Two – After your enrollment in Parts A and B, your second option is to join a Part C plan. We call these Medicare Advantage Plans, and private insurance companies run them.

In fact, the government calls these “bundled plans.” Most of them wrap parts A, B and D all into one package. In addition, they often give their members extra benefits and hopefully lower out-of-pocket costs. To learn more about Medicare Advantage click here.

Medicare Supplements vs Medicare Advantage

Not everyone will make the same choice on what plan is best for them. Both paths are good options and have many advantages. If you would like to read about the advantages and disadvantages to both, please read this article.

What is Open Enrollment?

Also called AEP – The Annual Enrollment Period is the time of year beneficiaries can make changes to their Medicare Advantage Plans and Part D Prescription Drug Plans. Conversely, you can change your Supplement (Medigap) Insurance any time of the year.

Information for new plans starts to become available each year on or around October 1st. However, changes can not be made until AEP actually starts on October 15th. AEP then ends on December 7th each year.

How Much Does Medicare Cost?

How much you pay for your insurance depends on how you set-up your plan. As for the basics. Most people receive Part A at no cost, and everyone pays a Premium for Part B. To learn more about who pays what, please read our article here.

Part A & B Cost Summary:

In 2020, the Medicare Part B Deductible will be $198
In 2020, the Medicare Part B Monthly Premium will be $144.60.

Click here to learn more about who pays the Part B Deductible and about income adjustments to these numbers.

Drug Costs

You will buy Part D, Prescription Coverage from a private insurance company. Each company will price their service differently. Additionally, you can shop for the best plan and price for you.

There is also an income adjustment for Part D coverage. This adjustment is on a sliding scale, and affects those that make more than $85,000 a year.

Part D also has co-pays and deductibles that raise your out-of-pocket expenses.

The Medicare and You Guidebook

Every year the Center for Medicare and Medicaid Services publish a guidebook that details out the Medicare Program: Medicare and You. In addition, this book outlines changes for the upcoming year.

The guide is helpful, but it is often way to long to capture most people attention long enough to get a full understanding of the program. For this reason, we at Medicare Life Health Co. produced a User’s Guide for the Medicare and You Guidebook, and you can find it here.

Where to find the guide

Again, you can start with our user friendly guide here.
Second, if you would like to download the guide for reference, you can find it online here: Medicare & You Handbook 2020
Finally, if you need a physical copy of the Medicare and You 2020 guide, you can request one here: 1-800-MEDICARE (1-800-633-4227)

What are My Next Steps?

Knowing which plan will be right for you circumstance is beyond Medicare 101, but you can start this journey by clicking here to read our article “Medicare Supplements vs. Medicare Advantage Plans.”

Talking to a licensed, independent insurance agent at any stage of your planning is a good idea. Agents know your area market and can tell you what the best options are for your unique circumstances.
- If you are in NE or IA, you can contact us for more information here.
- If you are in any of our other fine states, you can find an agent here.

Medicare 101 Archives - Medicare Life Health

Medicare and You 2020 & 2021

Medicare and You 2020 & 2021 Guidebook – Read This First

Where to find the guide

What is included in the Medicare and You 2021 Guidebook?

What are the Parts of Medicare?

Intro Section (page 5)

What are my Medicare options?

Intro Section on Original vs Medicare Advantage (pages 6-8)

How do I get Medicare?

“Section 1: Signing up for Medicare” (pages 15-24)

Hey, Medicare and You 2021, Will Medicare Cover My…?

“Section 2: Find out if Medicare covers your test, service or item” (pages 25-50)

What exactly is Original Medicare?

“Section 3: Original Medicare” (pages 51-54)

What is Medicare Advantage?

“Section 4: Medicare Advantage Plans & other options”

What is a Medicare Supplement / Medigap Plan?

“Section 5: Medicare Supplement Insurance (Medigap) policies” (pages 69-72)

What is Part D?

“Section 6: Medicare Prescription Drug Coverage (Part D)” (pages 73-82)

Can I get help paying for medical costs?

“Section 7: Get help paying your health & prescription drug costs” (pages 83-88)

How can I protect myself?

“Section 8: Know your rights & protect yourself from fraud” (pages 89-100)

How do I get my questions answered?

“Section 9: Get more information” (pages 101-112)

What does this word mean?

“Section 10: Definitions” (pages 113-116)

Medicare and You 2020/2021 Handbook Review

Further Medicare and You 2021 Topic Relevant Reading

What is Medicare?

What is Medicare?

A Simple Guide to the Basics

Who is Eligible for Medicare?

When do I sign-up?

How do I Sign-up for Medicare?

Where do I Sign-Up?

What am I getting with Original Medicare?

Let’s look at each part:

Prescription Drug Coverage

The Two Paths of Coverage

Original Medicare

Medicare Advantage

Medicare Supplements vs Medicare Advantage

What is Open Enrollment?

How Much Does Medicare Cost?

Drug Costs

The Medicare and You Guidebook

Where to find the guide

What are My Next Steps?

Further Reading