MEDICARE SUPPLEMENT HEALTH INSURANCE
PLANS
Medicare in California
- Parts A, B, C and D
You can compare low cost California
Medicare Supplement Insurance Quotes, but
first, understanding Medicare and
how it works will allow you to choose
the best plan to fit your needs.
In a nutshell, Medicare has several
parts to consider when making your
health insurance choices.
First we will discuss Part A. There
is no premium to be paid for
Part A because every working American
has already paid tax through their
employer into Medicare Part A.
What is Medicare
Part A?
The main benefit of Medicare Part A is hospital
insurance. Also included
on a limited scale is Skilled Nursing care
and Hospice care. It is important to know
that Medicare does not cover all hospital
costs. There are deductibles and co-payments
that you will be responsible for. Most
supplemental plans will pay these deductibles
and co-payments. Also, Part A does
not pay the first day deductible when hospitalized.
As of 2008 this deductible is $1,024 and
covers the first 60 days of a Medicare –covered
hospital stay.
What is Medicare Part B?
Part B is Medical insurance, and covers
what Part A does not Cover. Medicare
Part B covers many services, including
tests, preventive care, doctor visits
and outpatient care. Like Part A, Medicare
Part B does NOT cover 100%. In fact you
can be responsible for as much as 35%
of your medical bills, and in today's
world that can be a significant amount. I
will explain how this works. Medicare pays
80% of the approved medical procedures
after you pay the Part B deductible.
Medical providers are allowed by law to
charge 15% over the Medicare approved
amount. You’re
responsible to pay 20% of the Medicare
approved amount and then you’re
still responsible to pay the overcharge
of 15%. This is how we arrived at the
35% liability.
One of the Medicare supplement
plans available to all that have Medicare
A & B is called "Plan
F". The good news is if a Medicare recipient
has Plan F as their supplement to
Medicare, all of the expenses mentioned
above as expenses not paid by Medicare
will be covered 100% by Plan F.
You pay no deductible and no co-pays.
This has always been my favorite plan.
You can use
any doctor and any hospital and you
pay nothing. What could be better?
For more information about Medicare,
see the Centers
for Medicare & Medicaid Services and the U.S.
Government Medicare sites.
How Much Does Medicare Part B cost?
Most people have
to pay for Medicare Part B, with the
exception of certain low income individuals.
The basic rate for Part B for 2008
is $96.40/ month. The Part B deductible
is $135, which is a calendar year deductible. As
of 2007, the higher your income the
higher the premium you will pay. The
breakdown of income is as follows,
and at each income level the premium
is increased: $82,000, $102,000,
153,000, $205,000. The premium range
is $96.40/mo to $238.40/mo.
What is Medicare Part C?
Knowing what Medicare is and how it works
will help you make the best decision. Most
of us in the business know Part C as Medicare Advantage
Plan.
As you will see below, I’m not an advocate
of the Medicare Part C option, and later
I will explain why not. Medicare Part
C combines your part A and Part B options
and must cover all needed medical
services.
What separates Part C from
standard Medicare supplements is that
private insurance companies that have
met the Medicare guidelines for Part
C plans are subsidized by Medicare
to provide the benefits outlined by
the government. This means that your
standard Medicare benefits (excluding
supplements) are no longer available,
and that the company providing benefits
replaces Medicare coverage. (I know,
this gets confusing.) This means that
an Advantage plan becomes your
primary coverage, and the government
pays the insurance company a monthly
fee to provide medical services. At
this point the government is off the
hook and the Advantage plan provider
will decide how and when you get care.
I’m
sure by now you see why I don’t like this idea. The only
good side of this picture is that the
premiums are lower than supplementing
the standard Medicare coverage and prescriptions
are normally included. That is a good
thing. However, you must use their
doctors and hospitals, and if you’re
out of the service area, Emergency Care
is your only benefit. Another point is
that your part B premium will always
be applicable.
My Take on Medicare Part C Advantage
Plans
Part C Advantage Plans have always dangled
the carrot of low premiums, and this has
worked well in meeting their enrollment
expectations. And on top of that they decorate
the cake by including your prescriptions
coverage, which is the icing
on the cake. This proposal is so enticing
that few stop and look at the long term
consequences of joining the Advantage Plans.
It's important to note that if you have
any pre-existing condition and you take
that giant step into the Advantage arena,
there is no going back. You just
got a life sentence.
For six months after you turn 65 you are guaranteed
to be able to buy any standard Medicare
supplement regardless of health. After
that “Open
Window” of guaranteed issue, to get a standard supplement
plan you must go through medical underwriting.
If you have a pre-existing condition
that becomes a problem to get enrollment
in a standard Medicare supplement plan.
Now, the Medical Group you joined
providing the Advantage Plan is in total
charge of your access to medical care.
Your Freedom of Choice is gone forever.
Maybe you joined because your doctor
was a member. The doctor is on an annual
contract, so what happens if he leaves
the program or dies? If he leaves you
simply lost your doctor of choice. The
only time I have ever suggested the Advantage
Plan offer is when someone just can’t afford
a standard plan. Then you have to do
what you have to do. I will sign off
on Part C now, because we have a lot
to talk about the last part of Medicare
and that is Part D.
Medicare Part D
Part D is the final plan offered by Medicare.
If you were wondering where prescription
drug coverage comes in, this is it. I’m
going to explain the basic benefits of
Part D. Private insurance companies
who offer Part D have many additional
benefit plans to offer if you pay a higher
premium. The higher premium plans will
eliminate the deductible, may offer
a better formulary drug list, and may
provide Generic coverage in the “Donut
Hole”. I'll explain later what
I mean by the "Donut Hole".
Medicare Part D Basic Benefits
Part D is the prescription drug insurance
coverage that is provided by private
companies approved by Medicare. You need
to enroll when you first become eligible
to prevent paying a penalty of 1% for
every month from your eligibility date.
If you join 3 years later you will pay
a 36% penalty for the rest of your life.
If the prevailing fee is $40/month, that
means you will pay approximately $54/mo.
for the same coverage.
Medicare Part D was designed to help people with
Medicare to lower their cost for drugs.
If you have a standard Medicare Supplement
you can purchase a separate prescription
plan from many private companies. You
will have an additional premium to pay
depending on the plans of choice. There
is NOT a set fee. Each company has their
own premium. Each company will
have various plans and most will offer
the Basic Plan required by the government.
They may offer benefits above the government
guidelines. If you have the Advantage
Plan the drug benefit is most likely
included.
Let's touch on the basic benefits of the standard
Part D plan. First and foremost the
basic plan has a $265.00 deductible,
after which you pay 25% of the next $2000
of drug cost. After the total drug cost
reaches $2250 you pay 100% of your drug
cost till you reach your maximum out-of-pocket
cost of $3850. The part which you
pay 100% of your drug cost is callled
the "Donut Hole". After you pay the
$3850, Medicare will pay 95% of your
drug cost for the remainder of the year. Starting
Jan 1st of each year you start all over
again.
Most companies offer plans that
have benefits above the basic coverage
and it is my experience that they are
worth the extra premium. Keep
in mind that the deductible of $265 equals
$22 per month. Add that to the basic
premium that companies charge for the
basic plan and you will discover that
that alone will buy you the upgraded
plan. This means if you have an annual
drug cost over $265 you will benefit
from buying the better coverage. If you’re
taking no prescriptions you could benefit
buying only the basic plan.
Click
Here for Free Quotes for Medicare
Supplement Plans.
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